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1

Vacuum-assisted closure therapy in patients with large postoperative wounds complicated by multiple fistulas.  

PubMed

Vacuum-assisted closure (VAC) therapy is a widely acknowledged method for chronic and traumatic wound healing. The feasibility of VAC therapy used for the treatment of intestinal fistulas is still a subject of debate. Complex postoperative wounds pose significant therapeutic problems, especially when there are several fistula openings in the wound area and other sites, usually at the site of previous drains. This paper describes the treatment of three patients in a critical condition, with complex postoperative wounds complicated by multiple fistulas. Vacuum-assisted closure therapy was based on effective drainage of the biggest fistula opening and ensuring conditions promoting the healing process of other fistulas and the wound. A considerable improvement in general condition and wound healing was noted within 2-4 weeks and both the number of fistulas and the volume of excreted contents decreased. After 5-7 weeks a significant improvement in wound healing was observed in all patients. Once the general condition of all patients was considered satisfactory (2-6 months), they underwent surgery aimed at restoration of the digestive tract continuity.In our opinion, VAC therapy used for the treatment of postoperative wounds with multiple fistulas in the wound area and other sites should aim mainly at the improvement of patients' general condition, limitation of the number of fistulas as well as accelerated wound healing. This may lead to formation of one stoma-type fistula, which can be dressed and cared for by patients until the continuity of the digestive tract has been surgically restored. PMID:23255975

Banasiewicz, Tomasz; Borejsza-Wysocki, Maciej; Meissner, Wiktor; Malinger, Stanis?aw; Szmeja, Jacek; Ko?ci?ski, Tomasz; Ratajczak, Andrzej; Drews, Micha?

2011-09-01

2

Endoscopic Versus Open Saphenous Vein Harvest: A Comparison of Postoperative Wound Complications  

Microsoft Academic Search

Background. Wound complications associated with long incisions used to harvest the greater saphenous vein are well documented. Recent reports suggest that tech- niques of endoscopic vein harvest may result in de- creased wound complications. A prospective, nonran- domized study was developed to compare outcomes of open versus endoscopic vein harvest procedures. Methods. There were 106 patients in the open vein

Jerene M. Bitondo; Willard M. Daggett; David F. Torchiana; Cary W. Akins; Alan D. Hilgenberg; Gus J. Vlahakes; Joren C. Madsen; Thomas E. MacGillivray; Arvind K. Agnihotri

2010-01-01

3

Endoscopic versus open saphenous vein harvest: a comparison of postoperative wound complications  

Microsoft Academic Search

Background. Wound complications associated with long incisions used to harvest the greater saphenous vein are well documented. Recent reports suggest that techniques of endoscopic vein harvest may result in decreased wound complications. A prospective, nonrandomized study was developed to compare outcomes of open versus endoscopic vein harvest procedures.Methods. There were 106 patients in the open vein harvest group, and 154

Jerene M Bitondo; Willard M Daggett; David F Torchiana; Cary W Akins; Alan D Hilgenberg; Gus J Vlahakes; Joren C Madsen; Thomas E MacGillivray; Arvind K Agnihotri

2002-01-01

4

Postoperative pulmonary complications updating.  

PubMed

Postoperative pulmonary complications (PPCs) are a major contributor to the overall risk of surgery. PPCs affect the length of hospital stay and are associated with a higher in-hospital mortality. PPCs are even the leading cause of death either in cardiothoracic surgery but also in non-cardiothoracic surgery. Thus, reliable PPCs risk stratification tools are the key issue of clinical decision making in the perioperative period. When the risk is clearly identified related to the patient according the ARISCAT score and/or the type of surgery (mainly thoracic and abdominal), low-cost preemptive interventions improve outcomes and new strategies can be developed to prevent this risk. The EuSOS, PERISCOPE and IMPROVE studies demonstrated this care optimization by risk identification first, then risk stratification and new care (multifaceted) strategies implementation allowing a decrease in PPCs mortality by optimizing the clinical path of the patient and the care resources. PMID:25168300

Langeron, O; Carreira, S; le Saché, F; Raux, M

2014-01-01

5

Management of postoperative complications: general approach.  

PubMed

The goal of postoperative management is to promote early mobility and avoid postoperative complications, recognizing the potentially devastating impact of complications on elderly patients with hip fracture. The recommended approach involves early mobilization; freedom from tethers (indwelling urinary catheters and other devices); effective pain control; treating malnutrition; preventing pressure ulcers; reducing risk for pulmonary, urinary, and wound infections; and managing cognition. This carefully structured and patient-centered management provides older, vulnerable patients their best chance of returning to their previous level of functioning as quickly and safety as possible. PMID:24721365

Sanguineti, V Ana; Wild, Jason R; Fain, Mindy J

2014-05-01

6

Acute postoperative complications of hypospadias repair  

PubMed Central

Purpose Complications in hypospadias surgery are higher than other reconstructive procedures. The incidence of complications can be reduced if proper preventive measures are taken. The review aims to highlight incidences, causes, and preventive measures of acute complications of hypospadias repair. Materials and Methods Literature reports were reviewed in Pubmed by giving the key word acute complications of hypospadias repair, wound infection, wound dehiscence, flap necrosis, edema, penile torsion, urethral fistula, bleeding and hematoma and urethral stents problems. Summaries of all articles were reviewed with full text of relevant article and results were analyzed. Results Besides mentioning the complications of hypospadias repair in individual articles on the subject, we did not come across any separate article on this subject in the published English literature. Fistula is the commonest complication followed by edema and penile torsion. Conclusions Most acute complications can be prevented with adherence to principles of plastic and microsurgery, meticulous preoperative planning, and judicious postoperative care. Deviation from these principles may lead to disaster and even failure of the repair. The aim in hypospadias surgery should be following these principles and bring down the complication rates < 5% in distal hypospadias and < 10% in proximal hypospadias. PMID:19468404

Bhat, Amilal; Mandal, Arup Kumar

2008-01-01

7

Postoperative surgical complications of lymphadenohysterocolpectomy  

PubMed Central

Rationale The current standard surgical treatment for the cervix and uterine cancer is the radical hysterectomy (lymphadenohysterocolpectomy). This has the risk of intraoperative accidents and postoperative associated morbidity. Objective The purpose of this article is the evaluation and quantification of the associated complications in comparison to the postoperative morbidity which resulted after different types of radical hysterectomy. Methods and results Patients were divided according to the type of surgery performed as follows: for cervical cancer – group A- 37 classic radical hysterectomies Class III Piver - Rutledge -Smith ( PRS ), group B -208 modified radical hysterectomies Class II PRS and for uterine cancer- group C -79 extended hysterectomies with pelvic lymphadenectomy from which 17 patients with paraaortic lymphnode biopsy . All patients performed preoperative radiotherapy and 88 of them associated radiosensitization. Discussion Early complications were intra-abdominal bleeding ( 2.7% Class III PRS vs 0.48% Class II PRS), supra-aponeurotic hematoma ( 5.4% III vs 2.4% II) , dynamic ileus (2.7% III vs 0.96% II) and uro - genital fistulas (5.4% III vs 0.96% II).The late complications were the bladder dysfunction (21.6% III vs 16.35% II) , lower limb lymphedema (13.5% III vs 11.5% II), urethral strictures (10.8% III vs 4.8% II) , incisional hernias ( 8.1% III vs 7.2% II), persistent pelvic pain (18.91% III vs 7.7% II), bowel obstruction (5.4% III vs 1.4% II) and deterioration of sexual function (83.3% III vs 53.8% II). PRS class II radical hysterectomy is associated with fewer complications than PRS class III radical hysterectomy , except for the complications of lymphadenectomy . A new method that might reduce these complications is a selective lymphadenectomy represented by sentinel node biopsy . In conclusion PRS class II radical hysterectomy associated with neoadjuvant radiotherapy is a therapeutic option for the incipient stages of cervical cancer. Abbreviations: PRS- Piver Rutledge-Smith, II- class II, III- class III PMID:24653760

Marin, F; Ple?ca, M; Bordea, CI; Voinea, SC; Burl?nescu, I; Ichim, E; Jianu, CG; Nicol?escu, RR; Teodosie, MP; Maher, K; Blidaru, A

2014-01-01

8

Postoperative wound infection in colorectal surgery.  

PubMed

Postoperative wound infection is one of common problems in a surgical ward. In our surgical department, from 1988 to December 1992, 254 cases were operated on for colorectal diseases. The indications for these operations were as follows; colorectal carcinoma (191 cases), inflammatory bowel diseases (22 cases), diverticulitis (14 cases), and others (27 cases). Of these 254 cases, 119 were males (46.85%) and 135 were females (53.15%), 211 cases (83.1%) were operated on as elective surgery, 43 cases (16.9%) as emergencies. Of these 254 cases, 36 (14.2%) had postoperative wound infection, 25 cases (11.8%) after elective surgery, and 11 cases (25.6%) postemergency operations. Of these 36 cases, 22 cases (61.11%) were males and 14 cases (38.88%) were females. In our study, postoperative wound infection was mostly noted in patients operated on for colorectal carcinoma (27 cases, 14.1%), as compared with 5 cases operated on for diverticulitis (35.7%), 2 cases for I.B.D. (9.1%) and 2 cases for other indications (7.4%). Most of these wound infections were treated with drainage and frequent dressing while 10 cases received antibiotics. PMID:8935193

Bielecki, K; Badi, H; Kami?ski, P; Kubiak, J

1995-01-01

9

Postoperative irradiation impairs or enhances wound strength depending on time of administration  

SciTech Connect

Irradiation can complicate surgical wound healing, yet little is known of the importance of the time between surgery and irradiation on this process. This study investigated the impact of post-operative irradiation on gain in wound tensile strength in a murine skin model. Irradiation on the same day as wounding or to 2-day-old wounds reduced wound tensile strength. In contrast, postoperative irradiation delivered at 7, 9 and 14 days transiently enhanced wound tensile strength, as measure d 3 but not 4 or 5 weeks later. This effect was independent of the inclusion (hemi-body) or exclusion (skin alone) of the hematopoietic system in the field of irradiation. Radiation-enhanced wound tensile strength was greater and occurred earlier after higher radiation doses. Even though the effect of irradiation in enhancing wound tensile strength is transitory, it could be important in assisting early wound healing. 14 refs., 3 figs., 1 tab.

Vegesna, V.; McBride, W.H.; Withers, H.R. [Univ. of California, Los Angeles, CA (United States)

1995-08-01

10

Predictors of Postoperative Complications After Trimodality Therapy for Esophageal Cancer  

PubMed Central

Purpose While trimodality therapy for esophageal cancer has improved patient outcomes, surgical complication rates remain high. The goal of this study was to identify modifiable factors associated with postoperative complications after neoadjuvant chemoradiation. Methods and Materials From 1998 to 2011, 444 patients were treated at our institution with surgical resection after chemoradiation. Postoperative (pulmonary, gastrointestinal [GI], cardiac, wound healing) complications were recorded up to 30 days postoperatively. Kruskal-Wallis tests and ?2 or Fisher exact tests were used to assess associations between continuous and categorical variables. Multivariate logistic regression tested the association between perioperative complications and patient or treatment factors that were significant on univariate analysis. Results The most frequent postoperative complications after trimodality therapy were pulmonary (25%) and GI (23%). Lung capacity and the type of radiation modality used were independent predictors of pulmonary and GI complications. After adjusting for confounding factors, pulmonary and GI complications were increased in patients treated with 3-dimensional conformal radiation therapy (3D-CRT) versus intensity modulated radiation therapy (IMRT; odds ratio [OR], 2.018; 95% confidence interval [CI], 1.104–3.688; OR, 1.704; 95% CI, 1.03–2.82, respectively) and for patients treated with 3D-CRT versus proton beam therapy (PBT; OR, 3.154; 95% CI, 1.365–7.289; OR, 1.55; 95% CI, 0.78–3.08, respectively). Mean lung radiation dose (MLD) was strongly associated with pulmonary complications, and the differences in toxicities seen for the radiation modalities could be fully accounted for by the MLD delivered by each of the modalities. Conclusions The radiation modality used can be a strong mitigating factor of postoperative complications after neoadjuvant chemoradiation. PMID:23845841

Wang, Jingya; Wei, Caimiao; Tucker, Susan L.; Myles, Bevan; Palmer, Matthew; Hofstetter, Wayne L.; Swisher, Stephen G.; Ajani, Jaffer A.; Cox, James D.; Komaki, Ritsuko; Liao, Zhongxing; Lin, Steven H.

2013-01-01

11

Perineal wound complications after abdominoperineal resection.  

PubMed

Perineal wound complications following abdominoperineal resection (APR) is a common occurrence. Risk factors such as operative technique, preoperative radiation therapy, and indication for surgery (i.e., rectal cancer, anal cancer, or inflammatory bowel disease [IBD]) are strong predictors of these complications. Patient risk factors include diabetes, obesity, and smoking. Intraoperative perineal wound management has evolved from open wound packing to primary closure with closed suctioned transabdominal pelvic drains. Wide excision is used to gain local control in cancer patients, and coupled with the increased use of pelvic radiation therapy, we have experienced increased challenges with primary closure of the perineal wound. Tissue transfer techniques such as omental pedicle flaps, and vertical rectus abdominis and gracilis muscle or myocutaneous flaps are being used to reconstruct large perineal defects and decrease the incidence of perineal wound complications. Wound failure is frequently managed by wet to dry dressing changes, but can result in prolonged hospital stay, hospital readmission, home nursing wound care needs, and the expenditure of significant medical costs. Adjuvant therapies to conservative wound care have been suggested, but evidence is still lacking. The use of the vacuum-assisted closure device has shown promise in chronic soft tissue wounds; however, experience is lacking, and is likely due to the difficulty in application techniques. PMID:20011400

Wiatrek, Rebecca L; Thomas, J Scott; Papaconstantinou, Harry T

2008-02-01

12

Incisional Negative Pressure Wound Therapy for Prevention of Postoperative Infections Following Caesarean Section  

ClinicalTrials.gov

Surgical Wound Infection; Infection; Cesarean Section; Cesarean Section; Dehiscence; Complications; Cesarean Section; Complications; Cesarean Section, Wound, Dehiscence; Wound; Rupture, Surgery, Cesarean Section

2014-10-15

13

[Use of Negative Pressure Wound Therapy on Surgical Incisions (Prevena™) after Surgery of Pectus Deformities Reduces Wound Complications.  

PubMed

Introduction: Pectus surgery can lead to postoperative wound complications in some cases. The purpose of this study is to determine whether preventive negative pressure wound therapy (NPWT) could reduce wound complications after open pectus surgery. Material and Methods: 100 patients after open procedure for the treatment of pectus excavatum or pectus carinatum in the years 2010 to 2012 were retrospectively analysed. 50 patients treated with Prevena™ (KCI Medical Products GmbH, Wiesbaden, Germany) were compared with 50 patients whose wounds were covered with OPSITE® film (Smith & Nephew, Hamburg, Germany). Wound closure was performed following a standard procedure as well as the placement of subcutaneous drains. Therefore two comparable groups of patients were formed and analysed by standardised parameters. The wound dressing was placed epicutaneously immediately after wound closure in the operating room and removed after 5 days in each case. Follow-ups were performed immediately after removal of the wound dressing, at the time of discharge from hospital as well as 6 and 12 weeks after operation. The wounds were checked for tenderness, pain, secretion, redness and fistulas. Results: The Prevena group showed 10?% wound complications which needed operative treatment, whereas the OPSITE group showed complications in 24?%. Some patients who were treated with Prevena showed superficial skin lesions at the rim of the foam and the film. All of these lesions healed well. Conclusion: Treating wounds postoperatively with preventive measures (NPWT) showed a remarkable reduction of wound complications following open pectus surgery whereas statistically the difference was not significant (p?=?0.074). PMID:24647815

Simon, K; Schulz-Drost, M; Besendörfer, M; Carbon, R T; Schulz-Drost, S

2014-03-19

14

Cardiac risk assessment: decreasing postoperative complications.  

PubMed

Preoperative cardiac assessment helps identify patients undergoing noncardiac surgery who are at risk for significant postoperative cardiac complications and those who may benefit from additional preoperative evaluation and perioperative care. Advanced practice nurses can identify surgery- and patient-related risks by conducting a thorough health history and physical examination. Multiple risk indices and evidence-based guidelines are available to inform health care providers regarding patient evaluation and strategies to reduce postoperative cardiac risk. In general, preoperative tests are recommended only if the findings will influence medical therapy or perioperative monitoring or will require postponement of surgery until a cardiac condition can be corrected or stabilized. Medication management is a crucial component of the preoperative assessment; providers may need to initiate the use of beta-blockers and make decisions regarding continuing or withholding antiplatelet and anticoagulant therapy. Preoperative cardiac risk stratification, medication reconciliation, and device management are essential for providing safe care for patients. PMID:25645037

Thanavaro, Joanne L

2015-02-01

15

Wound complications of adjuvant radiation therapy in patients with soft-tissue sarcomas  

SciTech Connect

Adjuvant radiation therapy by the brachytherapy technique has been suggested by us to diminish local recurrence following resection of extremity and superficial truncal soft-tissue sarcoma. However, loading of the catheters with radioactive sources on the first through the fifth postoperative days results in a 48% significant wound-complication rate. Our previous animal experiments would suggest that delay of application of radiation to one week after wounding is accompanied by significant improvement in wound-breaking strength, new H3 hydroxyproline accumulation, and improved force-tension curves. As part of our ongoing prospective randomized trial of the effects of brachytherapy on local control, one change was made: the catheters were loaded five or more days after operation. Wound complications were then reviewed in 50 patients following this single change in brachytherapy delivery. Of the 21 patients receiving brachytherapy, 14% had significant wound complications; 10% of the 29 patients who did not receive radiation had wound complications of similar severity. This decrease in wound complications represents a major improvement over our prior experience and suggests that the timing of radioactive source loading in the postoperative period is a major factor in radiation-induced wound-healing delay.

Ormsby, M.V.; Hilaris, B.S.; Nori, D.; Brennan, M.F.

1989-07-01

16

Effectiveness of Postoperative Wound Drains in One- and Two-Level Cervical Spine Fusions  

PubMed Central

Background Cervical drains have historically been used to avoid postoperative wound and respiratory complications such as excessive edema, hematoma, infection, re-intubation, delayed extubation, or respiratory distress. Recently, some surgeons have ceased using drains because they may prolong hospital stay, operative time, or patient discomfort. The objective of this retrospective case-control series is to investigate the effectiveness of postoperative drains following one- and two-level cervical fusions. Methods A chart review was conducted at a single institution from 2010-2013. Outcome measures included operative time, hospital stay, estimated blood loss and incidence of wound complications (infection, hematoma, edema, and complications with wound healing or evacuation), respiratory complications (delayed extubation, re-intubation, and respiratory treatment), and overall complications (wound complications, respiratory complications, dysphagia, and other complications). Statistical analyses including independent samples t-test, chi-square, analysis of covariance, and linear regression were used to compare patients who received a postoperative drain to those who did not. Results The study population included 39 patients who received a postoperative drain and 42 patients who did not. There were no differences in demographics between the two groups. Patients with drains showed increased operative time (100.1 vs 69.3 min, p < 0.001), hospital stay (38.9 vs. 31.7 hrs, p = 0.021), and blood loss (62.7 vs 29.1 mL, p < 0.001) compared to patients without drains. The frequency of wound complications, respiratory complications, and overall complications did not vary significantly between groups. Conclusions/Level of Evidence Cervical drains may not be necessary for patients undergoing one- and two-level cervical fusion. While there were no differences in incidence of complications between groups, patients treated with drains had significantly longer operative time and length of hospital stay. Clinical relevance This could contribute to excessive costs for patients treated with drains, despite the lack of compelling evidence of the advantages of this treatment in the literature and in the current study.

Poorman, Caroline E.; Bianco, Kristina M.; Boniello, Anthony; Yang, Sun; Gerling, Michael C.

2014-01-01

17

Immediate postoperative complications in transsphenoidal pituitary surgery: A prospective study  

PubMed Central

Background: Considering the important role of pituitary gland in regulating various endocrine axes and its unique anatomical location, various postoperative complications can be anticipated resulting from surgery on pituitary tumors. We examined and categorized the immediate postoperative complications according to various tumor pathologies. Materials and Methods: We carried out a prospective study in 152 consecutive patients and noted various postoperative complications during neurosurgical intensive care unit stay (within 48 hrs of hospital stay) in patients undergoing transsphenoidal removal of pituitary tumors. Results: In our series, various groups showed different postoperative complications out of which, cerebrospinal fluid leak was the commonest followed by diabetes insipidus, postoperative nausea and vomiting, and hematoma at operation site. Conclusion: Various immediate postoperative complications can be anticipated in transsphenoidal pituitary surgery even though, it is considered to be relatively safe. PMID:25191182

Chowdhury, Tumul; Prabhakar, Hemanshu; Bithal, Parmod K.; Schaller, Bernhard; Dash, Hari Hara

2014-01-01

18

Wound management with vacuum-assisted closure in postoperative infections after surgery for spinal stenosis  

PubMed Central

Objective To evaluate the results of negative-pressure wound therapy (NPWT) in the treatment of surgical spinal site infections. Materials and methods The use of NPWT in postoperative infections after dorsal spinal surgery (transforaminal lumbar interbody fusion plus posterior instrumentation) was studied retrospectively. From February 2011 to January 2012, six patients (females) out of 317 (209 females; 108 males) were readmitted to our clinic with surgical site infections on postoperative day 14 (range 9–19) and were treated with debridement, NPWT, and antibiotics. We evaluated the clinical and laboratory data, including the ability to retain the spinal hardware and recurrent infections. Results The incidence of deep postoperative surgical site infection was six (1.89%) patients (females) out of 317 patients (209 females; 108 males) at 1 year. All patients completed their wound NPWT regimen successfully. An average of 5.1 (range 3–8) irrigation and debridement sessions was performed before definitive wound closure. The mean follow-up period was 13 (range 12–16) months. No patient had a persistent infection requiring partial or total hardware removal. The hospital stay infection parameters normalized within an average of 4.6 weeks. Conclusion The study illustrates the usefulness of NPWT as an effective adjuvant treatment option for managing complicated deep spinal surgical wound infections.

Karaaslan, Fatih; Erdem, ?evki; Mermerkaya, Musa U?ur

2015-01-01

19

Postoperative wound infection in 32,000 clean operations.  

PubMed

The frequencies of postoperative wound infection in clean operations have been registered at a county hospital (Falun, Sweden) during a 15-year period (1958-1972). A total of 64,000 operations were done and about 32,000 of these have been registered as clean operations. In 1968 the wards were transformed from 12-bed rooms to 5-bed rooms and the operating theatres were rebuilt. All premises were equipped with high pressure air ventilation including lock system. Furthermore, a new intensive care unit and a new awakening unit were built. The overall postoperative wound infection (sepsis) rate during this 15-year period was 1.7 percent. The infection rates in the 5-year period before and in the 5-year period after opening of the new buildings were the same: 1.6 percent. After adding postoperative infections (sepsis) and postoperative inflammatory reactions, the total rates were almost the same: 4.1 percent before and 4.2 percent after. A slight rise in staphylococcal infections has been registered. This rise might suggest that the expected positive effects of the new buildings have been counteracted by other exogenous and endogenous factors. Some of these factors have been discussed (rise in mean age etc.). On the basis of this investigation it seems likely that the management (in all respects) of the surgical patients is still of the greatest importance, regardless of fine new buildings. PMID:1007788

Leissner, K H

1976-01-01

20

Impact of high preoperative steroid doses on postoperative complications among patients on prolonged preoperative steroid therapy.  

PubMed

Corticosteroids are essential to maintain the organic homeostasis. Steroid, glucocorticoid or its synthetic analog is widely used for inflammatory and autoimmune diseases. Prolonged steroid therapy is reported to cause the susceptibility to infection, impaired wound healing and psychoneurosis, however whether the quantity of taking the preoperative steroid is associated the postoperative complication is still unknown. The aim of this study was to elucidate whether the steroid dose in patients on prolonged preoperative steroid therapy is associated postoperative morbidity and mortality. Twenty-five patients taking steroid for various illnesses and underwent the surgery under general anesthesia were selected in this study. The mean +/- standard deviation and the median of the steroid dose converted into hydrocortisone (mg/day) were 39.2 +/- 31.0 and 20, respectively. Of 25 cases, postoperative complications were seen in 10 cases. The postoperative complication was severe based on the grade of Clavien and Dindo by ANOVA as the doses of taking steroid increased (p = 0.0171). The grave postoperative complication classified as Clavien and Dindo grade III occurred with 100% sensitivity and 87% specificity for the steroid dose converted into hydrocortisone > 80 mg/day. Preoperative taking the large amount of steroid (> 80 mg/day) could cause a grave complication. More careful selection of the operative procedure might improve the mobidity rate. PMID:24693677

Iguchi, Tomohiro; Shirabe, Ken; Inoue, Kentaro; Ito, Shuhei; Ohga, Takefumi; Nozoe, Tadahiro; Ezaki, Takahiro; Yoshizumi, Tomoharu; Uchiyama, Hideaki; Soejima, Yuji; Ikegami, Toru; Yamashita, Yo-Ichi; Kawanaka, Hirofumi; Ikeda, Tetsuo; Saeki, Hiroshi; Morita, Masaru; Maehara, Yoshihiko

2013-12-01

21

Increased postoperative complications after protective ileostomy closure delay: An institutional study  

PubMed Central

AIM: To study the morbidity and complications associated to ileostomy reversal in colorectal surgery patients, and if these are related to the time of closure. METHODS: A retrospective analysis of 93 patients, who had undergone elective ileostomy closure between 2009 and 2013 was performed. Demographic, clinical and surgical variables were reviewed for analysis. All complications were recorded, and classified according to the Clavien-Dindo Classification. Statistical univariate and multivariate analysis was performed, setting a P value of 0.05 for significance. RESULTS: The patients had a mean age of 60.3 years, 58% male. The main procedure for ileostomy creation was rectal cancer (56%), and 37% had received preoperative chemo-radiotherapy. The average delay from creation to closure of the ileostomy was 10.3 mo. Postoperative complications occurred in 40% of the patients, with 1% mortality. The most frequent were ileus (13%) and wound infection (13%). Pseudomembranous colitis appeared in 4%. Increased postoperative complications were associated with delay in ileostomy closure (P = 0.041). Male patients had more complications (P = 0.042), mainly wound infections (P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure (P = 0.003). End-to-end intestinal anastomosis without resection was significantly associated with postoperative ileus (P = 0.037). CONCLUSION: Although closure of a protective ileostomy is a fairly common surgical procedure, it has a high rate of complications, and this must be taken into account when the indication is made. The delay in stoma closure can increase the rate of complications in general, and specifically wound infections and colitis. PMID:25276286

Rubio-Perez, Ines; Leon, Miguel; Pastor, Daniel; Diaz Dominguez, Joaquin; Cantero, Ramon

2014-01-01

22

Relation of anthropometric and dynamometric variables to serious postoperative complications  

Microsoft Academic Search

Prediction of serious postoperative complications by using standard anthropometric and biochemical nutritional variables was attempted in 225 patients admitted for major abdominal surgery. In 102 of the patients hand-grip dynamometry was also measured, and this proved the most sensitive test, predicting complications in 48 of the 55 patients (87%) who developed them (p < 0.001). Arm muscle circumference and forearm

A M Klidjian; K J Foster; R M Kammerling; A Cooper; S J Karran

1980-01-01

23

Sterile versus clean technique in postoperative wound care of patients with open surgical wounds: A pilot study  

Microsoft Academic Search

Purpose: This study was completed to determine whether there were differences between sterile versus clean dressing change technique for open surgical wounds in the postoperative period with respect to (1) rate of wound healing and (2) cost of supplies.Methods: A two-group design was used for this pilot study. Of a sample of 30 patients undergoing elective gastrointestinal operations with wounds

Nancy A. Stotts; Susan Barbour; Kathleen Griggs; Brenda Bouvier; Leslie Buhlman; Deidre Wipke-Tevis; Donna F. Williams

1997-01-01

24

Pelvi-perineal flap reconstruction: normal imaging appearances and post-operative complications on cross-sectional imaging  

Microsoft Academic Search

Radical pelvic surgery is often required in patients with advanced, persistent or recurrent gynaecological and anorectal malignancies.\\u000a In the last decade, pedicled flap reconstructions have been increasingly used for pelvic floor and neovaginal reconstruction,\\u000a introducing well-vascularised non-irradiated tissue into the wound cavity and hence reducing wound complications. The aim\\u000a of this pictorial review is to describe the normal post-operative cross-sectional

Nyree Griffin; Jeremy Rabouhans; Lee A. Grant; Roy L. H. Ng; David Ross; Paul Roblin; Mark L. George

2011-01-01

25

Incisional negative pressure wound therapy after hemiarthroplasty for femoral neck fractures - reduction of wound complications.  

PubMed

The aim of the study was to evaluate the use of incisional negative pressure wound therapy (iNPWT) in wound healing after femoral neck fracture (FNF) treated with hip hemiarthroplasty (HA) and its influence on postoperative seromas, wound secretion, as well as time and material consumption for dressing changes. The study is a prospective randomised evaluation of iNPWT in patients with large surgical wounds after FNF. Patients were randomised either to be treated by iNPWT (group A) or a standard wound dressing (group B). Follow-up included ultrasound measurements of seroma volumes on postoperative days 5 and 10, duration of wound secretion, and time and material spent for wound dressing changes. For comparison of the means, we used the t-test for independent samples, P?>?0·05 was considered significant. There were 21 patients randomised in this study. Group A (11 patients, 81·6?±?5·2?years of age) developed a seroma of 0·257?±?0·75?cm(3) after 5?days and had a secretion of 0·9?±?1·0?days, and the total time for dressing changes was 14·8?±?3·9?minutes, whereas group B (ten patients, 82·6?±?8·6?years of age) developed a seroma of 3·995?±?5·01?cm(3) after 5?days and had a secretion of 4·3?±?2·45?days, and the total time for dressing changes was 42·9?±?11·0?minutes. All mentioned differences were significant. iNPWT has been used on many different types of traumatic and non-traumatic wounds. This prospective, randomised study has demonstrated decreased development of postoperative seromas, reduction of total wound secretion days and reduction of needed time for dressing changes. PMID:25125244

Pauser, Johannes; Nordmeyer, Matthias; Biber, Roland; Jantsch, Jonathan; Kopschina, Carsten; Bail, Hermann J; Brem, Matthias H

2014-08-14

26

Early Postoperative Complications after Heart Transplantation in Adult Recipients: Asan Medical Center Experience  

PubMed Central

Background Heart transplantation has become a widely accepted surgical option for end-stage heart failure in Korea since its first success in 1992. We reviewed early postoperative complications and mortality in 239 patients who underwent heart transplantation using bicaval technique in Asan Medical Center. Methods Between January 1999 and December 2011, a total of 247 patients aged over 17 received heart transplantation using bicaval technique in Asan Medical Center. After excluding four patients with concomitant kidney transplantation and four with heart-lung transplantation, 239 patients were enrolled in this study. We evaluated their early postoperative complications and mortality. Postoperative complications included primary graft failure, cerebrovascular accident, mediastinal bleeding, renal failure, low cardiac output syndrome requiring intra-aortic balloon pump or extracorporeal membrane oxygenation insertion, pericardial effusion, and inguinal lymphocele. Follow-up was 100% complete with a mean follow-up duration of 58.4±43.6 months. Results Early death occurred in three patients (1.3%). The most common complications were pericardial effusion (61.5%) followed by arrhythmia (41.8%) and mediastinal bleeding (8.4%). Among the patients complicated with pericardial effusion, only 13 (5.4%) required window operation. The incidence of other significant complications was less than 5%: stroke (1.3%), low cardiac output syndrome (2.5%), renal failure requiring renal replacement (3.8%), sternal wound infection (2.0%), and inguinal lymphocele (4.6%). Most of complications did not result in the extended length of hospital stay except mediastinal bleeding (p=0.034). Conclusion Heart transplantation is a widely accepted option of surgical treatment for end-stage heart failure with good early outcomes and relatively low catastrophic complications. PMID:24368968

Kim, Ho Jin; Kim, Jae Joong; Kim, Joon Bum; Choo, Suk Jung; Yun, Tae-Jin; Chung, Cheol Hyun; Lee, Jae Won

2013-01-01

27

Low dose heparin: bleeding and wound complications in the surgical patient. A prospective randomized study.  

PubMed Central

A randomized prospective study of low dose heparin was performed in 175 surgical patients to determine the frequency of bleeding and wound complications. The patients were divided into three groups: (1) low dose heparin (5000 units two hours before operation and 5000 units every 12 hours following operation for five days); (2) low dose heparin postoperatively only; and (3) a control group. The frequency of bleeding and wound complications was 27% in group I, 7.5% in group II, and 1.4% in group III. The difference between the control patients and those heparinized pre- and postoperatively is statistically significant (p less than 0.005). None of the patients in any of the three groups had a pulmonary embolus, but the number of patients involved is too small to assess the significance of this finding. However, a bleeding and wound complication rate of 27% is significant. These findings indicate that perhaps the routine use of low dose heparin should be reserved for those patients with preoperative factors indicating an increased risk from thromboembolism. PMID:603271

Pachter, H L; Riles, T S

1977-01-01

28

Evaluation of vacuum-assisted closure in patients with wound complications following tumour surgery.  

PubMed

Covering the reconstructed area with a healthy soft-tissue envelope is a major challenge after limb-sparing surgery in patients with malignant bone and soft-tissue tumours. Negative pressure wound therapy (NPWT) of open wounds hastens healing and minimises the requirement for complex reconstructive soft-tissue surgery. The aim of this study was to investigate the effectiveness and safety of NPWT in bone and soft-tissue malignant tumour patients with postoperative wound complications. Between January 2006 and November 2009, at a single institution, 13 patients with malignant bone and soft-tissue tumours who had undergone wide resection were retrospectively analysed. NPWT was performed in all patients to temporarily close the soft-tissue defects. After obtaining the culture negativity and normal infection markers, definitive soft-tissue reconstruction was performed to close the wound with primary suturisation in two patients, split thickness grafts in four patients, full thickness grafts in two patients, rotational flaps in three patients and free flaps in two patients. Mean duration of hospitalisation was 20 (range 8-48) days and mean follow-up period was 57·3 (range 50-74) months. There was no tumour recurrence or skip metastasis in the follow-up period. In addition, there was no periprosthetic infection or complication associated with NPWT. In conclusion, NPWT therapy seems to be a safe and effective option in the management of local wound problems and secondary surgical site infections after musculoskeletal tumour surgery. PMID:24976480

Mermerkaya, Ugur; Bekmez, Senol; Alkan, Erkan; Ayvaz, Mehmet; Tokgozoglu, Mazhar

2014-06-26

29

Postoperative wound dealing and superficial surgical site infection in open radical prostatectomy.  

PubMed

The number of open radical prostatectomy (RP) surgeries has been decreasing owing to the spread of laparoscopic and robotic surgery, which has implications for postoperative wound healing. The purpose of this study was to investigate and document the current status of postoperative wound healing and superficial surgical site infection (SSI) in open RPs. One hundred and seventy-five antegrade RPs with the same or similar kinds of prophylactic antibiotic administration were divided into two groups: (i) 'no intervention' (wound covering group) and (ii) 'washing', using a washing solution from the second postoperative day to the day of skin staple removal (wound washing group). We compared these groups for the occurrence of superficial SSI. The wound covering group had three (3·03%) cases of superficial SSI, with one case caused by methicillin sensitive Staphylococcus aureus (MSSA). The wound washing group had nine (11·8%) cases of superficial SSI, with three cases caused by MSSA, two cases caused by methicillin resistant Staphylococcus aureus (MRSA) and one by Pseudomonas aeruginosa. The wound covering group showed a significantly lower ratio of superficial SSI (P?=?0·0472). In conclusion, the postoperative wound status data in this study suggests that no wound intervention after RP resulted in a comparatively lower ratio of superficial SSI than in the wound washing group. PMID:25186077

Yamamichi, Fukashi; Shigemura, Katsumi; Yamashita, Mauso; Tanaka, Kazushi; Arakawa, Soishi; Fujisawa, Masato

2014-09-01

30

Use of intraoperative indocyanin-green angiography to minimize wound healing complications in abdominal wall reconstruction.  

PubMed

Complication rates following abdominal wall reconstruction (AWR) remain high. Early complications are related to skin necrosis and delayed healing, whereas late complications are related to recurrence. When concomitant body contouring procedures are performed, complication rates can be further increased. It is hypothesised that fluorescent angiography using indocyanin green (ICG) can identify poorly perfused tissues and thus reduce the incidence of delayed healing. A retrospective review was conducted of all patients who underwent AWR with concomitant panniculectomy from 2007-2012. Intraoperative ICG angiography with the SPY system (LifeCell Corp.) was used to determine the amount of resection for body contouring in patients who underwent reconstruction in a cohort of patients. SPY-Q was used to assess relative perfusion of analysed areas. Preoperative, postoperative, and operative details were analyzed. Seventeen patients met inclusion criteria, 12 patients were included in the non-ICG cohort, while five patients were included in the ICG cohorts. Wound-healing complications occurred in 5/12 (42%) patients in the non-ICG cohort vs 1/5 (20%) of the ICG cohorts. A description of the sole patient with complications in the ICG cohort is illustrated. Operative debridement and wound infection development occurred more frequently in the non-ICG cohort compared with the ICG cohort (17%, 17% vs 0%, 0%, respectively). Average time to wound healing was 41.1 days. Intraoperative ICG angiography can accurately detect perfusion abnormalities and can decrease wound healing related complications in complex hernia repair with concomitant panniculectomy. Assessing and ensuring skin viability can decrease the need for operative debridement. PMID:23596988

Patel, Ketan M; Bhanot, Parag; Franklin, Brenton; Albino, Frank; Nahabedian, Maurice Y

2013-12-01

31

Severe complications after negative pressure wound therapy in burned wounds: two case reports.  

PubMed

We present two typical cases of severe complications (sepsis and hemorrhage) after negative pressure wound therapy (NPWT) in burned patients. Necrotic tissues in some deep burn wounds are difficult to judge correctly and remove thoroughly. An electrically burned blood vessel looks "intact" but can easily break. Necrotic tissue or injured blood vessels when using NPWT are dangerous, both for causing sepsis and hemorrhage. This is the first article that reports the severe complications of NPWT in burned patients. It is imperative to heed indications and avoid contraindications. Proper preparation of wound beds, close observation, and sufficient irrigation are also crucial to avoid these severe complications, and there is an urgent need to substitute the central vacuum system with the low-pressure system. PMID:25061310

Ren, Haitao; Li, Yuan

2014-01-01

32

Probiotics for the treatment of postoperative complications following intestinal surgery.  

PubMed

Probiotics are living micro-organisms that belong to the normal enteric flora and exert a beneficial effect on health and well-being. The rationale for the therapeutic use of probiotics in pouchitis (the most frequent long-term complication following pouch surgery for ulcerative colitis) and postoperative recurrence in Crohn's disease is based on convincing evidence suggesting a crucial role for the endogenous intestinal microflora in the pathogenesis of these conditions. Positive results have been obtained with the administration of highly concentrated probiotic preparations in preventing the onset and relapses of pouchitis. Further controlled studies are needed to establish the efficacy of probiotics in the prophylaxis of postoperative recurrences of Crohn's disease and in the treatment of mild pouchitis. PMID:14507591

Gionchetti, Paolo; Amadini, Cristina; Rizzello, Fernando; Venturi, Alessandro; Poggioli, Gilberto; Campieri, Massimo

2003-10-01

33

The preoperative evaluation prevent the postoperative complications of thyroidectomy  

PubMed Central

Objective Thyroid surgery is generally a safe surgery but its complications are still common. We wish to identify preoperative factors that predict postoperative complications. Methods A nationwide survey was conducted by senior surgeons from 16 medical centers and 5 regional hospitals in Taiwan to thyroid operations performed over 3 years. 3846 cases were retrospectively examined to identify factors influencing complications: indication for surgery, preoperative evaluation, such as ultrasonography, chest X-ray, computed tomography and magnetic resonance imaging, isotope scanning, fine-needle aspiration cytology (FNAC) and thyroid function test, and patient characteristics. Results Eighty-four percent of patients were female. Seven percent of the patients had immediate postoperative hypocalcemia (mild and severe) and 2.3%, hoarseness (recurrent laryngeal nerve (RLN) injury, temporary/permanent). Logistic regression analysis identified an association between hypocalcemia and RLN injury with age, hospital category, surgical procedure types (total thyroidectomy, unilateral, bilateral subtotal or total resection). A lower incidence of hypocalcemia was related to preoperative neck ultrasound and FNAC analysis (the odds ratio (OR) = 0.5 and 0.65, [95% confidence interval (CI) 0.331–0.768 and 0.459–0.911], P = 0.0014 and 0.0127, respectively), while RLN injury was not associated with any preoperative evaluation. The ORs of hypocalcemia and RLN injury for patients older than 50 years were 0.55 and 2.15, [0.393–0.763 and 1.356–3.4], P < 0.001 and 0.0012, respectively. Conclusions The success of thyroid surgery depends on careful preoperative planning, including a preoperative neck ultrasound to determine the proximity of the nodule to the recurrent laryngeal nerve course, and the consideration of the type of anesthesia, adjuvant devices for intra-op monitoring of the RLN, and surgical modalities. Our results suggest that preoperative evaluation implementations are positively associated with strategy of surgery and postoperative hypocalcemia prevention.

Huang, Chien-Feng; Jeng, Yachung; Chen, Kuo-Dong; Yu, Ji-Kuen; Shih, Chao-Ming; Huang, Shih-Ming; Lee, Chen-Hsen; Chou, Fong-Fu; Shih, Ming-Lang; Jeng, Kee-Ching; Chang, Tzu-Ming

2014-01-01

34

Efficacy of postoperative continuous wound infiltration with local anesthetic after major abdominal surgery.  

PubMed

The aim of this study was to evaluate the analgesic efficacy, safety, opioid sparing effects and improvement of respiratory function when using 0.2% ropivacaine continuous wound infiltration after major intra-abdominal surgery. Forty patients undergoing major intra-abdominal surgery requiring a midline incision of > or = 20 cm were enrolled into this IRB-approved, randomized, prospective controlled study. Group 1: 20 patients, parenteral analgesia (control group). Group II: 20 patients, with local anesthetic wound infiltration (pain pump group). At the end of the procedure, in the pain pump group of patients, a multi hole, 20-gauge catheter was inserted percutaneously, above the fascia. An initial dose of 10 ml of 0.2% ropivacaine was injected in the wound through the catheter. A device provided continuous delivery of 0.2% ropivacaine; the infusion was initiated at 6 ml/h for the following two days. The total "rescue" morphine and oxycodone/acetaminophen tablets administered were significantly lower in the pain pump group. At all time intervals, resting pain scores were significantly lower in the pain pump group when compared with the control group. However, at the 4-48 and 12-48 hours pain scores generated after leg raise and coughing, respectively, were significantly lower in group II. The patient vital capacities were insignificantly higher in group II. We conclude that after major abdominal surgery, infiltration and continuous wound instillation with 0.2% ropivacaine decreases postoperative pain, opioid requirements and oral analgesia. Early patient rehabilitation, hastening convalescence, and preventing respiratory complications are expected outcomes of this approach. PMID:22128418

Abadir, Adel R; Nicolas, Fred; Gharabawy, Ramiz; Shah, Trusha; Michael, Rafik

2009-01-01

35

Modified Mandibulotomy Technique to Reduce Postoperative Complications: 5-Year Results  

PubMed Central

Purpose To review the 5-year outcomes of our modified mandibulotomy technique. Retrospective review of a tertiary level oral cancer center. Materials and Methods During a 5-year period, 30 patients who had a uniform surgical technique consisting of a lower lip-splitting, modified stair-step osteotomy with thin saw blade and osteotome after plate-precontouring and combination fixation with monocortical osteosynthesis (miniplate) and bicortical osteosynthesis (maxiplate and bicortical screws), with at least 14 months postoperative follow-up, were selected and reviewed retrospectively. Results There were 8 women and 22 men with an average age of 56.5 years. All the patients involved malignancies were squamous cell carcinoma. The main primary sites of the those who underwent a mandibulotomy were the tonsil, the base of tongue, the oral tongue, the retromolar pad area, and others. Others included buccal cheek, floor of mouth, and soft palate. 23 patients received postoperative radiation therapy, and among whom 8 patients also received chemotherapy. Total four (13%) mandibulotomy-related complications occurred, only two (6.7%) requiring additional operation under general anesthesia. Conclusion Our modified mandibulotomy meets the criteria for an ideal mandibulotomy technique relatively well because it requires no intermaxillary fixation, can precise preserve the occlusion in a precise way, allows early function, requires no secondary procedures, and has few complications. PMID:23918577

Na, Hye-Young; Choi, Eun-Joo; Kim, Hyung Jun; Cha, In-Ho

2013-01-01

36

Fournier's Gangrene as a Postoperative Complication of Inguinal Hernia Repair.  

PubMed

Fournier's gangrene is the necrotizing fasciitis of perianal, genitourinary, and perineal regions. Herein, we present a case of scrotal Fournier's gangrene as a postoperative complication of inguinal hernia repair. A 51-year-old male with giant indirect hernia is presented. Patient underwent inguinal hernia repair, and after an unproblematic recovery period, he was discharged. He applied to our outpatient clinic on the fifth day with swollen and painful scrotum and it turned out to be Fournier's gangrene. Polypropylene mesh was not infected. Patient recovered and was discharged after repeated debridements. Basic principles in treatment of Fournier's gangrene are comprised of initial resuscitation, broad-spectrum antibiotics therapy, and early aggressive debridement. In the management of presented case, aggressive debridement was made right after diagnosis and broad-spectrum antibiotics were given to the hemodynamically stable patient. In these circumstances, the important question is whether we could prevent occurrence of Fournier's gangrene. PMID:25506030

Dinc, Tolga; Kayilioglu, Selami Ilgaz; Sozen, Isa; Yildiz, Baris Dogu; Coskun, Faruk

2014-01-01

37

Development of a Prediction Rule for Estimating Postoperative Pulmonary Complications  

PubMed Central

Patient- and procedure-related factors associated with postoperative pulmonary complications (PPCs) have changed over the last decade. Therefore, we sought to identify independent risk factors of PPCs and to develop a clinically applicable scoring system. We retrospectively analyzed clinical data from 2,059 patients who received preoperative evaluations from respiratory physicians between June 2011 and October 2012. A new scoring system for estimating PPCs was developed using beta coefficients of the final multiple regression models. Of the 2,059 patients studied, 140 (6.8%) had PPCs. A multiple logistic regression model revealed seven independent risk factors (with scores in parentheses): age ?70 years (2 points), current smoker (1 point), the presence of airflow limitation (1 point), American Society of Anesthesiologists class ?2 (1 point), serum albumin <4 g/dL (1 point), emergency surgery (2 points), and non-laparoscopic abdominal/cardiac/aortic aneurysm repair surgery (4 points). The area under the curve was 0.79 (95% CI, 0.75–0.83) with the newly developed model. The new risk stratification including laparoscopic surgery has a good discriminative ability for estimating PPCs in our study cohort. Further research is needed to validate this new prediction rule. PMID:25437175

Eom, Jung Seop; Yoo, Hongseok; Song, Wonjun; Han, Sangbin; Lee, Kyung Jong; Jeon, Kyeongman; Um, Sang-Won; Koh, Won-Jung; Suh, Gee Young; Chung, Man Pyo; Kim, Hojoong; Kwon, O. Jung; Woo, Sookyoung; Park, Hye Yun

2014-01-01

38

Causes and managements of postoperative complications after degenerative scoliosis treatments with internal fixation  

PubMed Central

Objective: To investigate the causes and managements of early postoperative complications of degenerative scoliosis (DS) treated with internal pedicle screw fixation. Methods: From Jan 2000 to Apr 2013, 325 DS patients treated with internal pedicle screw fixation in our hospital were retrospectively involved. The categories, causes, managements and outcomes of early postoperative complications were statistically analyzed. Results: Early postoperative complications occurred in 10.76% of the patients including 16 cases of lower limb numb or pain, 6 cases of decreased lower limb sensitivity and motor functions, which accounted for 62.86% of all complications, followed by incision infections (4/35, 11.43%) and rare cases of cerebrospinal fluid leakage, cardiac and renal inadequacy, urinary system and pulmonary infections. The incidence of overall complications (19.79%, p = 0.001) and nerve injuries (11.46%, p = 0.000) were significantly higher in long-segment than in short-segment fixations. Improper screw implanting, over correction of scoliosis and insufficient blood supply of the spinal cord during operation were risk factors for early postoperative complications and most of them were cured by anti-infection medication, incision dressing change, nerve nourishment, adjusting the screws and anti-osteoporosis treatments within 6 months after surgery. Only three cases with severe nerve injury did not improve until the 6 months postoperative follow-up. Conclusions: Most of the postoperative complications in our DS patients disappeared within 6 months after surgery and more than half of complications were nerve injuries.

Yang, Yong-Hong; Zheng, Jie; Lou, Shu-Liang

2014-01-01

39

Wound infiltration with lidocaine prolongs postoperative analgesia after haemorrhoidectomy with spinal anaesthesia  

Microsoft Academic Search

Purpose  There are few clinical data examining whether sensitization of peripheral nerves contributes to postoperative pain when the\\u000a entry of noxious impulses to the central nervous system is blocked. We hypothesized that wound infiltration with lidocaine\\u000a would provide better postoperative analgesia than with normal saline following haemorrhoidectomy with spinal blockade.\\u000a \\u000a \\u000a \\u000a Methods  In a randomized, placebo-controlled, blinded study, 168 adults undergoing haemorrhoidectomy were

Hiroshi Morisaki; Junichi Masuda; Kazuaki Fukushima; Yasuhide Iwao; Kazunori Suzuki; Makoto Matsushima

1996-01-01

40

The Effect of Early Postoperative Physical Activity on Tissue Oxygen and Wound Healing  

Microsoft Academic Search

Background.Supplemented postoperative activity was compared to standard activity for effects on wound healing, subcutaneous tissue perfusion, and oxygen (PscO2) following hip replacement (THR).Methods. 58 patients were randomized to standard post-THR activity (N = 27) or supplemental activity (N = 31) (arm and leg exercises, walking protocol). PscO2was measured with a microelectrode\\/tonometer system and perfusion determined by oxygen response. Healing was

JoAnne D. Whitney; Sharon Parkman

2004-01-01

41

Wound Complications in Preoperatively Irradiated Soft-Tissue Sarcomas of the Extremities  

SciTech Connect

Purpose: To determine whether the involvement of plastic surgery and the use of vascularized tissue flaps reduces the frequency of major wound complications after radiation therapy for soft-tissue sarcomas (STS) of the extremities. Methods and Materials: This retrospective study evaluated patients with STS of the extremities who underwent radiation therapy before surgery. Major complications were defined as secondary operations with anesthesia, seroma/hematoma aspirations, readmission for wound complications, or persistent deep packing. Results: Between 1996 and 2010, 73 patients with extremity STS were preoperatively irradiated. Major wound complications occurred in 32% and secondary operations in 16% of patients. Plastic surgery closed 63% of the wounds, and vascularized tissue flaps were used in 22% of closures. When plastic surgery performed closure the frequency of secondary operations trended lower (11% vs 26%; P=.093), but the frequency of major wound complications was not different (28% vs 38%; P=.43). The use of a vascularized tissue flap seemed to have no effect on the frequency of complications. The occurrence of a major wound complication did not affect disease recurrence or survival. For all patients, 3-year local control was 94%, and overall survival was 72%. Conclusions: The rates of wound complications and secondary operations in this study were very similar to previously published results. We were not able to demonstrate a significant relationship between the involvement of plastic surgery and the rate of wound complications, although there was a trend toward reduced secondary operations when plastic surgery was involved in the initial operation. Wound complications were manageable and did not compromise outcomes.

Rosenberg, Lewis A. [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States)] [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States); Esther, Robert J. [Department of Orthopedics, University of North Carolina, Chapel Hill, North Carolina (United States)] [Department of Orthopedics, University of North Carolina, Chapel Hill, North Carolina (United States); Erfanian, Kamil [Department of Surgery, University of North Carolina, Chapel Hill, North Carolina (United States)] [Department of Surgery, University of North Carolina, Chapel Hill, North Carolina (United States); Green, Rebecca [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States)] [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States); Kim, Hong Jin; Sweeting, Raeshell [Department of Surgery, University of North Carolina, Chapel Hill, North Carolina (United States)] [Department of Surgery, University of North Carolina, Chapel Hill, North Carolina (United States); Tepper, Joel E., E-mail: tepper@med.unc.edu [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States)

2013-02-01

42

Efficacy of Postoperative Continuous Wound Infiltration With Local Anesthesia After Open Hepatectomy  

PubMed Central

Objectives: Local anesthetic wound infiltration is widely used as an effective adjunct during multimodal postoperative pain management. The aim of this study was to evaluate the effectiveness of continuous wound infusion of ropivacaine in postoperative pain relief, opioid sparing, incidence of nausea and vomiting, and bowel and liver function improvement in patients undergoing open hepatectomy. Methods: Forty patients undergoing open hepatectomy were enrolled in this prospective, randomized, double-blinded, placebo-controlled trial. Patients were divided into 2 groups: the 0.9% saline continuous infusion group (the control group; n=20) and the ropivacaine continuous infusion group (the Ropi group; n=20). Outcomes measured postoperatively were pain score at rest and on movement, sufentanil consumption, incidence of nausea and vomiting, and sedation score across 48 postoperative hours. Time to bowel recovery, liver function change, mean length of hospitalization, patient satisfaction, and other data after 48 postoperative hours were collected until hospital discharge. Results: Pain scores at rest were lower for the ropivacaine group and reached significance after 8 and 16 hours (P<0.01). Sufentanil consumption (41.50±21.80 vs. 89.70±35.22 ?g; P<0.01) after 48 hours, time to bowel recovery (1.80±0.70 vs. 3.15±1.04 d; P<0.01), incidence of nausea and vomiting (1.75±0.72 vs. 2.40±0.68; P<0.05), and mean length of hospitalization (5.6±2.44 vs. 7.35±2.85 d; P<0.01) were significantly reduced, and the sedation score and liver function change were also comparable between the 2 groups. There was no difference with respect to pain scores on movement, nor with respect to patient satisfaction. Conclusions: Surgical wound infusion with ropivacaine after hepatectomy can improve pain relief at rest and accelerate recovery and discharge. PMID:24281275

Hong, Yu; Yong, Li Zhe

2014-01-01

43

Wound Complications Following Cleft Repair in Children with Van der Woude Syndrome  

PubMed Central

Van der Woude Syndrome (VWS, OMIM #119300) is an autosomal dominant condition associated with clefts of the lip and/or palate and lower lip pits and is caused by mutations in Interferon Regulatory Factor 6 (IRF6). The standard of practice for children born with cleft lip/palate is surgical repair, which requires proper wound healing. We tested the hypothesis that children with VWS are more likely to have wound complications following cleft repair than children with non-syndromic cleft lip/palate (NSCLP). Furthermore, we hypothesized that children with VWS have more surgical procedures. A retrospective, case-controlled study was performed. Seventeen children with VWS and 68 matched controls with NSCLP were scored for presence of wound complications following cleft repair, severity of complications and number of surgeries from ages 0–10. Of the 17 children with VWS, 8 had wound complications. Thirteen of 68 controls had wound complications (P=0.02). Six of eight wound complications in the VWS group were major with nine of 13 complications in the control group major (P=0.04). The majority of wound complications were fistulae and occurred in isolated cleft palate and bilateral cleft lip. The mean number of surgeries in the VWS group was 3.0 compared to 2.8 in the control group (P=0.67). Our studies suggest that children with VWS have an increased risk for wound complications following cleft repair compared to children with NSCLP. Furthermore the data supports a role for IRF6 in wound healing. PMID:20856020

Jones, Jodi; Canady, John W.; Brookes, James T.; Wehby, George L.; Schutte, Brian C.; Murray, Jeffrey C.; Dunnwald, Martine

2010-01-01

44

The utility of midtrimester ultrasound assessment of the subcutaneous space in predicting cesarean wound complications.  

PubMed

Abstract Objective: To evaluate the association between cesarean wound complications and thickness of the subcutaneous space within the anterior abdomen at the midtrimester fetal anatomical survey. Methods: In this case-control study, cases were identified using an ICD9 code for wound complications of cesarean delivery. For each case, we identified the woman with the next consecutive midtrimester ultrasound who had a cesarean delivery without a wound complication, matched on age and race, as the control. A blinded investigator measured subcutaneous space at three distinct suprapubic levels in the midsagital plane. Results: Of 7228 women with a cesarean delivery, 123 (1.7%) had a wound complication. Seventy-nine cases were eligible. Midline suprapubic subcutaneous thickness did not differ between cases and controls at the superior, middle or inferior locations (p???0.35). Body mass index was moderately correlated with ultrasound-derived measurements (r???0.63; p?wound complication risk with increasing subcutaneous space thickness, even after adjustment (p???0.34). Conclusion: Prenatal ultrasound can quantify the subcutaneous space. Vertical skin incision, stapled wound closure, and a classical hysterotomy were associated with cesarean wound complication, but midtrimester subcutaneous thickness was not. PMID:25302863

Shainker, Scott A; Raghuraman, Nandini; Modest, Anna M; Schnettler, William T; Hacker, Michele R; Ralston, Steven J

2014-11-11

45

Relationship between Post-kidney Transplantation Antithymocyte Globulin Therapy and Wound Healing Complications  

PubMed Central

Background: Wound healing disorders are probably the most common post-transplantation surgical complications. It is thought that wound healing disturbance occurs due to antiproliferative effects of immunosuppressive drugs. On the other hand, success of transplantation is dependent on immunosuppressive therapies. Antihuman thymocyte globulin (ATG) has been widely used as induction therapy but the impact of this treatment on wound healing is not fully understood. Objective: To investigate wound healing complications after ATG therapy in renal transplant recipients. Methods: The medical records of 333 kidney transplant recipients were assessed for wound healing disorders. Among these patients, 92 received ATG and 5 doses of 1.5 mg/kg ATG along with the standard protocol of drugs. Results: The mean age of patients was 38.9 years. Of 333 recipients, 92 (23.7%) received ATG; 21 (6.3%) developed wound healing complications. There was a significant relationship between ATG therapy and wound complications (p=0.034). Also, women were more likely to develop wound healing disorders than men (p=0.002). No statistical difference was observed between age and wound healing complication (p=0.28). There was no significant difference between the mean duration of hospitalization between ATG and Non-ATG group (p=0.9). Conclusion: ATG increases the risk of overall wound complications. It is needed to pay more attention to the patients treated with this immunosuppressant to avoid the risk of re-interventions, lessen the duration of hospitalization and decrease the impairment of graft function. PMID:25013627

Pourmand, G. R.; Dehghani, S.; Saraji, A.; Khaki, S.; Mortazavi, S. H.; Mehrsai, A.; Sajadi, H.

2012-01-01

46

Postoperative evaluation of penetrating hepatic trauma and complications  

SciTech Connect

Postoperative hepatobiliary scintigraphy is recommended in selected cases of hepatic trauma to evaluate the integrity and patency of the biliary system. The authors present a patient with a traumatic hematoma that eventuated in a biloma with spontaneous biliary-cutaneous fistula. Repeat study demonstrated biliary obstruction at the canalicular level, which by more invasive imaging was found secondary to toal obstruction of the common hepatic duct. The precise anatomical level and cause of his obstruction were defined by the findings of endoscopic retrograde cannulation of the pancreas, percutaneous transhepatic cholangiongraphy, and surgery.

Lecklitner, M.L.; Dittman, W.

1984-09-01

47

Surgical Site Infections and Other Postoperative Complications following Prophylactic Anticoagulation in Total Joint Arthroplasty  

PubMed Central

Background Anticoagulants reduce the risk of venous thromboembolism (VTE) after total joint replacement. However, concern remains that pharmacologic VTE prophylaxis can lead to bleeding, which may impact on postoperative complications such as infections and reoperations. Methods and Findings From the Global Orthopedic Registry (GLORY), we reviewed 3,755 patients in US who elected for primary total hip or knee arthroplasty, received either warfarin or low molecular weight heparin (LMWH) as VTE prophylactics, and had up-to-90-day follow-up after discharge. We compared incidence rates of VTE, infections and other complications between LMWH and warfarin groups, and used multivariate analyses with propensity score weighting to generate the odds ratio (OR). Patients receiving LMWH tended to be older and higher in the American Society of Anesthesiologists grade scores. In contrast, warfarin was used more frequently for hip arthroplasty with longer duration among patients with more pre-existing comorbidity (all P<0.02). A weight variable was created with propensity score to account for differences in covariate distributions. Propensity score-weighted analyses showed no differences in VTE complications. However, compared to warfarin, LMWH was associated with significantly higher rates of bleeding (6.2% vs. 2.1%; OR?=?3.82, 95% confidence interval [CI], 2.64 to 5.52), blood transfusion (29.4% vs. 22.0%; OR?=?1.75, 95% CI, 1.51 to 2.04), reoperations (2.4% vs. 1.3%; OR?=?1.77, 95% CI, 1.07 to 2.93) and infections (1.6% vs. 0.6%; OR?=?2.79, 95% CI, 1.42 to 5.45). Similar results were obtained from compliant uses of warfarin (26%) and LMWH (62%) according to clinical guidelines. While surgical site infections were mostly superficial, current study was underpowered to compare incidence rates of deep infections (<1.0%). Conclusions Surgical site infections and reoperations in 3 months following primary total joint arthroplasty may be associated with anticoagulant use that exhibited higher bleeding risk. Long-term complications and deep wound infections remain to be studied. PMID:24717837

Wang, Zhong; Anderson, Frederick A.; Ward, Michael; Bhattacharyya, Timothy

2014-01-01

48

Postoperative Complications in the Tube Versus Trabeculectomy (TVT) Study During Five Years of Follow-up  

PubMed Central

Purpose To describe postoperative complications encountered in the Tube Versus Trabeculectomy (TVT) Study during 5 years of follow-up. Design Multicenter randomized clinical trial. Methods Settings Seventeen clinical centers. Study Population Patients 18 to 85 years of age who had previous trabeculectomy and/or cataract extraction with intraocular lens implantation and uncontrolled glaucoma with intraocular pressure (IOP) ?18 mm Hg and ?40 mm Hg on maximum tolerated medical therapy. Interventions Tube shunt (350-mm2 Baerveldt glaucoma implant) or trabeculectomy with mitomycin C (MMC 0.4 mg/mL for 4 minutes). Main Outcome Measures Surgical complications, reoperations for complications, visual acuity, and cataract progression. Results Early postoperative complications occurred in 22 patients (21%) in the tube group and 39 patients (37%) in the trabeculectomy group (P = .012). Late postoperative complications developed in 36 patients (34%) in the tube group and 38 patients (36%) in the trabeculectomy group during 5 years of follow-up (P = .81). The rate of reoperation for complications was 22% in the tube group and 18% in the trabeculectomy group (P = .29). Cataract extraction was performed in 13 phakic eyes (54%) in the tube group and 9 phakic eyes (43%) in the trabeculectomy group (P = .43). Conclusions A large number of surgical complications were observed in the TVT Study, but most were transient and self-limited. The incidence of early postoperative complications was higher following trabeculectomy with MMC than tube shunt surgery. The rates of late postoperative complications, reoperation for complications, and cataract extraction were similar with both surgical procedures after 5 years of follow-up. PMID:22244522

Gedde, Steven J.; Herndon, Leon W.; Brandt, James D.; Budenz, Donald L.; Feuer, William J.; Schiffman, Joyce C.

2013-01-01

49

Preoperative factors predictive of complicated postoperative management after Roux-en-Y gastric bypass for morbid obesity  

Microsoft Academic Search

Introduction: This study was undertaken to determine preoperative predictive factors of complicated postoperative management after Roux-en-Y gastric bypass (RYGB) for morbid obesity. Methods: Between January 1999 and January 2002, 158 patients who underwent a RYGB received a standardized preoperative evaluation and data were collected prospectively. Complicated postoperative management was defined as patients requiring postoperative ICU admission for ?48 h, or

R. Gonzalez; S. P. Bowers; K. R. Venkatesh; E. Lin; C. D. Smith

2003-01-01

50

Is low serum albumin associated with postoperative complications in patients undergoing oesophagectomy for oesophageal malignancies?  

PubMed

A best evidence topic was written according to a structured protocol. The question addressed was: in patients undergoing oesophagectomy for oesophageal malignancy, is low serum albumin associated with postoperative complications? Altogether, 87 papers were found using the reported search, of which 16 demonstrated the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. This paper includes 2 level 2 papers, 12 level 3 papers and 2 level 4 papers. All the papers compared either all or some of the following postoperative complications: mortality, morbidity, anastomotic leak, respiratory and non-respiratory complications, and length of hospital stay. Eleven of the 16 papers found an association between low serum albumin and postoperative complications. Of these, one study showed that low serum albumin combined with low fibrinogen levels (FA score) was predictive of postoperative recurrence of oesophageal cancer. Another study showed that when combined with white cell count and C-reactive protein (CRP, NUn score), serum albumin had a high diagnostic accuracy for major complications after postoperative day 3. The largest study compared the in-hospital mortality in 7227 patients who underwent oesophageal surgery for malignancy. The percentage of in-hospital mortality was associated with low serum albumin (<15.0 vs >35.0 g/l, 21.0 vs 11.3%, P <0.001). Five of the 16 papers found no significant association between low serum albumin and postoperative complications. Of these papers, one showed that low serum albumin was not an independent risk factor, while four others found no association between low serum albumin with respiratory complications, anastomotic leak and postoperative mortality. Instead, these studies found other factors responsible for postoperative complications such as: CRP, smoking, disease duration, malnutrition and low T-cell levels. Taken together, while low serum albumin is associated with postoperative complications, opinion regarding the prognostic value of low serum albumin and nutritional support remains conflicted. Because of the confounding factors encountered in these studies, the clinician should consider the finding of low serum albumin in patients, together with disease and surgical factors to provide optimal care for these patients. PMID:25260893

Goh, Sean L; De Silva, Ramesh P; Dhital, Kumud; Gett, Rohan M

2015-01-01

51

Early postoperative complications in patients with Crohn's disease given and not given preoperative total parenteral nutrition  

PubMed Central

Objective The effect of preoperative total parenteral nutrition (TPN) on the rate of early (within 30 days) postoperative complications in patients with moderate to severe Crohn's disease (CD) was examined. Material and methods A series of 15 consecutive patients with CD (mean CD activity index score, 270) given preoperative TPN for 18–90 days (mean, 46 days) and undergoing bowel resection and primary anastomosis was compared with matching controls (105 patients) consecutively selected from all CD patients operated in Stockholm County during a preceding 20-year period without preoperative TPN. Results During the preoperative TPN, all the patients studied displayed clinical remission of CD as reflected in improvement in their general well-being, relief of abdominal pain, and abatement of fever and diarrhea. There was no significant early postoperative complication in the TPN-treated group, whereas there were 29 patients with early postoperative complications in the control group, which means a significantly higher rate of postoperative complications when preoperative TPN was not provided. During the preoperative TPN, some crucial variables increased such as the body weight, the serum concentrations of albumin and triiodothyronine reflecting improved nutritional state, whereas the serum concentration of haptoglobin and the white cell count decreased reflecting decreased inflammatory activity. Conclusions This study shows that preoperative TPN for at least 18 days may be recommended to be given to patients with moderate to severe CD until clinical remission is achieved in order to minimize the risk of early postoperative complications. PMID:22242614

Jacobson, Stefan

2012-01-01

52

Reoperation for early postoperative complications after gastric cancer surgery in a Chinese hospital  

PubMed Central

AIM: To investigate the occurrence of postoperative complications of gastric cancer surgery, and analyze the potential causes of reoperation for early postoperative complications. METHODS: A total of 1639 patients who underwent radical or palliative gastrectomies for gastric cancer were included in the study. The study endpoint was the analysis of postoperative complications in inpatients. RESULTS: About 31% of patients had early postoperative complications, and complications of infection occurred most frequently. Intra-abdominal hemorrhage and anastomotic leak were the main causes of reoperation, which accounted for about 2.2%. Mortality was 11.1% in the reoperation group, but was only 0.8% in other patients. The duration of postoperative stay in hospital was significantly longer and the total expenditure was markedly higher in the patients who underwent reoperation (P < 0.001). There was no significant association of any available factors in this study with the high rate of reoperation. CONCLUSION: Reoperation significantly increases the mortality rate and raises the burden of the surgical unit. More prospective studies are required to explore the potential risk factors. PMID:20039455

Sah, Birendra Kumar; Chen, Ming-Min; Yan, Min; Zhu, Zheng-Gang

2010-01-01

53

[Laparoscopic gastric bypass: computed tomography appearance of common postoperative changes and complications].  

PubMed

Laparoscopic Roux-en-Y bypass is being increasingly used for weight reduction in patients with morbid obesity. Unfortunately, some complications can occur after this procedure, the most frequent being intestinal obstruction (due to stenosis of the anastomosis at the distal end of the loop, internal hernias, bands, and adhesions), anastomotic leaks, and bleeding. This article provides basic knowledge about the surgical technique and its correlation with the common postoperative changes with the aim of facilitating the interpretation of CT findings and the identification of postoperative complications in these patients. PMID:24508056

Caracela Zeballos, C R; Diéguez Tapias, S; Cereceda Pérez, C N; Pinto Varela, J M

2014-01-01

54

Major postoperative complications after benign gynecologic surgery: a clinical prediction model  

PubMed Central

Objective To create a clinical prediction tool to differentiate women at risk for postoperative complications after benign gynecologic surgery. Methods We utilized the 2005 to 2009 American College of Surgeons National Surgical Quality Improvement Program participant use data files to perform a secondary dataset analysis of women over the age of 16 years who underwent benign gynecologic procedures. We then temporally divided women into two similar cohorts. Our derivation cohort included all women undergoing benign gynecologic procedures in the 2005 to 2008. Our validation cohort included all women undergoing benign gynecologic procedures in the 2009. The primary outcome, composite 30-day major postoperative complications, was analyzed as a dichotomous variable. A prediction tool was then constructed to predict the occurrence of postoperative complications built from the logistic regression model by rounding the value of each estimated ? coefficient to the nearest integer. An individual’s risk score was then computed by summing the number of points based on her preoperative characteristics. This risk score was then used to categorize women into low, medium, and high-risk groups. Results A prediction tool for benign gynecologic procedures identified women at low (2.7% and 2.4%), medium (6.3% and 6.8%), and high (29.5% and 23.8%) risk of complications in the derivation and validation cohorts, respectively. Conclusion A prediction tool can differentiate women at risk for postoperative complications after benign gynecologic surgery. PMID:22983270

EREKSON, Elisabeth A.; YIP, Sallis O.; MARTIN, Deanna K.; CIARLEGLIO, Maria M.; CONNELL, Kathleen A.; FRIED, Terri R.

2013-01-01

55

[Postoperative pyoinflammatory complications in patients with colostomy for large intestinal obstruction caused by colonic neoplasms].  

PubMed

Premises of the pyoinflammatory complications of colostomy in patients with tumorous obstructive ileus were analyzed. These were: age >60 years, concomitant diseases, extent of anemia, duration of the operative treatment more then 2,5-3 hours, mass of subcutaneous fat tissue and time before stoma opening. Highlighting of risk factors allowed prediction of inflammatory postoperative complications and take steps of its prophylaxis. PMID:19668137

Sotnikov, D N; Abraamian, B A; Kurilov, V P

2009-01-01

56

Sarcopenia Adversely Impacts Postoperative Complications Following Resection or Transplantation in Patients with Primary Liver Tumors  

PubMed Central

Background Sarcopenia is a surrogate marker of patient frailty that estimates the physiologic reserve of an individual patient. We sought to investigate the impact of sarcopenia on short- and long-term outcomes in patients having undergone surgical intervention for primary hepatic malignancies. Methods Ninety-six patients who underwent hepatic resection or liver transplantation for HCC or ICC at the John Hopkins Hospital between 2000 and 2013 met inclusion criteria. Sarcopenia was assessed by the measurement of total psoas major volume (TPV) and total psoas area (TPA). The impact of sarcopenia on perioperative complications and survival was assessed. Results Mean age was 61.9 years and most patients were men (61.4 %). Mean adjusted TPV was lower in women (23.3 cm3/m) versus men (34.9 cm3/m) (P<0.01); 47 patients (48.9 %) had sarcopenia. The incidence of a postoperative complication was 40.4 % among patients with sarcopenia versus 18.4 % among patients who did not have sarcopenia (P=0.01). Of note, all Clavien grade ?3 complications (n=11, 23.4 %) occurred in the sarcopenic group. On multivariable analysis, the presence of sarcopenia was an independent predictive factor of postoperative complications (OR=3.06). Sarcopenia was not associated with long-term survival (HR=1.23; P=0.51). Conclusions Sarcopenia, as assessed by TPV, was an independent factor predictive of postoperative complications following surgical intervention for primary hepatic malignancies. PMID:25389056

Valero, Vicente; Amini, Neda; Spolverato, Gaya; Weiss, Matthew J.; Hirose, Kenzo; Dagher, Nabil N.; Wolfgang, Christopher L.; Cameron, Andrew A.; Philosophe, Benjamin; Kamel, Ihab R.

2015-01-01

57

Analysis of postoperative complications after esophagectomy for esophageal cancer in patients receiving neoadjuvant therapy  

Microsoft Academic Search

Postoperative complications were investigated in 72 patients who received neoadjuvant therapy with esophagectomy. Preoperative\\u000a chemotherapy consisted of 5-fluorouracil (700 mg\\/m2\\/day, on days 1 to 5), cisplatinum (70 mg\\/m2\\/day, on day 1), and leucovorin\\u000a (20 mg\\/m2\\/day, on days 1 to 5). Preoperative chemoradiotherapy consisted of cisplatinum combined chemotherapy and radiotherapy\\u000a (total dosage of 30–70 Gy). The incidence of postoperative pneumonia (16%)

Reiki Eguchi; Hiroko Ide; Tsutomu Nakamura; Kazuhiko Hayashi; Masaho Ohta; Fumiki Okamoto; Hiroyuki Itoh; Ken Takasaki

1999-01-01

58

[Duration of smoking cessation for the prevention of surgical wound healing complications].  

PubMed

The study aimed to find scientific evidence about the duration of preoperative smoking cessation required to reduce surgical wound healing complications. An integrative review was performed in the databases, Latin American and Caribbean Literature on Health Sciences (LILACS) and Medical Literature Analysis and Retrieval System Online (MEDLINE), from 08/17/2012 to 09/17/2012, using the keywords: tobacco use cessation and wound healing; tobacco use cessation and preoperative period; tobacco use cessation and perioperative period (LILACS) and tobacco use cessation and perioperative period; tobacco use cessation and wound healing (MEDLINE). Out of the 81 eligible studies, 12 were included. The duration of smoking cessation needed to reduce healing complications was at least four weeks (four studies with level of evidence I, three studies with level of evidence II, two studies with level of evidence IV, and one study with level of evidence VII). PMID:24676124

Cavichio, Barbara Vieira; Pompeo, Daniele Alcalá; Oller, Graziella Allana Serra Alves de Oliveira; Rossi, Lídia Aparecida

2014-02-01

59

Management of complicated gastroschisis with porcine small intestinal submucosa and negative pressure wound therapy  

Microsoft Academic Search

IntroductionIn almost all cases of gastroschisis, fascial closure may be achieved primarily or after silo reduction. Rarely, fascial and skin closure are impossible. We report our experience with visceral coverage in complicated cases of gastroschisis with porcine small intestinal submucosa (SIS) augmented by negative pressure wound therapy (NPWT).

Allen Gabriel; Gerald Gollin

2006-01-01

60

Are postoperative fever and\\/or septic complications prognostic factors in colorectal cancer resected for cure?  

Microsoft Academic Search

The authors have examined the survival rate of 111 patients with colorectal cancer (Dukes' A, B, and C stages) treated by\\u000a potentially curative surgery. In particular, the survival has been evaluated with regard to the appearance of postoperative\\u000a fever and\\/or septic complications. The preliminary results demonstrate that these factors do not significantly influence the\\u000a long-term prognosis.

Claudio Fucini; Luca Bandettini; Massimo D'Elia; Franco Filipponi; Andrea Herd-Smith

1985-01-01

61

A Review of the Impact of Preoperative Chemoradiotherapy on Outcome and Postoperative Complications in Esophageal Cancer Patients.  

PubMed

Preoperative chemoradiotherapy has emerged in the treatment of esophageal cancer as a means to down-stage tumors, improve local control, and possibly improve overall survival. However, there are concerns that postoperative complications may be increased by preoperative chemoradiotherapy. We review the rationale for preoperative chemoradiotherapy. We review the literature to identify the potential postoperative complications, the risk of complications, and the risk factors for complications. Although individual and previous studies have shown an increased risk of postoperative complications, the 4 most recent randomized trials published after the year 2000 have not shown an increase in postoperative complications and mortality rates in patients treated with preoperative chemoradiation compared with patients treated with surgery alone. Pulmonary complications are frequently reported, and we focus on dosimetric factors that can be used to minimize lung toxicity. Several dose-volume-histogram parameters, including V10?40%, V15?30%, V20?20%, have been shown to correlate with 32% to 35% of pulmonary complications including pneumonia and acute respiratory distress syndrome. More recent evidence has suggested that an absolute volume of lung spared doses of > 5 Gy (VS5) correlates with pulmonary complications. As these data show, low-dose volume may be more important in the prevention of pulmonary complications than high-dose volume. These dosimetric constraints can be used by physicians to prevent postoperative pulmonary complications in patients treated with preoperative chemoradiotherapy. PMID:24351783

Wilke, Trevor J; Bhirud, Abhijeet R; Lin, Chi

2013-12-17

62

Effects of Suppository Acetaminophen, Bupivacaine Wound Infiltration, and Caudal Block With Bupivacaine on Postoperative Pain in Pediatric Inguinal Herniorrhaphy  

PubMed Central

Background: The control of postoperative pain is important in children, and poor pain control leads to organ dysfunction and behavioral problems. Objectives: We compared the analgesic effects of suppository acetaminophen, bupivacaine wound infiltration, and caudal block with bupivacaine on postoperative pain in pediatric inguinal herniorrhaphy. Patients and Methods: In this double-blinded, randomized controlled clinical trial, 90 children of American Society of Anesthesiologists (ASA) grade I-II, aged between 3 months and 7 years, and scheduled for elective unilateral inguinal herniorrhaphy under general anesthesia were assigned to three equal groups. Patients in the first group received 20 mg/kg of suppository acetaminophen. In the second group, 2 mg/kg of 0.5% bupivacaine was infiltrated in the incisional site, and in the third group, a caudal block was performed with 0.75 mL/kg of 0.25% bupivacaine. The Face, Legs, Activity, Cry, Consolability (FLACC) pain scale was applied 30 minutes after operation. Thereafter, the FLACC score was obtained every hour during the next 6 hours. If the FLACC score was 4 or over, we administered 0.5 mg/kg of intravenous meperidine. The data was transferred to SPSS-10 software and analyzed statistically with chi-square and analysis of variance tests. P < 0.05 was considered significant. Results: The mean analgesic duration in the acetaminophen, bupivacaine infiltration, and caudal block groups was 4.07, 5.40, and 5.37 hours, respectively. Significant differences were not observed between the bupivacaine infiltration and caudal block groups (P = 0.9), but the differences between the bupivacaine infiltration and acetaminophen groups (P = 0.034) and the caudal block and acetaminophen groups (P = 0.039) were significant. With regard to meperidine administration, significant differences were not observed between the bupivacaine infiltration and caudal block groups (P = 0.848), but significant differences were observed between these two groups and the acetaminophen group (P < 0.05). Conclusions: Patients in the bupivacaine infiltration and caudal block groups had less postoperative pain than those in the acetaminophen group and received lower amount of meperidine. We concluded that in children, bupivacaine infiltration and caudal block with bupivacaine produce better analgesia than suppository acetaminophen. It seems that bupivacaine infiltration is better than caudal block because of its simplicity, lower incidence of complications, and failure rate. PMID:24904808

Hosseini Jahromi, Seyed Abbas; Sadeghi poor, Sadegh; Hosseini Valami, Seyedeh Masoumeh; Javadi, Amir

2012-01-01

63

Intra- and postoperative complications in 137 cases of giant thyroid gland tumor  

PubMed Central

The intra- and postoperative complications resulting from surgery for giant thyroid gland tumors (diameter greater than 10 cm) present serious challenges to patient recovery. Although there are a number of methods, all have limitations. In this study, we present our experience with several complications of surgical treatment of giant thyroid gland tumors to increase the awareness and aid the prevention of these complications. A total of 137 consecutive patients who underwent surgical treatment in Henan Tumor Hospital were retrospectively analyzed. Statistics pertaining to the patients’ clinical factors were gathered. We found that the most common surgical complications were recurrent laryngeal nerve (RLN) injury and symptomatic hypoparathyroidism. Other complications included incision site infections, bleeding, infection and chyle fistula, the incidence of which increased significantly with increasing extent of surgery from group I (near-total thyroidectomy) to group V (total thyroidectomy plus lateral neck dissection). Low complication rates may be achieved with more accurate knowledge of the surgical anatomy, skilled surgical treatment and experience. More extensive surgery results in a greater number of complications. PMID:23162632

DU, WEI; LIU, SHAN-TING; LI, PENG; SUN, LI-YAN; ZHAO, MING; QI, JIN-XING; LUO, RUI-HUA; FENG, LU; DAI, LI-YUAN; CUI, MENG; SUN, CHANG-FU; LIU, FA-YU

2012-01-01

64

Postoperative pulmonary complications after preoperative chemoradiation for esophageal carcinoma: correlation with pulmonary dose–volume histogram parameters  

Microsoft Academic Search

PurposeTo clarify the relationship between the percentage of lung receiving low radiation doses with concurrent chemotherapy and the occurrence of postoperative pulmonary complications in the treatment of esophageal carcinoma.

Hoon K Lee; Ara A Vaporciyan; James D Cox; Susan L Tucker; Joe B Putnam; Jaffer A Ajani; Zhongxing Liao; Stephen G Swisher; Jack A Roth; W. Roy Smythe; Garrett L Walsh; Radhe Mohan; Hui H Liu; Deidre Mooring; Ritsuko Komaki

2003-01-01

65

Neuropsychological examination detects post-operative complications in idiopathic normal pressure hydrocephalus (iNPH): report of two cases.  

PubMed

Subdural fluid collections (SFC) are characteristic complications of shunting for idiopathic normal pressure hydrocephalus (iNPH). This report presents two shunted iNPH patients with clinically silent postoperative SFC, detected after abnormal neuropsychological findings. These cases highlight the value of neuropsychological assessment in the routine postoperative assessment of iNPH. PMID:24579876

Liouta, Evangelia; Kalamatianos, Theodosis; Liakos, Faidon; Stranjalis, George

2015-04-01

66

Intraoperative and Postoperative Complications of Laser in situ Keratomileusis Flap Creation Using IntraLase Femtosecond Laser and Mechanical Microkeratomes  

PubMed Central

An essential step of laser in situ keratomileusis surgery is corneal flap creation, Femtosecond (FS)-assisted or mechanical microkeratome. Each type has rare intraoperative and postoperative complication rates. Several recent studies have identified risk factors and guidelines to help manage these complications. Fortunately, studies have shown no loss of best-corrected visual acuity (BCVA) after the management of intraoperative and postoperative complications in IntraLase FS and mechanical microkeratome. Refractive surgeons need to be aware of the types of complications that can occur, how to avoid them and how to manage them to ensure the best possible outcomes. PMID:20543937

Espandar, Ladan; Meyer, Jay

2010-01-01

67

Does preoperative scalp shaving result in fewer postoperative wound infections when compared with no scalp shaving? A systematic review.  

PubMed

Preoperative scalp shaving has been a well-established practice among neurosurgeons based on the belief that hair removal prevents postoperative infections. Apart from aiding in improved visualization of the incision line, ease of closure, and dressing application, there are concerns that the presence of hair at the surgical site may interfere with the surgical procedure. Preoperative scalp shaving is a controversial practice, and many neurosurgeons are moving toward not removing any hair or clipping minimal hair along the incision line rather than shaving the scalp. The following is a systematic review of articles related to preoperative scalp shaving before cranial surgeries and the implications for postoperative wound infections. Eighteen articles were identified as potentially relevant based on the search criteria. These articles were selected based on the inclusion and exclusion criteria to provide concise background information and an explanation of scalp-shaving practices in neurosurgery leading to the clinical question posed. An evidence table was compiled to organize the study data and identify key points. The review brings strong evidence that preoperative scalp shaving does not confer any benefit against postoperative wound infection and, paradoxically, may lead to higher rates of infection. Because hair removal neither contributes benefits to the surgery itself nor decreases the risk of wound infection but has considerable cosmetic value for the patient, many of the authors recommended that cranial surgeries should be done without hair shaving. PMID:22555352

Sebastian, Sherly

2012-06-01

68

Wound complications following pre-operative radiotherapy for soft tissue sarcoma  

Microsoft Academic Search

Aims: We analysed wound complications in 43 patients with soft tissue sarcoma who were treated with combined pre-operative radiotherapy and surgery. Methods: All patients received the same protocol of pre-operative radiotherapy at our institution. Results: Thirty-six (84%) patients developed acute skin toxicity following radiotherapy. After wide local excision, 15 patients required primary soft tissue reconstruction with vascularized muscle transfer and

T Kunisada; S. Y Ngan; G Powell; P. F. M Choong

2002-01-01

69

Deep Sternal Wound Complications: An Overview of Old and New Therapeutic Options  

PubMed Central

Deep sternal wound complications represent a significant problem in current open heart surgery and still pose a tremendous challenge to surgeons. Over the years, many treatment modalities have been proposed, but only few found their way into daily clinical practice of cardiothoracic surgeons. A gold standard has not been defined yet. This review was designed to give an overview of the preferred surgical strategies. PMID:25512698

Rupprecht, Leopold; Schmid, Christof

2013-01-01

70

Postoperative Ascites of Unknown Origin following Laparoscopic Appendicectomy: An Unusual Complication of Laparoscopic Surgery  

PubMed Central

Postoperative ascites is a very rare complication of laparoscopic surgery. Significant iatrogenic injuries to the bowel, the urinary tract, and the lymphatic system should be excluded promptly to avoid devastating results for the patient. In some cases, in spite of investigating patients extensively, no definitive causative factor for the accumulation of fluid can be identified. In such cases, idiopathic allergic or inflammatory reaction of the peritoneum may be responsible for the development of ascites. We present a case of ascites of an unknown origin in a young female patient following a laparoscopic appendicectomy. PMID:24822146

Feretis, M.; Boyd-Carson, H.; Karim, A.

2014-01-01

71

Prophylactic plastic surgery closure of neurosurgical scalp incisions reduces the incidence of wound complications in previously-operated patients treated with bevacizumab (Avastin®) and radiation.  

PubMed

Neurosurgical craniotomy, craniectomy, or other trans-galeal interventions are performed for a variety of indications, including the resection of benign or malignant tumors, hematoma evacuation, and for the management of intractable seizure disorders. Despite an overall low complication rate of intervention, wound healing complications such as dehiscence, surgical site infection, and cerebrospinal fluid leak are not uncommon. A retrospective review was performed of all patients who underwent scalp incision closure at a single institution by a single plastic surgeon between 2006 and 2013. Sixty patients (83 procedures) were included in the study. Fifty-seven patients (95.0 %) underwent previous craniotomy, craniectomy, or other trans-galeal procedure. Of the total 60 patients, 35 patients received preoperative radiation. Sixteen patients received bevacizumab prior to their index case, while 12 received bevacizumab postoperatively. Ten patients (16.7 %) required additional plastic surgical intervention for wound complications after their index plastic surgery procedure. Plastic surgery was consulted prophylactically in 34 patients (38 procedures). When plastic surgery was consulted prophylactically, 4 patients (11.8 %) required further wound revision. None of the 14 patients who underwent prophylactic plastic surgery closure for previous scalp incision, preoperative bevacizumab, and XRT administration required re-intervention. Plastic surgery closure of complex scalp incisions reduces the incidence of wound complications among patients who underwent previous neurosurgical intervention, XRT administration, and preoperative bevacizumab administration. This is particularly true when plastic surgery closure is performed "prophylactically." Further collaboration between the neurosurgical and plastic surgery teams is therefore warranted, particularly in the setting of these high-risk cases. PMID:24872117

Golas, Alyssa Reiffel; Boyko, Tatiana; Schwartz, Theodore H; Stieg, Philip E; Boockvar, John A; Spector, Jason A

2014-09-01

72

Do statins have a role in the promotion of postoperative wound healing in cardiac surgical patients?  

PubMed

Cardiac surgical patients often have associated comorbidities that can impede normal wound healing; however, statin therapy has the potential to improve this process through augmentation of the normal inflammatory response. Outcomes included a 30% earlier rate of wound epithelialization and an 80% greater wound-breaking strength combined with faster wound healing rates (13.0 days vs 18.7 days, p<0.0001). Inhibition of farnesyl pyrophosphate may hold a key role in the mediation of such advantageous effects. This systematic review suggests that there is sufficient evidence to warrant completion of a human trial to assess the effects of statins on wound healing. PMID:24980602

Fitzmaurice, Gerard J; McWilliams, Billy; Nölke, Lars; Redmond, J Mark; McGuinness, Jonathan G; O'Donnell, Mark E

2014-08-01

73

Perioperative and post-operative complications of transvaginal ultrasound-guided oocyte retrieval: prospective study of >1000 oocyte retrievals  

Microsoft Academic Search

BACKGROUND: Although transvaginal ultrasound-guided oocyte retrievals (OR) are performed routinely world- wide, there is very little systematic data about its complications. METHODS: We performed a prospective cohort study following the perioperative and post-operative complications of over 1058 ORs. Additionally, we assessed the pain experienced during the OR. RESULTS: A total of 1166 OR were performed during the study period, of

A. K. Ludwig; M. Glawatz; G. Griesinger; K. Diedrich; M. Ludwig

2006-01-01

74

Determinants of Malnutrition and Post-operative Complications in Hospitalized Surgical Patients  

PubMed Central

ABSTRACT The study aimed to determine the nutritional status (NS) of hospitalized surgical patients and investigate a possible association between NS and type of disease, type of surgery and post-operative complications. The gender, age, disease, surgery, complications, length of hospital stay, number of medications, laboratory test results, and energy intake of 388 hospitalized surgical patients were recorded. NS was determined by classical anthropometry. The inclusion criteria were: nutritional status assessment done within the first 24 hours of admission, age ?20 years, and complete medical history. Univariate and multiple Cox's regression analyses were employed to determine which variables were possible risk factors of malnutrition and complications. Malnutrition was more common in males (p=0.017), individuals aged 70 to 79 years (p=0.000), and individuals with neoplasms and digestive tract diseases (p=0.000). Malnourished individuals had longer hospital stays (p=0.013) and required more medications (p=0.001). The risk of malnutrition was associated with age and disease. Individuals aged 70 years or more had a two-fold increased risk of malnutrition (p=0.014; RR=2.207; 95% CI 1.169-4.165); those with neoplasms (p=0.008; RR=14.950; 95% CI 2.011-111.151) and those having digestive tract diseases (p=0.009; RR=14.826; 95% CI 1.939-113.362) had a 14-fold increased risk of malnutrition. Complications prevailed in older individuals (p=0.016), individuals with longer hospital stays (p=0.007), and individuals who died (p=0.002). The risk of complications was associated with age and BMI. In the present study, the risk of malnutrition was associated with age and type of disease; old age and low BMI may increase complications. PMID:25395903

de Aquino, José Luiz Braga

2014-01-01

75

Spinal Osteotomy Techniques in Management of Severe Pediatric Spinal Deformity and Analysis of Postoperative Complications.  

PubMed

Study Design. Retrospective analysis.Objective. To compare radiographic analysis and clinical outcomes of spinal osteotomy techniques, including Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR), and analyze the relationship between preoperative evaluation and postoperative complication incidence.Summary of Background Data. These three techniques have been extensively reported previously, while, few literatures are available on comparing these three techniques in management of severe pediatric spinal deformity.Methods. In all of these 34 pediatric patients, 14 were treated with SPO, 12 were treated with PSO and 8 were treated with VCR. All operations were performed by the senior author beteen 2005 and 2009 in our institute. Preoperative Halo-gravity traction was applied for 2 weeks in all patients, patients were evaluated by standing radiographs taken before and after traction and post operation and a prospectively collected database with ourcomes questionnaires. The postoperative complications and its relationship to preoperative assessment were also analyzed in this study.Results. All these 34 patient were diagnosed as severe pediatric spinal deformity (22 females and 12 males), with an average age of 11.97 years (range, 6-17 years) and an average follow-up of 66.38 months (range, 48-97 months). The mean preoperative major curve for each group was 103.43° in SPO group, 108.08° in PSO group and 117.00° in VCR group, and was corrected to 15.21°, 16.83° and 25.88°, respectively. The apical vertebral translation was corrected by 73.29% by SPO, 73.35% by PSO and 59.71% by VCR. The coronal balance were improved from 16.57 mm to 1.50 mm in SPO group, 17.33 mm to 3.83 mm in PSO group and 29.38 mm to 3.63 mm in VCR group. The mean correction of the kyphotic angle for single SPO was 19.00°, for those with two and three SPOs, the average correction was 34.40° and 47.5°, and 33.83° for the PSO group, 47.38° for VCR group. There were significant improvements in the overall clinical outcomes. The overall complication rate was 35.3%. Complication rate was high in patients with respiratory insufficiency and rigid spine.Conclusion. There was no significant difference in coronal correction among these three techniques, while, the average corrections in the sagittal plane were progressively higher from single SPO to two SPOs or PSO to three SPOs or VCR. Preoperative respiratory insufficiency and rigidity of the spinal deformity are associated with high complication rate. PMID:25494310

Xia, Lei; Li, Peng; Wang, Dan; Bao, Deming; Xu, Jinglei

2014-12-01

76

Study of two techniques for midline laparotomy fascial wound closure.  

PubMed

To study the results of two techniques, simple interrupted closure and continuous with intermittent Aberdeen knot technique for midline laparotomy fascial wound closure. A random selection of 200 midline laparotomy cases was done. In one group (group A) of 100 cases, midline fascial wound closure was done with continuous sutures with intermittent Aberdeen knot technique using Prolene No. 1 suture material. In the other group (group B) of 100 cases, closure was done with the technique of simple interrupted sutures with Prolene No.1 suture material. Comparison of both the techniques regarding preoperative status and postoperative complication such as incisional hernia, wound dehiscence, suture sinus formation, stitch granuloma, and chronic wound pain was done according to clinical examination and recorded in the pro forma prepared. In group A, postoperative complications were incisional hernia 3 %, wound dehiscence 4 %, and suture sinus formation 1 %. In group B, postoperative complication were incisional hernia 5 %, wound dehiscence 4 %, and suture sinus formation 1 %. All these complications were statistically insignificant, in both group comparisons. While the complication such as stitch granuloma 3 %, chronic wound pain 3 %, and wound infection 4 % in group A was significantly less than in group B where the complication of stitch granuloma was 12 %, chronic wound pain 13 %, and wound infection 13 % (P value 0.03, P value 0.018, and P value 0.048, respectively). Both the techniques, simple interrupted suture closure and continuous with intermittent Aberdeen knot closure for midline laparotomy fascial wounds, show a similar rate of postoperative complication such as incisional hernia, wound dehiscence, and suture sinus formation. But the continuous suturing with intermittent Aberdeen knot technique is a better option to prevent complications such as stitch granuloma, chronic wound pain, and wound infection, which are higher in the simple interrupted fascial wound closure technique. PMID:24891770

Gurjar, Vipul; Halvadia, B M; Bharaney, R P; Ajwani, Vicky; Shah, S M; Rai, Samir; Trivedi, Mitesh

2014-04-01

77

The effect of neoadjuvant chemoradiotherapy on airway colonization and postoperative respiratory complications in patients undergoing oesophagectomy for oesophageal cancer†  

PubMed Central

Respiratory complication is one of the important postoperative complications of oesophageal cancer. The aim of this study was to evaluate whether neoadjuvant chemotherapy before surgery is effective for postoperative respiratory complications. In this study, patients with oesophageal cancer were divided into two group: one with neoadjuvant therapy and the other without neoadjuvant therapy. Before surgery, they all underwent bronchoscopy and bronchoalveolar lavage. We evaluated respiratory complications and the effects of preoperative neoadjuvant therapy. Forty patients (M/F = 23/17 and mean age 61 years) were enrolled in this study. Twenty-two cases had cancer in the middle part and 18 in the lower part of the oesophagus. Significant correlation was observed between the number of positive micro-organism and difficulty in weaning and receiving neoadjuvant therapy. But no significant correlation was found between neoadjuvant therapy and respiratory complications. PMID:22392934

Bagheri, Reza; RajabiMashhadi, Mohammad Taghi; Ghazvini, Kiyarash; Asnaashari, Amir; Zahediyan, Ali; Sahebi, Mehdi Abasi

2012-01-01

78

The effect of neoadjuvant chemoradiotherapy on airway colonization and postoperative respiratory complications in patients undergoing oesophagectomy for oesophageal cancer.  

PubMed

Respiratory complication is one of the important postoperative complications of oesophageal cancer. The aim of this study was to evaluate whether neoadjuvant chemotherapy before surgery is effective for postoperative respiratory complications. In this study, patients with oesophageal cancer were divided into two group: one with neoadjuvant therapy and the other without neoadjuvant therapy. Before surgery, they all underwent bronchoscopy and bronchoalveolar lavage. We evaluated respiratory complications and the effects of preoperative neoadjuvant therapy. Forty patients (M/F = 23/17 and mean age 61 years) were enrolled in this study. Twenty-two cases had cancer in the middle part and 18 in the lower part of the oesophagus. Significant correlation was observed between the number of positive micro-organism and difficulty in weaning and receiving neoadjuvant therapy. But no significant correlation was found between neoadjuvant therapy and respiratory complications. PMID:22392934

Bagheri, Reza; RajabiMashhadi, Mohammad Taghi; Ghazvini, Kiyarash; Asnaashari, Amir; Zahediyan, Ali; Sahebi, Mehdi Abasi

2012-06-01

79

Anesthetic complications including two cases of postoperative respiratory depression in living liver donor surgery  

PubMed Central

Background: Living liver donation is becoming a more common means to treat patients with liver failure because of a shortage of cadaveric organs and tissues. There is a potential for morbidity and mortality, however, in patients who donate a portion of their liver. The purpose of this study is to identify anesthetic complications and morbidity resulting from living liver donor surgery. Patients and Methods: The anesthetic records of all patients who donated a segment of their liver between January 1997 and January 2006 at University of Minnesota Medical Center-Fairview were retrospectively reviewed. The surgical and anesthesia time, blood loss, hospitalization length, complications, morbidity, and mortality were recorded. Data were reported as absolute values, mean ± SD, or percentage. Significance (P < 0.05) was determined using Student's paired t tests. Results: Seventy-four patients (34 male, 40 female, mean age = 35.5 ± 9.8 years) donated a portion of their liver and were reviewed in the study. Fifty-seven patients (77%) donated the right hepatic lobe, while 17 (23%) donated a left hepatic segment. The average surgical time for all patients was 7.8 ± 1.5 hours, the anesthesia time was 9.0 ± 1.3 hours, and the blood loss was 423 ± 253 ml. Forty-six patients (62.2%) received autologous blood either from a cell saver or at the end of surgery following acute, normovolemic hemodilution, but none required an allogenic transfusion. Two patients were admitted to the intensive care unit due to respiratory depression. Both patients donated their right hepatic lobe. One required reintubation in the recovery room and remained intubated overnight. The other was extubated but required observation in the intensive care unit for a low respiratory rate. Twelve patients (16.2%) had complaints of nausea, and two reported nausea with vomiting during their hospital stay. There were four patients who developed complications related to positioning during the surgery: Two patients complained of numbness and tingling in the hands which resolved within two days, one patient reported a blister on the hand, and one patient complained of right elbow pain that resolved quickly. Postoperative hospitalization averaged 7.4 ± 1.5 days. There was no patient mortality. Discussion: Living liver donation can be performed with low morbidity. However, postoperative respiratory depression is a concern and is perhaps due to altered metabolism of administered narcotics and anesthetic agents. PMID:21897509

Beebe, David; Singh, Harpreet; Jochman, John; Luikart, Paul; Gruessner, Ranier; Gruessner, Angelica; Belani, Kumar

2011-01-01

80

Use of Electrocautery for Coagulation and Wound Complications in Caesarean Sections  

PubMed Central

Objective. To evaluate the safety of electrocautery for coagulation during Caesarean sections. Study Design. A randomized, controlled, clinical pilot study was performed at a university maternity hospital. After admission for delivery and decision to perform a C-section, volunteers were randomized to either the intervention group (use of electrocautery for coagulation) or nonintervention group. The women were examined at the time of postpartum discharge (day 3), at days 7 to 10, and again at days 30 to 40 for signs of infection, hematoma, seroma, or dehiscence. Data were analyzed using an intention-to-treat analysis, and risk ratios were calculated. Results. No significant differences were found between the two groups. Only 2.8% of patients in the intervention group developed surgical wound complications during hospitalization. However, 7 to 10 days following discharge, these rates reached 23.0% and 15.4% in the intervention and nonintervention groups, respectively (RR = 1.50, 95% CI = 0.84–2.60). Conclusion. Further studies should confirm whether the use of electrocautery for coagulation does not increase the risk of surgical wound complications in patients undergoing Caesarean sections. PMID:25143985

Moreira, Cristiane M.; Amaral, Eliana

2014-01-01

81

Does immediate tissue expander placement increase immediate postoperative complications in patients with breast cancer?  

PubMed

The objectives of this study were to evaluate 1) the rate of immediate breast reconstruction; 2) the frequency of immediate tissue expander placement; and 3) to compare perioperative outcomes in patients who underwent breast reconstruction after mastectomy for breast cancer with immediate tissue expander placement (TE) with those with no reconstruction (NR). Using the Nationwide Inpatient Sample database, we examined the clinical data of patients with breast cancer who underwent mastectomy with or without immediate TE from 2006 to 2010 in the United States. A total of 344,253 patients with breast cancer underwent mastectomy in this period in the United States. Of these patients, 31 per cent had immediate breast reconstruction. We only included patients with mastectomy and no reconstruction (NR: 237,825 patients) and patients who underwent only TE placement with no other reconstruction combination (TE: 61,178 patients) to this study. Patients in the TE group had a lower overall postoperative complication rate (2.6 vs 5.5%; P < 0.01) and lower in-hospital mortality rate (0.01 vs 0.09%; P < 0.01) compared with the NR group. Fifty-three per cent of patients in the NR group were discharged the day of surgery compared with 36 per cent of patients in the TE group. Using multivariate regression analyses and adjusting patient characteristics and comorbidities, patients in the TE group had a significantly lower overall complication rate (adjusted odds ratio [AOR], 0.6) and lower in-hospital mortality (AOR, 0.2) compared with the NR group. The rate of immediate reconstruction is 31 per cent. TE alone is the most common type of immediate reconstruction (57%). There is a lower complication rate for the patients who underwent immediate TE versus the no-reconstruction cohort. PMID:25642875

Masoomi, Hossein; Paydar, Keyianoosh Z; Evans, Gregory R D; Tan, Emily; Lane, Karen T; Wirth, Garrett A

2015-02-01

82

The Role of MicroRNAs in Diabetic Complications—Special Emphasis on Wound Healing  

PubMed Central

Overweight and obesity are major problems in today’s society, driving the prevalence of diabetes and its related complications. It is important to understand the molecular mechanisms underlying the chronic complications in diabetes in order to develop better therapeutic approaches for these conditions. Some of the most important complications include macrovascular abnormalities, e.g., heart disease and atherosclerosis, and microvascular abnormalities, e.g., retinopathy, nephropathy and neuropathy, in particular diabetic foot ulceration. The highly conserved endogenous small non-coding RNA molecules, the micro RNAs (miRNAs) have in recent years been found to be involved in a number of biological processes, including the pathogenesis of disease. Their main function is to regulate post-transcriptional gene expression by binding to their target messenger RNAs (mRNAs), leading to mRNA degradation, suppression of translation or even gene activation. These molecules are promising therapeutic targets and demonstrate great potential as diagnostic biomarkers for disease. This review aims to describe the most recent findings regarding the important roles of miRNAs in diabetes and its complications, with special attention given to the different phases of diabetic wound healing. PMID:25268390

Moura, João; Børsheim, Elisabet; Carvalho, Eugenia

2014-01-01

83

Risk Factors for the Development of Postoperative Complications After Bronchial Sleeve Resection for Malignancy: A Univariate and Multivariate Analysis  

Microsoft Academic Search

Background. This study was designed to identify risk factors responsible for postoperative complications after bronchoplastic procedures. Methods. Excluding sleeve pneumonectomies between January 1994 and December 2001, 108 patients underwent bronchoplastic procedures for bronchial malignancy. Prospectively documented data were age, gender, side, type of bronchial reconstruction, extended resection, his- tology, TNM stage, diseased lobe, and bronchial tumour occlusion. Cardiovascular (CV) risk

Peter H. Hollaus; Gerold Wilfing; Peter N. Wurnig; Nestor S. Pridun

2010-01-01

84

Characteristics of abdominal cavity drainage fluid in Chinese patients without postoperative complications after surgery for gastrointestinal or retroperitoneal tumors  

PubMed Central

Background Abdominal cavity drainage fluid can be used as an early diagnostic tool of postoperative complications, and observing its characteristics can help us to judge and handle postoperative complications. There is no accurate standard reference range on its characteristics after surgeries for gastrointestinal or retroperitoneal tumors. This research attempted to analyze its characteristics in Chinese patients without postoperative complications after surgery for gastrointestinal or retroperitoneal tumors, and to offer an experimental basis for establishing a reliable standard reference range for abdominal cavity drainage fluid used to detect postoperative complications. Methods This study enrolled 262 Chinese patients without postoperative complications after surgery for gastrointestinal or retroperitoneal tumors. Results All patients had a median age (range) of 55 (19–72) years, and 150 (57.3%) were men. There were 93 (35.5%), 115 (43.9%), and 54 (20.6%) patients who underwent surgery for upper gastrointestinal tumors, lower gastrointestinal tumors, and retroperitoneal tumors, respectively. The total amount, density, and pH of the abdominal cavity drainage fluid were 204 (0–6,195) mL, 1.032 (1.011–1.047) kg/m3, and pH 7.0 (5.0–7.5), respectively. The total numbers of cells and white blood cells were 1.3×1011 (5.5×108–6.2×1012)/L and 3.7×109 (1.0×107–5.0×1011)/L, respectively. The levels of sugar and protein were 3 (0–37) mmol/L and 39 (1–272) g/L. The total amount of abdominal cavity drainage fluid, the total number of cells, the total number of white blood cells, the number of multinucleated cells, the number of monocytes, and the levels of sugar were statistically significantly different between the three groups (P<0.05 for all). Conclusion This study described the characteristics of abdominal cavity drainage fluid in Chinese patients without postoperative complications after surgery for gastrointestinal or retroperitoneal tumors, and provided an experimental basis for establishing a reliable standard reference range for abdominal cavity drainage fluid for screening for postoperative complications.

Zhou, Jing; Pi, Hongying; Zheng, Yingying

2015-01-01

85

Vacuum-Assisted Closure of Postoperative Abdominal Wounds: A Prospective Study  

Microsoft Academic Search

Background  We aimed to study outcome in patients with an open abdomen in whom the abdominal vacuum-assisted closure system (V.A.C.® Therapy™) was used to provide temporary cover and achieve wound closure.\\u000a \\u000a \\u000a \\u000a Methods  All patients in whom V.A.C. Therapy was used to manage laparotomy wounds between February 2006 and May 2007 at a University\\u000a Teaching Hospital were followed up prospectively until successful completion

Sriram Subramonia; Sarah Pankhurst; Brian J. Rowlands; Dileep N. Lobo

2009-01-01

86

Risk factors for postoperative infectious complications following percutaneous nephrolithotomy: a prospective clinical study.  

PubMed

The aim of the study was to assess the preoperative and intraoperative potential risk factors for infectious complications after percutaneous nephrolithotomy (PCNL). A total of 303 patients who underwent PCNL for renal stones were included in the recent study. A detailed history including past renal surgery, nephrostomy insertion and recurrent urinary infection were obtained from all patients. Preoperative urine culture, renal pelvic urine culture and stone culture were obtained from all patients. The intraoperative data were prospectively noted. All patients were followed up postoperatively for signs of systemic inflammatory response syndrome (SIRS) and sepsis. In 83 (27.4 %) of the patients, SIRS was observed and of these patients 23 (7.6 %) were diagnosed as sepsis. Escherichia coli was the most common organism detected in cultures, followed by Pseudomonas aeruginosa, Enterococcus and Klebsiella spp. in all patients. By multivariate logistic regression analysis, presence of infection stone, stone burden and recurrent urinary tract infection were associated with both SIRS and sepsis development. Presence of infection stone, stone burden ?800 mm(2) and recurrent urinary tract infection can be identified as independent predictors for the development of SIRS and sepsis. PMID:25269441

Koras, Omer; Bozkurt, Ibrahim Halil; Yonguc, Tarik; Degirmenci, Tansu; Arslan, Burak; Gunlusoy, Bulent; Aydogdu, Ozgu; Minareci, Suleyman

2015-02-01

87

Influence of injection site for low-dose heparin on wound complication rates after inguinal hernia repair.  

PubMed Central

A high incidence of complications related to bleeding was observed after open prosthetic inguinal hernia repair. The site of injection of low-dose heparin into the abdominal wall was thought to be a possible causal factor for these complications. The wound complication rate after repair of primary unilateral inguinal hernias was recorded for 51 patients who had been given abdominal wall injections of heparin. Subsequently the injection site was changed to the upper limb in a further 63 patients and the incidence of wound complications recorded. A significantly higher incidence of haematomas and seromas was found in the abdominal wall injection group (39.2% vs 17.5%, P = 0.01). The role of low-dose heparin prophylaxis in inguinal hernia repair is discussed. We conclude that in those patients receiving heparin prophylaxis the injections should be given at a site remote from the operative area. PMID:9579130

Wright, D. M.; O'Dwyer, P. J.; Paterson, C. R.

1998-01-01

88

[Transdrainage closed ultrasonic cleansing of the abdominal cavity in the prevention and treatment of infectious complications in abdominal gunshot wounds].  

PubMed

Under analysis were results of treatment of 112 wounded with gunshot injuries of the abdomen. The flowing-irrigating aspiration dialysis followed by the closed transdrainage ultrasonic sanitation in combination with a medicinal composition (dioxidine, gentamycine, tripsin) and simultaneous intramuscular injection of solcoseryl and thymalin were used for prophylactics and treatment of infectious complications in the abdominal cavity and in the wound of the abdominal wall. The method of treatment was found to result in less amount of pyo-inflammatory complications (from 34.8 to 2.6%), shorter terms of cleansing the wound from pyo-necrotic formations and liquidation of the perifocal inflammatory reaction, shorter duration of the stationary treatment. PMID:10368889

Ibishov, K G

1999-01-01

89

Effects of Surgical Wound Infiltration with Bupivacaine on Postoperative Analgesia in Cats Undergoing Bilateral Mastectomy  

PubMed Central

The analgesic effect of wound infiltration with bupivacaine was evaluated in cats undergoing bilateral mastectomy. Twenty-one female cats with mammary gland tumors were anesthetized with propofol and oxygen-isoflurane anesthesia following premedication with atropine. In the trial group (Group I; n=11), 30 ml of saline containing 2 mg/kg of bupivacaine was infiltrated topically into the surgical wound right after removal of the mammary glands, whereas only saline solution was infiltrated in the control group (Group II; n=10). At the same time, carprofen (4 mg/kg) was also administered subcutaneously in both groups. Behavioral signs of pain were monitored during the recovery period after general anesthesia. In order to examine the behavioral changes associated with acute pain, a questionnaire was prepared and given to the owners to be completed 4 hr and then 10 hr after the operation. According to the owners’ anwers to the questionnaire, a pain score was specified using a “numerical rating scale” for each cat. Although some cats showed mild to moderate pain, the pain score recorded at 4 hr after the operation was significantly lower in Group I (P<0.001). No significant difference was found at 10 hr after the operation between the groups. The incidence of vocalization, aggression and convulsion within 2 hr after the operation was also lower in Group I. In conclusion, wound infiltration with bupivacaine before incisional closure provided reliable analgesia at least 4 hr after bilateral radical mastectomy in cats. PMID:25649941

YILMAZ, Özge Turna; TOYDEMIR, T. Seval Fatma; KIR?AN, ?smail; DOKUZEYLUL, Banu; GUNAY, Zeynep; KARACAM, Esra

2014-01-01

90

Regional anesthesia in pediatric surgery: complications and postoperative comfort level in 174 children.  

PubMed

Postoperative pain control (PPC) in children is a difficult management problem. Systemic narcotics often result in respiratory depression, while nonnarcotic analgesics are associated with inconsistent PPC. This report reviews a 29-month (January 1989 through July 1991) experience with 174 children (aged < 18 years) who received regional PPC through indwelling catheters. There were 105 males and 69 females. Patient age ranged from 1 day to 17 years 10 months (mean age, 97 months). All catheters were placed using introduction needles ranging from 24 to 16 gauge. Agents were delivered as either continuous infusion (151 patients, 87%) or bolus injections (23 patients, 13%). Analgesics were age- and weight-determined dosages of bupivacaine with or without narcotic supplementation. All patients had surgical procedures except two who had catheters placed for pain control after trauma and one who had a catheter for intractable abdominal pain of unknown etiology. Twenty-five (15%) children had thoracic incisions, 76 (43%) abdominal, 16 (9%) flank, and 54 (31%) extremity. Catheter placement included 40 thoracic epidurals (23%), 100 lumbar (57%), 27 caudal (16%), and 7 pleural (4%). Catheters were utilized for a duration of 0.5 to 8 days (mean, 2.1 +/- 1.2 days). One hundred forty-four children required no additional pain medications (83%). Thirty (17%) patients required supplemental medications. Acetaminophen was used in 6 (3%), acetaminophen with codeine in 4(2%), morphine in 18 (10%), and Percocet in 1(1%). Minor complications occurred 21 times in 16 children (9%).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8483070

Pietropaoli, J A; Keller, M S; Smail, D F; Abajian, J C; Kreutz, J M; Vane, D W

1993-04-01

91

Analysis of complications of permanent transvenous implantable cardiac pacemaker related to operative and postoperative management in 717 consecutive patients.  

PubMed

A retrospective study on complications especially related to operative or postoperative management was carried out in 1000 pacemaker implantations in 717 patients between September, 1972 and December, 1986. In 33 of our series (4.8%), 24 pacing failure occurred within two weeks of implantation. Flange-type leads had the highest incidence of complications. Wedging the electrode close to the longitudinal axis of the heart was found to be the best placing, assuming that the tip of the electrode and the section immediately adjacent were pointing downward. There were 6 cases of diaphragmatic pacing which could not be corrected through programming. No relation with the position of the electrode could be found. We recommend using bipolar pacing to lower the incidence of diaphragmatic pacing. We also had 9 patients with lead fractures (1.3%); these included 3 cases with silicone insulation breaks and 6 cases with wire fractures which occurred closely proximal to the area where the lead was fixed to the vessels. No relationship between the ratio of lead fractures and their brand was found. Five patients developed infections, all of them late postoperatively, over a period of 8 months to 5 years postop. Of these, there were 3 cases with postoperative prolonged hematoma at the pocket site, and 4 cases which had required lead repositioning because of pacing failure. The incidence of infection in our series was low when compared to previous reports, probably due to local use of one gram of Kanamycin during the operation and active chemotherapy performed short term postoperatively. To manage infection of the skin pocket, the pacemaker was removed and a new pacemaker was implanted in the opposite side. There was 7 early postoperative deaths. One of them due to cardiac tamponade caused by perforation of the cardiac wall by temporary electrode lead. The resustation was unsuccessful. PMID:2086564

Matsuura, Y; Yamashina, H; Higo, M; Fujii, T

1990-12-01

92

Syringobulbia Caused by Delayed Postoperative Tethering of the Cervical Spinal Cord – Delayed Complication of Foramen Magnum Decompression for Chiari Malformation  

Microsoft Academic Search

Summary  ?Postoperative tethering of the high cervical spinal cord is a rare cause of neurological deterioration after foramen magnum\\u000a decompression (FMD) with duraplasty for Chiari type I malformation. A review of the literature revealed that only 5 cases\\u000a have been reported. This entity is not widely known to occur as a complication of the common surgical procedure for Chiari\\u000a type I

Y. Takahashi; Y. Tajima; S. Ueno; T. Tokutomi; M. Shigemori

1999-01-01

93

Intermediate acting non-depolarizing neuromuscular blocking agents and risk of postoperative respiratory complications: prospective propensity score matched cohort study  

PubMed Central

Objective To determine whether use of intermediate acting neuromuscular blocking agents during general anesthesia increases the incidence of postoperative respiratory complications. Design Prospective, propensity score matched cohort study. Setting General teaching hospital in Boston, Massachusetts, United States, 2006-10. Participants 18?579 surgical patients who received intermediate acting neuromuscular blocking agents during surgery were matched by propensity score to 18?579 reference patients who did not receive such agents. Main outcome measures The main outcome measures were oxygen desaturation after extubation (hemoglobin oxygen saturation <90% with a decrease in oxygen saturation after extubation of >3%) and reintubations requiring unplanned admission to an intensive care unit within seven days of surgery. We also evaluated effects on these outcome variables of qualitative monitoring of neuromuscular transmission (train-of-four ratio) and reversal of neuromuscular blockade with neostigmine to prevent residual postoperative neuromuscular blockade. Results The use of intermediate acting neuromuscular blocking agents was associated with an increased risk of postoperative desaturation less than 90% after extubation (odds ratio 1.36, 95% confidence interval 1.23 to 1.51) and reintubation requiring unplanned admission to an intensive care unit (1.40, 1.09 to 1.80). Qualitative monitoring of neuromuscular transmission did not decrease this risk and neostigmine reversal increased the risk of postoperative desaturation to values less than 90% (1.32, 1.20 to 1.46) and reintubation (1.76, 1.38 to 2.26). Conclusion The use of intermediate acting neuromuscular blocking agents during anesthesia was associated with an increased risk of clinically meaningful respiratory complications. Our data suggest that the strategies used in our trial to prevent residual postoperative neuromuscular blockade should be revisited. PMID:23077290

2012-01-01

94

Morphine Spinal Block Anesthesia in Patients Who Undergo an Open Hemorrhoidectomy: A Prospective Analysis of Pain Control and Postoperative Complications  

PubMed Central

Purpose This study evaluated the use of adding morphine to bupivacaine in spinal anesthesia for pain control in patients who underwent an open hemorrhoidectomy. Methods Forty patients were prospectively selected for an open hemorrhoidectomy at the same institution and were randomized into two groups of 20 patients each: group 1 had a spinal with 7 mg of heavy bupivacaine associated with 80 µg of morphine (0.2 mg/mL). Group 2 had a spinal with 7 mg of heavy bupivacaine associated with distilled water, achieving the same volume of spinal infusion as that of group 1. Both groups were prescribed the same pain control medicine during the postoperative period. Pain scores were evaluated at the anesthetic recovery room and at 3, 6, 12, and 24 hours after surgery. Postoperative complications, including pruritus, nausea, headaches, and urinary retention, were also recorded. Results There were no anthropometric statistical differences between the two groups. Pain in the anesthetic recovery room and 3 hours after surgery was similar for both groups. However, pain was better controlled in group 1 at 6 and 12 hours after surgery. Although pain was better controlled for group 1 after 24 hours of surgery, the difference between the groups didn't achieved statistical significance. Complications were more common in group 1. Six patients (6/20) presented coetaneous pruritus and 3 with (3/20) urinary retention. Conclusion A hemorrhoidectomy under a spinal with morphine provides better pain control between 6 and 12 hours after surgery. However, postoperative complications, including cutaneous pruritus (30%) and urinary retention (15%), should be considered as a negative side of this procedure. PMID:24999465

Moreira, José PT; Isaac, Raniere R; Alves-Neto, Onofre; Moreira, Thiago AC; Vieira, Tiago HM; Brasil, Andressa MS

2014-01-01

95

Precaution against postoperative venous complications after major hepatectomy using the pedicled omental transposition flap: Report of two cases  

PubMed Central

INTRODUCTION Vascular complications following hepato-pancreatic biliary surgery can be devastating, and therefore precaution of them must be critical. We report two cases in which the pedicled omental transposition flap might be effective to avoid postoperative venous complications following major hepatectomy. PRESENTATION OF CASE Case 1 is a 80-year-old male who required to perform re-laparotomy at postoperative day 1 following major hepatectomy due to acute portal venous thrombosis (PVT). In the second surgery, the main trunk of PV was occluded by thrombus resulted from its redundancy and kinking. PV was resected with an adequate length and reconstructed. The omental flap was placed between PV and inferior vena cava (IVC) to fill in the dead space, resulting in favorable intrahepatic portal blood flow. Case 2 is a 64-year-old male who underwent left trisectionectomy because of giant hepatocellular carcinoma located close to the trunk of right hepatic vein (RHV) and IVC. After removal of the specimens, the dead space developed between the RHV and IVC. In order to prevent outflow block caused by kinking of the RHV, the omental flap was placed between the RHV and IVC, and the right triangle ligament of the liver was fixed to the diaphragm. RHV patency was confirmed by postoperative imaging. DISCUSSION The omental flap is a simple procedure and useful to fill the dead space developed in the area surrounding major vessels. CONCLUSIONS We experienced two cases in which vascular complications might be avoided by filling the dead space surrounding major vessels using the omental flap. PMID:25194595

Narita, Masato; Matsusue, Ryo; Hata, Hiroaki; Yamaguchi, Takashi; Otani, Tetsushi; Ikai, Iwao

2014-01-01

96

Health-related quality of life after cardiac surgery – the effects of age, preoperative conditions and postoperative complications  

PubMed Central

Background Factors influencing the postoperative health-related quality of life (HRQOL) after cardiac surgery have not been well described yet, mainly in the older people. The study’s aim was to explore differences in clinical conditions and HRQOL of patients before and after cardiac surgery taking into account the influence of age and to describe factors influencing changes of HRQOL in the postoperative period. Methods This was a prospective consecutive observational study with two measurements using the SF-36 questionnaire before surgery and 1 year after surgery. It considered main clinical characteristics of participants prior to surgery as well as postoperative complications. Results At baseline assessment the study considered 310 patients, predominantly male (69%). Mean age was 65 (SD 10.4) years and 101 patients (33%), who were older than 70, constituted the older group. This older group showed greater comorbidity, higher cardiac operative risk and lower HRQOL in the preoperative period as well as a higher prevalence of postoperative complications than the younger group. Thirty-day mortality was 1.4% in the younger group and 6.9% in the older group (p < 0.001). One year mortality was 3.3% in the younger group and 10.9% in the older group (p < 0.001). There was a significant improvement in all 8 health domains of the SF-36 questionnaire (p < 0.001) in the overall sample. There was no significant difference in change in a majority of HRQOL domains between the younger and the older group (p > 0.05). Logistic multivariate analysis identified a higher values of preoperative PCS (Physical component summary) scores (OR 1.03, CI 1.00 – 1.05, p = 0.0187) and MCS (Mental component summary) scores (OR 1.02, CI 0.997 – 1.00, p = 0.0846) as the only risk factors for potential non-improvement of HRQOL after cardiac surgery after correction for age, gender and type of surgery. Conclusions Older patients with higher operative risk have lower preoperative HRQOL but show a similar improvement in a majority of HRQOL domains after cardiac surgery as compared with younger patients. The multivariate analysis has shown the higher preoperative HRQOL status as a only significant factor of potential non-improvement of postoperative HRQOL. PMID:24618329

2014-01-01

97

Postoperative complications do not influence the pattern of early lung function recovery after lung resection for lung cancer in patients at risk  

PubMed Central

Background The pattern and factors influencing the lung function recovery in the first postoperative days are still not fully elucidated, especially in patients at increased risk. Methods Prospective study on 60 patients at increased risk, who underwent a lung resection for primary lung cancer. Inclusion criteria: complete resection and one or more known risk factors in form of COPD, cardiovascular disorders, advanced age or other comorbidities. Previous myocardial infarction, myocardial revascularization or stenting, cardiac rhythm disorders, arterial hypertension and myocardiopathy determined the increased cardiac risk. The severity of COPD was graded according to GOLD criteria. The trend of the postoperative lung function recovery was assessed by performing spirometry with a portable spirometer. Results Cardiac comorbidity existed in 55%, mild and moderate COPD in 20% and 35% of patients respectively. Measured values of FVC% and FEV1% on postoperative days one, three and seven, showed continuous improvement, with significant difference between the days of measurement, especially between days three and seven. There was no difference in the trend of the lung function recovery between patients with and without postoperative complications. Whilst pO2 was decreasing during the first three days in a roughly parallel fashion in patients with respiratory, surgical complications and in patients without complications, a slight hypercapnia registered on the first postoperative day was gradually abolished in all groups except in patients with cardiac complications. Conclusion Extent of the lung resection and postoperative complications do not significantly influence the trend of the lung function recovery after lung resection for lung cancer. PMID:24884793

2014-01-01

98

Pre-operative granulocyte/lymphocyte ratio as a predictive marker of post-operative complications in patients with colorectal cancer  

PubMed Central

The aim of the present study was to assess the clinical relevance of the pre-operative granulocyte/lymphocyte (G/L) ratio as a predictive marker of post-operative complications in patients with colorectal cancer. In total, 85 patients (59 males and 26 females; mean age, 68.9 years) underwent surgery for colorectal cancer at the Department of Surgery, Ibraki Medical Center, Tokyo Medical University (Ami, Japan), and were divided into post-operative complication and non-complication groups. Clinical data, including age, gender, body mass index, tumor localization, tumor pathological type, cancer staging, surgery time, volume of surgical bleeding, pre-operative G/L ratio and further pre-operative laboratory data, including levels of albumin and C-reactive protein, Glasgow Prognostic Score, white blood cell count and levels of hemoglobin, creatine kinase, lactate dehydrogenase, carcinoembryonic antigen and carbohydrate antigen 19-9 were analyzed between these groups. The total post-operative complication rate was 18.8%. On univariate analysis, the amount of surgical bleeding and the pre-operative G/L ratio were significantly higher in the complication group than in the non-complication group (299.8±361.7 vs. 155.6±268.6 ml, P<0.05; and 6.73±10.38 vs. 3.49±2.78, P<0.05, respectively). Multivariate logistic regression analysis for the risk factors of post-operative complications, determined using univariate analysis, demonstrated that the amount of surgical bleeding and the pre-operative G/L ratio were independent risk factors of post-operative complications in patients with colorectal cancer. In conclusion, the G/L ratio may be a clinically relevant pre-operative predictive marker for post-operative complications. PMID:25436003

SHIMAZAKI, JIRO; TABUCHI, TAKANOBU; NAKACHI, TAKESHI; MOTOHASHI, GYO; NISHIDA, KIYOTAKA; UBUKATA, HIDEYUKI; TABUCHI, TAKAFUMI

2015-01-01

99

Pre-operative granulocyte/lymphocyte ratio as a predictive marker of post-operative complications in patients with colorectal cancer.  

PubMed

The aim of the present study was to assess the clinical relevance of the pre-operative granulocyte/lymphocyte (G/L) ratio as a predictive marker of post-operative complications in patients with colorectal cancer. In total, 85 patients (59 males and 26 females; mean age, 68.9 years) underwent surgery for colorectal cancer at the Department of Surgery, Ibraki Medical Center, Tokyo Medical University (Ami, Japan), and were divided into post-operative complication and non-complication groups. Clinical data, including age, gender, body mass index, tumor localization, tumor pathological type, cancer staging, surgery time, volume of surgical bleeding, pre-operative G/L ratio and further pre-operative laboratory data, including levels of albumin and C-reactive protein, Glasgow Prognostic Score, white blood cell count and levels of hemoglobin, creatine kinase, lactate dehydrogenase, carcinoembryonic antigen and carbohydrate antigen 19-9 were analyzed between these groups. The total post-operative complication rate was 18.8%. On univariate analysis, the amount of surgical bleeding and the pre-operative G/L ratio were significantly higher in the complication group than in the non-complication group (299.8±361.7 vs. 155.6±268.6 ml, P<0.05; and 6.73±10.38 vs. 3.49±2.78, P<0.05, respectively). Multivariate logistic regression analysis for the risk factors of post-operative complications, determined using univariate analysis, demonstrated that the amount of surgical bleeding and the pre-operative G/L ratio were independent risk factors of post-operative complications in patients with colorectal cancer. In conclusion, the G/L ratio may be a clinically relevant pre-operative predictive marker for post-operative complications. PMID:25436003

Shimazaki, Jiro; Tabuchi, Takanobu; Nakachi, Takeshi; Motohashi, Gyo; Nishida, Kiyotaka; Ubukata, Hideyuki; Tabuchi, Takafumi

2015-01-01

100

Is the Neutrophil-to-Lymphocyte Ratio more correlated than C-reactive protein with postoperative complications after major abdominal surgery?  

PubMed Central

Background. The Neutrophil-to-Lymphocyte Ratio (NLR) is an inflammatory marker that has proven usefulness for predicting late complications. Whether it is associated with immediate postoperative complications after abdominal surgery is not known. In this study, we attempted to correlate the NLR and the C-reactive protein (CRP) with postoperative complications rate. Methods. We performed a post-hoc analysis of previously collected data concerning 82 consecutive patients (median age: 62 years, range: 27–80, female/male 32/50) undergoing major abdominal surgeries. For each patient, we recorded preoperative characteristics, the NLR and CRP values, and postoperative complications (between D + 8 and D + 30) such as infections (N = 29), cardiovascular complications (N = 12) and other complications (N = 28). We performed uni- and multivariate analyses using logistic/linear regression models. Results. Patients with complications did not present a higher preoperative NLR than those without, but a higher ratio at D + 7 (10.73 ± 9.86 vs. 4.73 ± 3.38 without complication) (P < 0.001). In the univariate analysis, the NLR at D + 7 was associated with postoperative complications (P < 0.001). At D + 7, in the multivariate analysis, an increased NLR was associated with more complications (P < 0.001), whereas none of the other factors, including CRP, showed any correlation. Conclusion. Postoperative NLR at day 7 after major abdominal surgery is associated with complications during the first postsurgical month, in contrast with the CRP level. The NLR is a simple and interesting parameter in the perioperative period. PMID:25653901

Dinant, Valérie; De Kock, Marc

2015-01-01

101

[Reduction of the recurrences and postoperative complications in surgical treatment of hepatic echinococcosis].  

PubMed

Results of examination and treatment of 326 patients, suffering hepatic echinococcosis, in whom 449 surgical interventions were performed, were analyzed. In 123 of them the disease recurrence was diagnosed, and laparoscopic, laparotomy and puncture interventions were applied. Conduction of active screening examination of population in the regions, endemic for echinococcosis, application of effective intraoperative methods for prophylaxis of abdominal dissemination of invasive material, usage of antiparasitic chemical and thermal processing of cystic contents and its walls, left after echinococcectomy performance, postoperative prophylactic application of antiparasitic medicinal therapy have had permitted to lower the hepatic echinococcosis recurrence rate (down to 1.3% in last 5 yrs). PMID:24923114

Chetverikov, S G; Akhmad, Z M

2014-02-01

102

[Postoperative spine].  

PubMed

Approximately 15-30?% of surgical procedures involving the lumbar spine are associated with complications that require further diagnostic work-up. The choice of imaging modality for postoperative complications depends on the extent, pattern and temporal evolution of the postoperative neurological signs and symptoms as well as on the preoperative clinical status, the surgical procedure itself and the underlying pathology. The interpretation of imaging findings, in particular the distinction between postoperative complications and normally expected nonspecific postoperative imaging alterations can be challenging and requires the integration of clinical neurological information and the results of laboratory tests. The combination of different imaging techniques might help in cases of equivocal imaging results. PMID:25398572

Schlaeger, R; Lieb, J M; Shariat, K; Ahlhelm, F J

2014-11-01

103

Obstructive Sleep Apnea and Postoperative Complications in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Need for Preventive Strategies  

PubMed Central

Background: Obstructive sleep apnea (OSA) is very frequent and often unrecognized in surgical patients. OSA is associated with perioperative complications. We evaluated the effects of OSA on postoperative complications and hospital outcomes in patients undergoing coronary artery bypass graft (CABG) surgery. Methods: Candidates of elective CABG were evaluated by the Berlin questionnaire for OSA. After surgery, patients were assessed for postoperative complications, re-admission to the Intensive Care Unit (ICU), duration of intubation, re-intubation, days spent in the ICU and the hospital. Results: We studied 61 patients who underwent CABG from which 25 (40.9%) patients had OSA. Patients with OSA had higher body mass index (29.5 ± 3.9 vs. 26.0 ± 3.7 kg/m2, P = 0.003) and higher frequency of hypertension (68.0% vs. 30.5%, P = 0.003), dyslipidemia (36.0% vs. 5.5%, P = 0.004), and pulmonary disease (16.0 vs. 2.7%, P = 0.08). Regarding the surgical outcomes, OSA patients had longer intubation duration (0.75 ± 0.60 vs. 0.41 ± 0.56 days, P = 0.03). Conclusions: Obstructive sleep apnea is frequent, but unrecognized among patients undergoing CABG. In these patients, OSA is associated with prolonged intubation duration. Preventing these problems may be possible by early diagnosis and management of OSA in cardiac surgery patients. Further studies with larger sample of patients and longer follow-ups are required in this regard.

Amra, Babak; Niknam, Nasim; Sadeghi, Mohsen Mir Mohammad; Rabbani, Majid; Fietze, Ingo; Penzel, Thomas

2014-01-01

104

Impact of preoperative patient education on prevention of postoperative complications after major visceral surgery: study protocol for a randomized controlled trial (PEDUCAT trial)  

PubMed Central

Background In line with the growing number of surgical procedures being performed worldwide, postoperative complications are also increasing proportionately. Prevention of these postoperative complications is a high medical priority. Preoperative education of patients, including provision of preparatory information about the correct behavior after surgery, could improve the postoperative outcome, but the evidence for this is inconclusive. The aim of the PEDUCAT trial is to evaluate the feasibility and the impact of preoperative patient education on postoperative morbidity, mortality and quality of life in patients scheduled for elective major visceral surgery. Methods/design PEDUCAT is designed as a cluster-randomized controlled pilot study. The experimental group will visit a standardized preoperative seminar to learn how best to behave after surgery in addition to being given a standard information brochure, whereas the control group will only receive the information brochure. Outcome measures such as postoperative morbidity, postoperative pain, postoperative anxiety and depression, patient satisfaction, quality of life, length of hospital stay and postoperative mortality will be evaluated. Statistical analysis will be based on the intention-to-treat population. Analysis of covariance will be applied for the intervention group comparison, adjusting for age, center and quality of life before surgery. This is a pilot study to show the feasibility of the concept. Nevertheless, the planned sample size of n = 204 is large enough to show an effect with power of 90% and a significance level of 5%. Trial registration German Clinical Trial Register number: DRKS00004226. PMID:23978275

2013-01-01

105

Value of MR cholangiography in the evaluation of postoperative biliary complications following orthotopic liver transplantation  

Microsoft Academic Search

.   The aim of this study was to describe the spectrum of abnormal biliary findings as seen with magnetic resonance cholangiography\\u000a (MRC) in symptomatic patients after orthotopic liver transplantation (OLT). In our study we included 12 consecutive patients\\u000a post-OLT who presented with clinical and\\/or biochemical suspicion of biliary complications. In all patients MRC was performed\\u000a on a 1.0-T whole-body magnet

V. Meersschaut; K. J. Mortelé; R. Troisi; H. Van Vlierberghe; M. De Vos; L. Defreyne; B. de Hemptinne; M. Kunnen

2000-01-01

106

Lung ultrasonography and pediatric cardiac surgery: first experience with a new tool for postoperative lung complications.  

PubMed

Lung ultrasonography is a diagnostic tool increasingly used in critical care. Few data are available for the pediatric population. We describe our experience with lung ultrasonography for 5 pediatric patients with common post-cardiac surgery lung complications (pleural effusion, pneumothorax, atelectasis, pneumonia). Ultrasonography was useful also for lung recruitment. Such data were confirmed by chest radiographs or by computed tomography, or both. Lung ultrasonography can be considered as a useful, real-time, bedside tool to detect specific lung diseases, reliably implementing radiographic images and potentially decreasing the total number of radiographs in critically ill children with congenital heart diseases. PMID:24694455

Vitale, Vincenzo; Ricci, Zaccaria; Cogo, Paola

2014-04-01

107

Post-operative brachial plexus neuropraxia: A less recognised complication of combined plastic and laparoscopic surgeries.  

PubMed

This presentation is to increase awareness of the potential for brachial plexus injury during prolonged combined plastic surgery procedures. A case of brachial plexus neuropraxia in a 26-year-old obese patient following a prolonged combined plastic surgery procedure was encountered. Nerve palsy due to faulty positioning on the operating table is commonly seen over the elbow and popliteal fossa. However, injury to the brachial plexus has been a recently reported phenomenon due to the increasing number of laparoscopic and robotic procedures. Brachial plexus injury needs to be recognised as a potential complication of prolonged combined plastic surgery. Preventive measures are discussed. PMID:25593443

Thomas, Jimmy

2014-01-01

108

Post-operative brachial plexus neuropraxia: A less recognised complication of combined plastic and laparoscopic surgeries  

PubMed Central

This presentation is to increase awareness of the potential for brachial plexus injury during prolonged combined plastic surgery procedures. A case of brachial plexus neuropraxia in a 26-year-old obese patient following a prolonged combined plastic surgery procedure was encountered. Nerve palsy due to faulty positioning on the operating table is commonly seen over the elbow and popliteal fossa. However, injury to the brachial plexus has been a recently reported phenomenon due to the increasing number of laparoscopic and robotic procedures. Brachial plexus injury needs to be recognised as a potential complication of prolonged combined plastic surgery. Preventive measures are discussed. PMID:25593443

Thomas, Jimmy

2014-01-01

109

Aorta-Left Renal Vein Fistula Complicating an Aortic Aneurysm: Preoperative and Postoperative Multislice CT Findings  

SciTech Connect

Fistulas complicating an abdominal aortic aneurysm (AAA) are rare, and fistulas involving the left renal vein are particularly uncommon. We highlight here a fistula between an infrarenal aortic aneurysm and a retroaortic left renal vein, revealed by left flank pain associated with hematuria and acute renal failure. The multislice CT angiography performed in this 68-year-old patient revealed communication and equal enhancement between the aorta and the left gonadic vein, suggesting the presence of a fistula. The three-dimensional VRT reconstructions presented in this case were of great value in the preoperative planning, enabling immediate visualization of this unusual feature. Alternative diagnoses to consider when encountering this clinical presentation are reviewed.

Barrier, Pierre, E-mail: p.barrier@gmail.com; Otal, Philippe [Hopital de Rangueil CHU de Toulouse, Department of Radiology (France); Garcia, Olivier; Vahdat, Olivier; Domenech, Brice [Clinique Pasteur, Department of Radiology (France); Lannareix, Valerie; Joffre, Francis; Rousseau, Herve [Hopital de Rangueil CHU de Toulouse, Department of Radiology (France)

2007-06-15

110

Wound healing complications and the use of mammalian target of rapamycin inhibitors in kidney transplantation: a critical review of the literature.  

PubMed

Surgical complications, including events such as lymphocele and urological complications that affect wound healing, are reported with an incidence of 15% to 32% after kidney transplantation. The experience of the surgeon and comorbidities play an important role in determining the risk of such complications occurring. Since the introduction of the inosine 5'-monophosphate dehydrogenase inhibitors (mycophenolate mofetil) to the immunosuppressive armamentarium, replacing the antimetabolite prodrug azathioprine, reports have associated certain forms of wound healing complications (wound dehiscence, impaired healing, lymphocele, and incisional hernia) with the use of these agents. When mammalian target of rapamycin (mTOR) inhibitors (sirolimus, everolimus) became available, these findings were observed increasingly, particularly in direct comparisons with inosine 5'-monophosphate dehydrogenase inhibitors. The purpose of this article was to review the reported incidence of wound healing complications from randomized clinical trials that investigated the use of sirolimus- and everolimus-based treatment regimens in de novo kidney transplantation and the information available from the U.S. Food and Drug Administration database. The clinical trials included were primarily identified using biomedical literature database searches, with additional studies added at the authors' discretion. This review summarizes these studies to consider whether modern mTOR inhibitor-based immunosuppressive regimens exert and affect wound healing after kidney transplantation. PMID:22941182

Nashan, Björn; Citterio, Franco

2012-09-27

111

Incidence and risk factors for post-operative complications after scoliosis surgery in patients with Duchenne muscular dystrophy : a comparison with other neuromuscular conditions.  

PubMed

We report the incidence of and risk factors for complications after scoliosis surgery in patients with Duchenne muscular dystrophy (DMD) and compare them with those of other neuromuscular conditions. We identified 110 (64 males, 46 females) consecutive patients with a neuromuscular disorder who underwent correction of the scoliosis at a mean age of 14 years (7 to 19) and had a minimum two-year follow-up. We recorded demographic and peri-operative data, including complications and re-operations. There were 60 patients with cerebral palsy (54.5%) and 26 with DMD (23.6%). The overall complication rate was 22% (24 patients), the most common of which were deep wound infection (9, 8.1%), gastrointestinal complications (5, 4.5%) and hepatotoxicity (4, 3.6%). The complication rate was higher in patients with DMD (10/26, 38.5%) than in those with other neuromuscular conditions (14/84, 16.7% (p = 0.019). All hepatotoxicity occurred in patients with DMD (p = 0.003), who also had an increased rate of deep wound infection (19% vs 5%) (p = 0.033). In the DMD group, no peri-operative factors were significantly associated with the rate of overall complications or deep wound infection. Increased intra-operative blood loss was associated with hepatotoxicity (p = 0.036). In our series, correction of a neuromuscular scoliosis had an acceptable rate of complications: patients with DMD had an increased overall rate compared with those with other neuromuscular conditions. These included deep wound infection and hepatotoxicity. Hepatotoxicity was unique to DMD patients, and we recommend peri-operative vigilance after correction of a scoliosis in this group. PMID:24986949

Duckworth, A D; Mitchell, M J; Tsirikos, A I

2014-07-01

112

Use of “custom made” porous hydroxyapatite implants for cranioplasty: postoperative analysis of complications in 1549 patients  

PubMed Central

Background: Cranioplasty is a surgical intervention aimed at reestablishing the integrity of skull defects, and should be considered the conclusion of a surgical act that began with bone flap removal. Autologous bone is still considered the treatment of choice for cranioplasty. An alternative choice is bioceramic porous hydroxyapatite (HA) as it is one of the materials that meets and comes closest to the biomimetic characteristics of bone. Methods: The authors analyzed the clinical charts, compiled by the neurosurgeon, of all patients treated with custom-made porous HA devices (Custom Bone Service Fin-Ceramica, Faenza) from which epidemiological and pathological data as well as material-related complications were extrapolated. Results: From November 1997 to December 2010, 1549 patients underwent cranioplasty with the implantation of 1608 custom-made porous HA devices. HA was used in 53.8% of patients for decompressive craniectomy after trauma or intracranial hemorrhage, while the remaining cases were for treated for comminuted fracture, cutaneous or osseous resection, cranial malformation, autologous bone reabsorption or infection or rejection of previously implanted material. The incidence of adverse events in patients treated for cranioplasty, as first line treatment was 4.78% (56 events/1171 patients), and 5.02%, (19 events/378 patients) at second line. Conclusion: This study demonstrates that HA is a safe and effective material, is well tolerated in both adult and pediatric patients, and meets the requirements necessary to repair craniolacunia. PMID:23493459

Stefini, Roberto; Esposito, Giacomo; Zanotti, Bruno; Iaccarino, Corrado; Fontanella, Marco Maria; Servadei, Franco

2013-01-01

113

Investigation of clinical and dosimetric factors associated with postoperative pulmonary complications in esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery  

SciTech Connect

Purpose: To assess the association of clinical and especially dosimetric factors with the incidence of postoperative pulmonary complications among esophageal cancer patients treated with concurrent chemoradiation therapy followed by surgery. Method and Materials: Data from 110 esophageal cancer patients treated between January 1998 and December 2003 were analyzed retrospectively. All patients received concurrent chemoradiotherapy followed by surgery; 72 patients also received irinotecan-based induction chemotherapy. Concurrent chemotherapy was 5-fluorouracil-based and in 97 cases included taxanes. Radiotherapy was delivered to a total dose of 41.4-50.4 Gy at 1.8-2.0 Gy per fraction with a three-dimensional conformal technique. Surgery (three-field, Ivor-Lewis, or transhiatal esophagectomy) was performed 27-123 days (median, 45 days) after completion of radiotherapy. The following dosimetric parameters were generated from the dose-volume histogram (DVH) for total lung: lung volume, mean dose to lung, relative and absolute volumes of lung receiving more than a threshold dose (relative V{sub dose} and absolute V{sub dose}), and absolute volume of lung receiving less than a threshold dose (volume spared, or VS{sub dose}). Occurrence of postoperative pulmonary complications, defined as pneumonia or acute respiratory distress syndrome (ARDS) within 30 days after surgery, was the endpoint for all analyses. Fisher's exact test was used to investigate the relationship between categorical factors and incidence of postoperative pulmonary complications. Logistic analysis was used to analyze the relationship between continuous factors (e.g., V{sub dose} or VS{sub dose}) and complication rate. Logistic regression with forward stepwise inclusion of factors was used to perform multivariate analysis of those factors having univariate significance (p < 0.05). The Mann-Whitney test was used to compare length of hospital stay in patients with and without lung complications and to compare lung volumes, VS5 values, and absolute and relative V5 values in male vs. female patients. Pearson correlation analysis was used to determine correlations between dosimetric factors. Results: Eighteen (16.4%) of the 110 patients developed postoperative pulmonary complications. Two of these died of progressive pneumonia. Hospitalizations were significantly longer for patients with postoperative pulmonary complications than for those without (median, 15 days vs. 11 days, p = 0.003). On univariate analysis, female gender (p = 0.017), higher mean lung dose (p = 0.036), higher relative volume of lung receiving {>=}5 Gy (V5) (p = 0.023), and smaller volumes of lung spared from doses {>=}5-35 Gy (VS5-VS35) (p < 0.05) were all significantly associated with an increased incidence of postoperative pulmonary complications. No other clinical factors were significantly associated with the incidence of postoperative pulmonary complications in this cohort. On multivariate analysis, the volume of lung spared from doses {>=}5 Gy (VS5) was the only significant independent factor associated with postoperative pulmonary complications (p = 0.005). Conclusions: Dosimetric factors but not clinical factors were found to be strongly associated with the incidence of postoperative pulmonary complications in this cohort of esophageal cancer patients treated with concurrent chemoradiation plus surgery. The volume of the lung spared from doses of {>=}5 Gy was the only independent dosimetric factor in multivariate analysis. This suggests that ensuring an adequate volume of lung unexposed to radiation might reduce the incidence of postoperative pulmonary complications.

Wang Shulian [Department of Radiation Oncology, Cancer Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing (China); Liao Zhongxing [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)]. E-mail: zliao@mdanderson.org; Vaporciyan, Ara A. [Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Tucker, Susan L. [Department of Biostatistics and Applied Mathematics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Liu, Helen [Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Wei Xiong [Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Swisher, Stephen [Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Ajani, Jaffer A. [Department of Gastrointestinal Oncology and Digestive Disease, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Cox, James D. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Komaki, Ritsuko [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)

2006-03-01

114

Preoperative and postoperative care in cosmetic laser resurfacing  

NASA Astrophysics Data System (ADS)

Advances in laser technology have allowed the application of lasers to cosmetic facial skin resurfacing. While this application has been extremely advantageous to patients, the development of pre- and postoperative therapeutic regimens was necessary to mitigate potential complications associated with laser resurfacing. Potential complications of laser resurfacing include prolonged postoperative erythema, hyperpigmentation, hypopigmentation, herpetic, bacterial or candidal infection, and other concerns including scarring and abnormal wound healing. In this report we review the state of the art of preoperative and postoperative care for cosmetic laser resurfacing.

Ross, Adam T.; Becker, Daniel G.

2001-05-01

115

Investigation of clinical and dosimetric factors associated with postoperative pulmonary complications in esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery  

Microsoft Academic Search

Purpose: To assess the association of clinical and especially dosimetric factors with the incidence of postoperative pulmonary complications among esophageal cancer patients treated with concurrent chemoradiation therapy followed by surgery. Method and Materials: Data from 110 esophageal cancer patients treated between January 1998 and December 2003 were analyzed retrospectively. All patients received concurrent chemoradiotherapy followed by surgery; 72 patients also

Wang Shulian; Liao Zhongxing; Ara A. Vaporciyan; Susan L. Tucker; Helen Liu; Wei Xiong; Stephen Swisher; Jaffer A. Ajani; James D. Cox; Ritsuko Komaki

2006-01-01

116

Chronic, non-healing wounds are a major complication of diabetes and are characterized by chronic inflammation and excessive protease activity. While once thought to function primarily as a pro-  

E-print Network

Abstract Chronic, non-healing wounds are a major complication of diabetes and are characterized, including fibronectin. We hypothesized that GzmB contributes to the pathogenesis of impaired diabetic wound of diabetic mouse wounds at higher levels. Subsequently, we observed that GzmB induced detachment of mouse

Ollivier-Gooch, Carl

117

Early postoperative hyperglycaemia is not a risk factor for infectious complications and prolonged in-hospital stay in patients undergoing oesophagectomy: a retrospective analysis of a prospective trial  

PubMed Central

Introduction Treating hyperglycaemia in hospitalized patients has proven to be beneficial, particularly in those with obstructive vascular disease. In a cohort of patients undergoing resection for oesophageal carcinoma (a group of patients with severe surgical stress but a low prevalence of vascular disease), we investigated whether early postoperative hyperglycaemia is associated with increased incidence of infectious complications and prolonged in-hospital stay. Methods Postoperative glucose values up to 48 hours after surgery were retrieved for 151 patients with American Society of Anesthesiologists class I or II who had been previously included in a randomized trial conducted in a tertiary referral hospital. Multivariate regression analysis was used to define the independent contribution of possible risk factors selected by univariate analysis. Results In univariate regression analysis, postoperative glucose levels were associated with increased length of in-hospital stay (P < 0.001) but not with infectious complications (P = 0.21). However, postoperative glucose concentration was not found to be an independent risk factor for prolonged in-hospital stay in multivariate analysis (P = 0.20). Conclusion Our data indicate that postoperative hyperglycaemia is more likely to be a risk marker than a risk factor in patients undergoing highly invasive surgery for oesophageal cancer. We hypothesize that patients with a low prevalence of vascular disease may benefit less from intensive insulin therapy. PMID:15566589

Vriesendorp, Titia M; DeVries, J Hans; Hulscher, Jan BF; Holleman, Frits; van Lanschot, Jan J; Hoekstra, Joost BL

2004-01-01

118

Preoperative inspiratory muscle training to prevent postoperative pulmonary complications in patients undergoing esophageal resection (PREPARE study): study protocol for a randomized controlled trial  

PubMed Central

Background Esophageal resection is associated with a high incidence of postoperative pneumonia. Respiratory complications account for almost half of the readmissions to the critical care unit. Postoperative complications can result in prolonged hospital stay and consequently increase healthcare costs. In cardiac surgery a preoperative inspiratory muscle training program has shown to prevent postoperative pneumonia and reduce length of hospital stay. While in some surgical centers inspiratory muscle training is already used in the preoperative phase in patients undergoing esophageal resection, the added value of this intervention on the reduction of pulmonary complications has not yet been investigated in large surgical populations other than cardiac surgery in a randomized and controlled study design. Methods/Design The effect of a preoperative inspiratory muscle training program on the incidence of postoperative pneumonia in patients undergoing esophageal resection will be studied in a single blind multicenter randomized controlled trial (the PREPARE study). In total 248 patients (age >18 years) undergoing esophageal resection for esophageal cancer will be included in this study. They are randomized to either usual care or usual care with an additional inspiratory muscle training intervention according to a high-intensity protocol which is performed with a tapered flow resistive inspiratory loading device. Patients have to complete 30 dynamic inspiratory efforts twice daily for 7 days a week until surgery with a minimum of 2 weeks. The starting training load will be aimed to be 60% of maximal inspiratory pressure and will be increased based on the rate of perceived exertion. The main study endpoint is the incidence of postoperative pneumonia. Secondary objectives are to evaluate the effect of preoperative inspiratory muscle training on length of hospital stay, duration of mechanical ventilation, incidence of other postoperative (pulmonary) complications, quality of life, and on postoperative respiratory muscle function and lung function. Discussion The PREPARE study is the first multicenter randomized controlled trial to evaluate the hypothesis that preoperative inspiratory muscle training leads to decreased pulmonary complications in patients undergoing esophageal resection. Trial registration NCT01893008. PMID:24767575

2014-01-01

119

Successful treatment of surgical abdominal wounds complicated by multiple bowel fistulas with a combination of total parenteral nutrition, hyaluronan-iodine complex and delayed surgery: results of a monocentric experience  

Microsoft Academic Search

Background: Abdominal catastrophe, suture leakage and wound dehiscence are seri- ous complications of surgical procedures. Wound infection is a frequent complication and the mor- tality is high due to long and difficult treatment procedures. Treatment is often difficult as a result of fistula formation, presence of necrotic and infected tissue, and complex surgical management. Long-term nutritional support is necessary between

L. SOBOTKA; J. MANAK; P. VYROUBAL; R. MOTTL; V. BLAHA; M. SLEMROVA; M. CHOBOLA

120

Infl uence of yoga on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery  

Microsoft Academic Search

After surgery, breast cancer patients experience particularly high levels of distress(1-4) manifested as anxiety, depression and anger due to the effects of surgery and the disease itself on life expectancy, physical appearance and sexual identity.(5) Furthermore, concerns regarding one's physical condition, postoperative recovery, hospital admissions, anticipating painful procedures, image problems, confronting cancer diagnosis and worries about survival and recovery can

Raghavendra M Rao; Nagendra H R; Nagarathna Raghuram; Vinay C; Chandrashekara S

121

Risk factors for postoperative complications after lung resection for non-small cell lung cancer in elderly patients at a single institution in China  

PubMed Central

Objective The purpose of this study was to assess the postoperative complications after lung resection for non-small cell lung cancer (NSCLC) in elderly patients and to identify possible associated risk factors. Methods All patients aged 70 years or older who underwent pulmonary resection for NSCLC by either an open approach or by a thoracoscopic approach between January 2003 and December 2013 at our institution were reviewed. Postoperative events were divided into minor and major complications. Risk factors for complications were assessed by univariate and multivariate logistic regression analysis. A matched case-control study was performed to determine if the utilization of video-assisted thoracic surgery (VATS) for lung resection for NSCLC in elderly patients’ results in decreased complications compared with thoracotomy. Results During the study period, 476 consecutive patients (410 thoracotomy, 66 thoracoscopy) older than 70 years underwent resection for NSCLC. Postoperative complications occurred in 169 patients (35.5%) and the overall operative mortality was 2.3% (11 patients). Univariate predictors of complications included history of smoking (P=0.032), CCI scores ?3 (P<0.001), pneumonectomy (P=0.016), as well as the duration of surgery (P=0.003). After multiple logistic regression analysis, CCI scores ?3 [odds ratio (OR) =29.95, P<0.001], pneumonectomy (OR =2.26, P=0.029) and prolonged surgery (?180 min) (OR =1.93, P=0.003) remained the only independent risk factors. After matching based on age, gender, the Charlson Comorbidity Index (CCI), pathologic stage, and the type of resection, there were 60 patients in each group. Patients had similar preoperative characteristics. A VATS approach resulted in a significantly lower rate of complications (25.0% vs. 43.3%, P=0.034) and a shorter median length of stay (19 days, range, 12 to 35 vs. 21 days, range, 13 to 38, P=0.013) compared with thoracotomy. Conclusions Pulmonary resection for NSCLC in patients older than 70 years shows acceptable morbidity and mortality. Postoperative complications are more likely to develop in patients with CCI scores ?3, those who undergo pneumonectomy, and those with a prolonged surgery. Thoracoscopic minimally invasive surgery for NSCLC in elderly patients is associated with fewer complications as well as a shorter hospital stay compared with thoracotomy. PMID:25276365

Pei, Guotian; Zhou, Shijie; Han, Yi

2014-01-01

122

A Case of Continuous Negative Pressure Wound Therapy for Abdominal Infected Lymphocele after Kidney Transplantation  

PubMed Central

Lymphocele is a common complication after kidney transplantation. Although superinfection is a rare event, it generates a difficult management problem; generally, open surgical drainage is the preferred method of treatment but it may lead to complicated postoperative course and prolonged healing time. Negative pressure wound therapy showed promising outcomes in various surgical disciplines and settings. We present a case of an abdominal infected lymphocele after kidney transplantation managed with open surgery and negative pressure wound therapy. PMID:25374744

Franchin, Marco; Tozzi, Matteo; Soldini, Gabriele; Piffaretti, Gabriele

2014-01-01

123

Elevated circulation levels of an antiangiogenic SERPIN in patients with diabetic microvascular complications impair wound healing through suppression of Wnt signaling.  

PubMed

Wound healing, angiogenesis, and hair follicle maintenance are often impaired in the skin of diabetic patients, but the pathogenesis has not been well understood. Here, we report that circulation levels of kallistatin, a member of the serine proteinase inhibitor (SERPIN) superfamily with antiangiogenic activities, were elevated in type 2 diabetic patients with diabetic vascular complications. To test the hypothesis that elevated kallistatin levels could contribute to a wound-healing deficiency via the inhibition of Wnt/?-catenin signaling, we generated kallistatin-transgenic (KS-TG) mice. KS-TG mice had reduced cutaneous hair-follicle density, microvascular density, and panniculus adiposus layer thickness, as well as altered skin microvascular hemodynamics and delayed cutaneous wound healing. Using Wnt reporter mice, our results showed that Wnt/?-catenin signaling is suppressed in the dermal endothelium and hair follicles in KS-TG mice. Lithium, a known activator of ?-catenin via inhibition of glycogen synthase kinase-3?, reversed the inhibition of Wnt/?-catenin signaling by kallistatin and rescued the wound-healing deficiency in KS-TG mice. These observations suggest that elevated circulating antiangiogenic serpins in diabetic patients may contribute to impaired wound healing through inhibition of Wnt/?-catenin signaling. Activation of Wnt/?-catenin signaling, at a level downstream of Wnt receptors, may ameliorate the wound-healing deficiency in diabetic patients. PMID:24463424

McBride, Jeffrey D; Jenkins, Alicia J; Liu, Xiaochen; Zhang, Bin; Lee, Kyungwon; Berry, William L; Janknecht, Ralf; Griffin, Courtney T; Aston, Christopher E; Lyons, Timothy J; Tomasek, James J; Ma, Jian-xing

2014-06-01

124

Dose-volume modeling of the risk of postoperative pulmonary complications among esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery  

SciTech Connect

Purpose: The aim of this study was to investigate the effect of radiation dose distribution in the lung on the risk of postoperative pulmonary complications among esophageal cancer patients. Methods and Materials: We analyzed data from 110 patients with esophageal cancer treated with concurrent chemoradiotherapy followed by surgery at our institution from 1998 to 2003. The endpoint for analysis was postsurgical pneumonia or acute respiratory distress syndrome. Dose-volume histograms (DVHs) and dose-mass histograms (DMHs) for the whole lung were used to fit normal-tissue complication probability (NTCP) models, and the quality of fits were compared using bootstrap analysis. Results: Normal-tissue complication probability modeling identified that the risk of postoperative pulmonary complications was most significantly associated with small absolute volumes of lung spared from doses {>=}5 Gy (VS5), that is, exposed to doses <5 Gy. However, bootstrap analysis found no significant difference between the quality of this model and fits based on other dosimetric parameters, including mean lung dose, effective dose, and relative volume of lung receiving {>=}5 Gy, probably because of correlations among these factors. The choice of DVH vs. DMH or the use of fractionation correction did not significantly affect the results of the NTCP modeling. The parameter values estimated for the Lyman NTCP model were as follows (with 95% confidence intervals in parentheses): n = 1.85 (0.04, {infinity}), m = 0.55 (0.22, 1.02), and D {sub 5} = 17.5 Gy (9.4 Gy, 102 Gy). Conclusions: In this cohort of esophageal cancer patients, several dosimetric parameters including mean lung dose, effective dose, and absolute volume of lung receiving <5 Gy provided similar descriptions of the risk of postoperative pulmonary complications as a function of Radiation dose distribution in the lung.

Tucker, Susan L. [Department of Biostatistics and Applied Mathematics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)]. E-mail: sltucker@mdanderson.org; Liu, H. Helen [Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Wang, Shulian [Department of Radiation Oncology, Cancer Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing (China); Wei Xiong [Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Liao Zhongxing [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Komaki, Ritsuko [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Cox, James D. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Mohan, Radhe [Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)

2006-11-01

125

Tracheal tube cuff inflation guided by pressure volume loop closure associated with lower postoperative cuff-related complications: Prospective, randomized clinical trial  

PubMed Central

Background: The main function of an endotracheal tube (ETT) cuff is to prevent aspiration. High cuff pressure is usually associated with postoperative complications. We tried to compare cuff inflation guided by pressure volume loop closure (PV-L) with those by just to seal technique (JS) and assess the postoperative incidence of sore throat, cough and hoarseness. Materials and Methods: In a prospective, randomized clinical trial, 100 patients’ tracheas were intubated. In the first group (n = 50), ETT cuff inflation was guided by PV-L, while in the second group (n. = 50) the ETT cuff was inflated using the JS technique. Intracuff pressures and volumes were measured. The incidence of postoperative cuff-related complications was reported. Results: Demographic data and durations of intubation were comparable between the groups. The use of PV-L was associated with a lesser amount of intracuff air [4.05 (3.7-4.5) vs 5 (4.8-5.5), P < 0.001] and lower cuff pressure than those in the JS group [18.25 (18-19) vs 33 (32-35), P ? 0.001]. The incidence of postextubation cuff-related complications was significantly less frequent among the PV-L group patients as compared with the JS group patients (P ? 0.009), except for hoarseness of voice, which was less frequent among the PV-L group, but not statistically significant (P ? 0.065). Multiple regression models for prediction of intra-cuff pressure after intubation and before extubation revealed a statistically significant association with the technique used for cuff inflation (P < 0.0001). Conclusions: The study confirms that PV-L-guided ETT cuff inflation is an effective way to seal the airway and associates with a lower ETT cuff pressure and lower incidence of cuff-related complications. PMID:25191181

Almarakbi, Waleed A.; Kaki, Abdullah M.

2014-01-01

126

Does the Application of Incisional Negative Pressure Therapy to High-Risk Wounds Prevent Surgical Site Complications? A Systematic Review  

PubMed Central

Purpose: The application of incisional negative pressure wound therapy (INPWT) to clean, closed surgical incisions is a growing clinical practice. A systematic review was conducted to evaluate the effect of INPWT on surgical sites healing by primary intention. The primary outcomes of interest are incidence of complications (infection, dehiscence, seroma, hematoma, skin necrosis, or blistering). Methods: Two independent reviewers performed a search of the Ovid MEDLINE and EMBASE databases from 2006 to 2012 for published articles. Supplemental searches were performed using reference lists and conference proceedings. Studies were selected for inclusion based on predetermined inclusion and exclusion criteria. Data extraction regarding study quality, demographic and clinical characteristics, and outcomes was performed independently, and data on the incidence of infection was combined using a fixed-effects meta-analysis model. Results: Ten (5 randomized controlled trials and 5 observational) studies were included, which investigated the outcomes of 626 incisions on 610 patients. Six studies compared INPWT with sterile dry dressings (SDDs). The literature shows a significant decrease in rates of infection when using INPWT. Results on dehiscence do show a decrease in some studies, but results are inconsistent to make a conclusion. Because of limited studies, it is difficult to make any assertions on seroma, hematoma, and skin necrosis. Conclusions: This systematic review shows possible evidence of a decrease in the incidence of infection with application of INPWT. Looking at other variables such as dehiscence, seroma, hematoma, and skin necrosis show no consistent data and suggest further studies in order for proper recommendations for INPWT. PMID:24106562

Ingargiola, Michael J.; Daniali, Lily N.; Lee, Edward S.

2013-01-01

127

Alterations in plasma soluble vascular endothelial growth factor receptor-1 (sFlt-1) concentrations during coronary artery bypass graft surgery: relationships with post-operative complications  

PubMed Central

Background Plasma concentrations of sFlt-1, the soluble form of the vascular endothelial growth factor receptor (VEGF), markedly increase during coronary artery bypass graft (CABG) surgery with extracorporeal circulation (ECC). We investigated if plasma sFlt-1 values might be related to the occurrence of surgical complications after CABG. Methods Plasma samples were collected from the radial artery catheter before vascular cannulation and after opening the chest, at the end of ECC just before clamp release, after cross release, after weaning from ECC, at the 6th and 24th post-operative hour. Thirty one patients were investigated. The presence of cardiovascular, haematological and respiratory dysfunctions was prospectively assessed. Plasma sFlt-1 levels were measured with commercially ELISA kits. Results Among the 31 investigated patients, 15 had uneventful surgery. Patients with and without complications had similar pre-operative plasma sFlt-1 levels. Lowered plasma sFlt-1 levels were observed at the end of ECC in patients with haematological (p = 0.001, ANOVA) or cardiovascular (p = 0.006) impairments, but not with respiratory ones (p = 0.053), as compared to patients with uneventful surgery. Conclusion These results identify an association between specific post-CABG complication and the lower release of sFlt-1 during ECC. sFlt-1-induced VEGF neutralisation might, thus, be beneficial to reduce the development of post-operative adverse effects after CABG. PMID:18423019

Denizot, Yves; Leguyader, Alexandre; Cornu, Elisabeth; Laskar, Marc; Orsel, Isabelle; Vincent, Christelle; Nathan, Nathalie

2008-01-01

128

Wound Care After Radiation Therapy  

Microsoft Academic Search

More than 50% of all cancer patients receive some form of radiotherapy for tumor control preoperatively, postoperatively, or as sole treatment. Radiation-induced wounds are a concern for patients and practitioners. Current research investigating alternative treatment strategies offers the hope of improved wound healing and enhanced quality of life for patients with these wounds. This paper reviews the pathophysiology of wounds

Felicia A. Mendelsohn; Celia M. Divino; Ernane D. Reis; Morris D. Kerstein

2002-01-01

129

Intensity Modulated Radiotherapy (IMRT) in the postoperative treatment of an adenocarcinoma of the endometrium complicated by a pelvic kidney  

PubMed Central

Background Pelvic Radiotherapy (RT) as a postoperative treatment for endometrial cancer improves local regional control. Brachytherapy also improves vaginal control. Both treatments imply significant side effects that a fine RT technique can help avoiding. Intensity Modulated RT (IMRT) enables the treatment of the target volume while protecting normal tissue. It therefore reduces the incidence and severity of side effects. Case We report on a 50 year-old patient with a serous-papiliferous adenocarcinoma of the uterus who was submitted to surgical treatment without lymph node sampling followed by Brachytherapy, and Chemotherapy. The patient had a pelvic kidney, and was therefore treated with IMRT. So far, the patient has been free from relapse and with normal kidney function. Conclusion IMRT is a valid technique to prevent the kidney from radiation damage. PMID:17116263

Castilho, Marcus S; Jacinto, Alexandre A; Viani, Gustavo A; Campana, Andre; Carvalho, Juliana; Ferrigno, Robson; Novaes, Paulo ERS; Fogaroli, Ricardo C; Salvajoli, Joao V

2006-01-01

130

Laparoscopic versus open appendicectomy for complicated appendicitis: A prospective study  

PubMed Central

Aims: The purpose of this study was to compare open versus laparoscopic appendicectomy (LA) in complicated appendicitis. Materials and Methods: We prospectively analyzed all children over a 2-year period who underwent appendicectomy in a single institution and found 30 cases of complicated appendicitis diagnosed on the table and confirmed by histopathology. These children were allocated randomly into Group 1 if they had LA and Group 2 if they had open appendicectomy (OA), solely based on surgeon assessment. The parameters assessed were duration of symptoms before surgery, use of postoperative parenteral analgesia, timing of initiation of feeds after surgery, postoperative complications and duration of postoperative stay. Results: Of the 30 patients with complicated appendicitis, 12 patients in Group 1 underwent LA and 18 patients in Group 2 underwent OA. The two groups were comparable for age and sex. Children in Group 1 were found to need less parenteral analgesia (two out of 12 versus six out of 18). Postoperatively, feeds were started earlier in Group 1 than in Group 2 (2.5 days versus 3.7 days). The average postoperative hospital stay was 5 days in Group 1 and 7.5 days in Group 2. There were only minor wound infections in Group1 as against two major complications in Group 2. There was no mortality in either group. Conclusions: In complicated appendicitis, laparoscopic approach carries definite advantages with less postoperative morbidity and hospital stay. It is a feasible and better alternative than the open approach in complicated appendicitis. PMID:20011484

Padankatti, L. R.; Pramod, R. Kirthy; Gupta, A.; Ramachandran, P.

2008-01-01

131

In-vitro antimicrobial activity screening of some ethnoveterinary medicinal plants traditionally used against mastitis, wound and gastrointestinal tract complication in Tigray Region, Ethiopia  

PubMed Central

Objective To screen the antibacterial activity of nine ethnoveterinary plants traditionally used for the treatment of mastitis, wound and gastrointestinal complications. Methods Hydroalcoholic exctracts of medicinal plants namely, Achyranthes aspera (A. aspera) L. (Family Asparagaceae), Ficus caria (F. caria) (Family Moraceae), Malvi parviflora (M. parviflora) (Family Malvaceae), Vernonia species (V. species) (local name Alakit, Family Asteraceae), Solanum hastifolium (S. hastifolium) (Family Solanaceae), Calpurinia aurea (C. aurea) (Ait) Benth (Family Fabaceae), Nicotiana tabacum (N. tabacum) L. (Family Solanaceae), Ziziphus spina-christi (Z. spina-christi) (Family Rhamnaceae), Croton macrostachys (C. macrostachys) (Family Euphorbiaceae), were screened against clinical bacterial isolates of veterinary importance from October 2007 to April 2009. The antibacterial activity was tested using disc diffusion at two concentrations (200 mg/mL and 100 mg/mL) and broth dilution methods using 70% methanol macerated leaf extracts. Results With the exception of S. hastifolium all plant extracts exhibited antibacterial activity. Among the medicinal plants tested C. aurea, C. macrostachyus, A. aspera, N. tabacum and vernonia species (Alakit) showed the most promising antimicrobial properties. Conclusions It can be concluded that many of the tested plants have antibacterial activity and supports the traditional usage of the plants for mastitis, wound and gastrointestinal complications treatment. Further studies into their toxicity and phytochemistry is advocated. PMID:23569962

Kalayou, Shewit; Haileselassie, Mekonnen; Gebre-egziabher, Gebremedhin; Tiku'e, Tsegay; Sahle, Samson; Taddele, Habtamu; Ghezu, Mussie

2012-01-01

132

Negative pressure wound therapy  

Microsoft Academic Search

iabetic foot disease is a major global burden. Foot ulcers frequently develop complications and become chronic, representing a considerable challenge as these are typically very difficult to treat. New therapies are needed to address these wounds and there is an increasing focus on negative pressure wound therapy (NPWT). This technique has been shown to accelerate wound healing and although its

Michael Kirby

2007-01-01

133

Negative pressure wound therapy  

Microsoft Academic Search

D iabetic foot disease is a major global burden. Foot ulcers frequently develop complications and become chronic, representing a considerable challenge as these are typically very difficult to treat. New therapies are needed to address these wounds and there is an increasing focus on negative pressure wound therapy (NPWT). This technique has been shown to accelerate wound healing and although

MICHAEL KIRBY

2010-01-01

134

Predicting and preventing postoperative decline in older cardiac surgery patients.  

E-print Network

??Introduction: Delirium, depression, pressure ulcers and infection are frequently occurring postoperative complications in older cardiac surgery patients. Prevention of postoperative complications in cardiac surgery is… (more)

Ettema, R.G.A.

2014-01-01

135

Application of negative pressure wound therapy in patients with wound dehiscence after abdominal open surgery: a single center experience  

PubMed Central

Purpose Since the 1990's, negative pressure wound therapy (NPWT) has been used to treat soft tissue defects, burn wounds, and to achieve skin graft fixation. In the field of abdominal surgery, the application of NPWT is increasing in cases with an open abdominal wound requiring temporary wound closure and a second look operation. In the present study, the authors analyzed patients that underwent NPWT for postoperative wound dehiscence. Methods The computerized records of patients that had undergone an abdominal operation from November 2009 to May 2012 were retrospectively analyzed. Results The number of total enrolled patients was 50, and 30 patients (60%) underwent an emergency operation. Diagnoses were as follows: panperitonitis or intra-abdominal abscess (24 cases, 48%), intestinal obstruction (10 cases, 20%), cancer (7 cases, 14%), mesentery ischemia (3 cases, 6%), and hemoperitoneum (1 case, 2%). NPWT was applied at a mean of 12.9 ± 8.2 days after surgery and mean NPWT duration was 17.9 days (2 to 96 days). The 11 patients (22%) with unsuccessful wound closure had a deeper and more complex wound than the other 39 patients (78%) (90.9% vs. 38.5%, P = 0.005). There were two complication cases (4%) due to delayed wound healing. Conclusion Most patients recovered well due to granulation formation and suturing. NPWT was found to be convenient and safe, but a prospective comparative study is needed to confirm the usefulness of NPWT in patients whose wounds are dehisced. PMID:24106685

Jang, Ji Young; Shim, Hongjin; Lee, Yun Jin; Lee, Seung Hwan

2013-01-01

136

Effects of Concomitant Surgeries during Mid-Urethral Slings (MUS) on Post-operative Complications, Voiding Dysfunction, Continence Outcomes, and Urodynamic Variables  

PubMed Central

Objectives To determine whether concomitant surgeries affected outcomes in a randomized trial comparing retropubic (RMUS) versus transobturator midurethral slings (TOMUS). Methods Subjects (n=597) were stratified into 4 groups based on type of concomitant surgeries: Group I had anterior/apical with or without posterior repairs (n=79, 13%), Group II had posterior repairs or perineorrhaphy only (n=38, 6%), Group III had non-prolapse procedures (n=34, 6%) and Group IV had no concomitant surgeries (n=446, 75%). Complication rates, voiding dysfunction, objective and subjective surgical failure rates and changes in urodynamic (UDS) values (post-op minus pre-op) were assessed and compared in these 4 groups. Results There were no differences in complications, voiding dysfunction and subjective failure outcomes between these 4 groups. Group I had lower odds ratio (OR) of objective surgical failure compared to Group IV (OR 0.38, 95% CI 0.18–0.81, p=0.05). The OR of failure of all undergoing concomitant surgeries (Groups I–III) was lower than Group IV (OR 0.57, 95% CI 0.35–0.95, p=0.03). The change in Pdet@Qmax (from pressure-flow) was significantly higher in Group III versus IV (p=0.01). The change in Qmax (from uroflowmetry) was significantly less in Group I and II versus Group IV (p=0.046 and 0.04, respectively). Conclusions Concomitant surgeries did not increase complications. Subjects who underwent certain concomitant surgeries had lower failure rates than those undergoing slings only. These data support safety and efficacy of performing concomitant surgery at the time of mid-urethral slings. PMID:22542356

Chai, Toby C.; Kenton, Kimberly; Xu, Yan; Sirls, Larry; Zyczynski, Halina; Wilson, Tracey S.; Rahn, David D.; Whitcomb, Emily L.; Hsu, Yvonne; Gormley, Elizabeth A.

2012-01-01

137

Vesico-acetabular cutaneous fistula: a delayed complication of hip surgery.  

PubMed

Vesico-acetabular cutaneous fistula is an uncommon but important postoperative complication of prosthetic hip surgery. We present a case and images involving a 70-year-old woman who presented with a chronically discharging gluteal wound, 5 years after a complex composite hip replacement. PMID:20708222

Jones, Abeyna L C; Acher, Pete; Cynk, Mark

2011-08-01

138

Alcoholic Chlorhexidine or Alcoholic Iodine Skin Antisepsis (ACAISA): protocol for cluster randomised controlled trial of surgical skin preparation for the prevention of superficial wound complications in prosthetic hip and knee replacement surgery  

PubMed Central

Introduction Wound complications following arthroplasty are associated with significant impact on the patient and healthcare system. Skin cleansing prior to surgical incision is a simple and effective method to prevent wound complications however, the question of which agent is superior for surgical skin antisepsis is unresolved. Methods and analysis This cluster randomised controlled trial aims to compare the incidence of superficial wound complications in patients undergoing elective prosthetic hip or knee replacement surgery receiving surgical skin antisepsis with either: 0.5% chlorhexidine gluconate (CHG) in 70% alcohol or 10% povidone in 70% alcohol. The trial will be conducted at an Australian tertiary, university affiliated hospital over a 3-year period involving 750 participants. Participants will be drawn from the surgical waiting list. Consent for this study will be ‘opt-out’ consent. On a given day, all eligible participants will have skin preparation either with 0.5% chlorhexidine in 70% alcohol or 10% povidone iodine in 70% alcohol. The primary outcome is superficial wound complications (comprised of superficial incisional surgical site infections (SSI) and/or prolonged wound ooze) in the first 30?days following prosthetic joint replacement surgery. Secondary outcomes will include the incidence of wound complications according to the joint replaced, assessment of the causative agents of SSI and cost-effectiveness analysis. The primary analysis is an intention-to-treat analysis including all participants who undergo randomisation and will be performed at the individual level taking into account the clustering effect. Ethics and dissemination The study design and protocol was reviewed and approved by the St Vincent's Hospital Human Research Ethics Committee (HREC-A 016/14 10/3/2014). Study findings will be disseminated in the printed media, and learned forums. A written lay summary will be available to study participants on request. Trial registration number The trial has been registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614000177651. PMID:24833699

Peel, T N; Cheng, A C; Buising, K L; Dowsey, M M; Choong, P F M

2014-01-01

139

Amnion-Derived Multipotent Progenitor Cells Increase Gain of Incisional Breaking Strength and Decrease Incidence and Severity of Acute Wound Failure  

PubMed Central

Objective: Acute wound failure is a common complication following surgical procedures and trauma. Laparotomy wound failure leads to abdominal dehiscence and incisional hernia formation. Delayed recovery of wound-breaking strength is one mechanism for laparotomy wound failure. Early fascial wounds are relatively acellular, and there is a delay in the appearance of acute wound growth factors and cytokines. The objective of this study was to accelerate and improve laparotomy wound healing using amnion-derived multipotent cells (AMPs). AMPs' nonimmunogenic phenotype and relative abundance support its role as a cell therapy. Methods: AMPs were injected into the load-bearing layer of rat abdominal walls prior to laparotomy, and cell viability was confirmed. Wound mechanical properties were measured over 28 days. The incidence and severity of laparotomy wound failure was measured in an incisional hernia model. Results: AMP cells were viable in laparotomy wounds for at least 28 days and did not migrate to other tissues. Laparotomy wound-breaking strength was increased by postoperative day 7 following AMP therapy. AMP therapy reduced the incidence of hernia formation and the size of hernia defects. Histology suggested stimulated wound fibroplasia and angiogenesis. Conclusions: AMP cell therapy reduces the incidence of laparotomy wound failure by accelerating the recovery of wound-breaking strength. This results in fewer incisional hernias and smaller hernia defects. PMID:18091982

Xing, Liyu; Franz, Michael G.; Marcelo, Cynthia L.; Smith, Charlotte A.; Marshall, Vivienne S.; Robson, Martin C.

2007-01-01

140

Comparative Study of Postoperative Complications in Patients With and Without an Obstruction Who Had Left-Sided Colorectal Cancer and Underwent a Single-Stage Operation After Mechanical Bowel Preparation  

PubMed Central

Purpose The purpose of this study is to compare postoperative complications for single-stage surgery after mechanical bowel preparation in patients who experienced obstruction and those who did not. Methods From 2000 to 2011, 1,224 patients underwent a single-stage operation for left colorectal cancer after bowel preparation. Nonobstruction (NOB) and obstruction (OB) colorectal cancer patients were 1,053 (86.0%) and 171 (14.0%), respectively. Postoperative morbidity and mortality were compared between groups. Results The OB group had poor preoperative conditions (age, white blood cell, hemoglobin, albumin level, and advanced tumor stage) compared with the NOB group (P < 0.05). Mean on-table lavage time for the OB group was 17.5 minutes (range, 14-60 minutes). Mean operation time for the OB group was statistically longer than that of the NOB group (OB: 210 minutes; range, 120-480 minutes vs. NOB: 180 minutes; range, 60-420 minutes; P < 0.001). Overall morbidity was similar between groups (NOB: 19.7% vs. OB: 23.4%, P = 0.259). Major morbidity was more common in the OB group than in the NOB group, but the difference was without significance (OB: 11.7% vs. NOB: 7.6%, P = 0.070). Postoperative death occurred in 16 patients (1.3%), and death in the OB group (n = 7) was significantly higher than it was in the NOB group (n = 9) (4.1% vs. 0.9%, P = 0.001). Twelve patients had surgical complications, which were the leading cause of postoperative death: postoperative bleeding in five patients and leakage in seven patients. Conclusion Postoperative morbidity for a single-stage operation for obstructive left colorectal cancer is comparable to that for NOB, regardless of poor conditions of the patient. PMID:25580411

Jung, Sang Hun

2014-01-01

141

Recombinant human erythropoietin stimulates vasculogenesis and wound healing in a patient with systemic sclerosis complicated by severe skin ulcers.  

PubMed

Systemic sclerosis (SSc) is often complicated by severe skin ulcers that are unresponsive to traditional treatments. Vascular alterations are responsible for the ischaemic features of the disease in both the skin and visceral organs. Defective neoangiogenesis correlates with an abnormally reduced quantity of circulating endothelial progenitor cells (EPCs) caused by impaired maturation potential and proliferative capacity of bonemarrow endothelial stem cells. We report a patient with nonhealing cutaneous ulcers successfully treated with recombinant human erythropoietin (rHuEPO). The possible biological effects of this drug were also investigated. Before rHuEPO treatment, the bone-marrow sample contained reduced numbers of EPCs, which were functionally impaired. After a 6-month rHuEPO cycle, a marked increase in endothelial progenitor markers was seen, along with a significant reduction in their apoptotic rates. The clinical and laboratory data variations before and after rHuEPO treatment give new insights into the pathogenetic role of impaired endothelial stem-cell maturation and defective neoangiogenesis in patients with SSc. PMID:20456380

Ferri, C; Giuggioli, D; Manfredi, A; Quirici, N; Scavullo, C; Colaci, M; Gianelli, U; Deliliers, G Lambertenghi; Del Papa, N

2010-12-01

142

Application of the Single Use Negative Pressure Wound Therapy Device (PICO) on a Heterogeneous Group of Surgical and Traumatic Wounds  

PubMed Central

Objectives: Traumatic wounds and surgery inherently have their complications. Localized infections, wound dehiscence, and excessive wound leakage can be devastating to the patient with a prolonged recovery, but it is also costly to the hospital with an increased length of stay, extra workload, and dressing changes. The single use PICO (Smith and Nephew Healthcare, Hull, United Kingdom) negative pressure wound therapy (NPWT) dressing has revolutionized our management of various acute, chronic, and high output wounds. It requires fewer dressing changes than conventional practice, is used in the outpatient setting, and is a necessary adjuvant therapy to hasten wound healing. Aims: To observe the efficacy of the PICO vacuum-assisted healing within a cost improvement programme. Settings: Plastic surgery department, Royal London Hospital. Materials and Methods: Twenty-one patients with a diversity of postoperative or posttraumatic wounds were considered suitable for PICO application and treated totally on an outpatient basis once the PICO dressing was applied. All wounds were then subjected to continued PICO dressings until healed. Results: All patients tolerated the PICO well with no dressing failure or failure to comply. The number of dressings per patient ranged from 1 to 7. The cost per patient of treatment ranged from £120 to £1578. Estimated cost of all PICO dressing for 21 patients including plastic surgery dressing clinic appointments = £13,345. Median length of treatment to healing (days) = 16; standard deviation = 9.5. Eight patients would have had an inpatient bed stay with conventional therapy, total 24 bed days saved at Bartshealth @£325 per day. Conclusions: The outpatient application of a disposable NPWT can benefit a wide range of clinical wounds that optimizes patient care, promotes rapid wound healing, and importantly helps manage costs. PMID:24917894

Payne, Caroline; Edwards, Daren

2014-01-01

143

Vacuum-assisted closure of necrotic and infected cranial wound with loss of dura mater: A technical note  

PubMed Central

Background: Complex cranial wounds can be a problematic occurrence for surgeons. Vacuum-assisted closure devices have a wide variety of applications and have recently been used in neurosurgical cases involving complex cranial wounds. There is only one report regarding the use of a vacuum-assisted closure device with loss of dura mater. We report a complicated case of a necrotic cranial wound with loss of dura mater. Case Description: A 68-year-old female underwent an evacuation of a subdural hematoma. Postoperatively, the patient developed a wound infection that required removal of the bone flap. The wound developed a wedge-shaped necrosis of the scalp with exposure of brain tissue due to loss of dura mater from previous surgeries. She underwent debridement and excision of the necrotic tissue with placement of a synthetic dural graft (Durepair®, Medtronic, Inc.) and placement of a wound vac. The patient underwent a latissismus dorsi muscle flap reconstruction that subsequently failed. After the wound vac was replaced, the synthetic dural graft was replaced with a fascia lata graft and an anterolateral thigh free flap reconstruction. We describe the technical nuances of this complicated case, how the obstacles were handled, and the literature that discusses the utility. Conclusion: We describe a case of a complex cranial wound and technical nuances on how to utilize a wound-vac with loss of dura mater.

Ahmed, Osama; Storey, Christopher M.; Zhang, Shihao; Chelly, Marjorie R.; Yeoh, Melvin S.; Nanda, Anil

2015-01-01

144

Effect of nutrition, diet and suture material on long term wound healing.  

PubMed Central

Although it is known that malnutrition hinders early wound healing, it has not been determined whether this occurs because of formation of a poor scar or a slow rate of normal healing; the ultimate fate of the malnourished wound is unknown. Malnutrition was produced in rats by short gut syndrome. Elemental diet was compared to rat chow and silk was compared with polyglycolic acid suture. Nutritional deficiency was seen in short gut rats for two weeks postoperatively. Thereafter adaptation allowed partial recovery, but relative deficiency persisted. Morbidity and mortality of short gut rats doubled that of controls and all wound complications were limited to this group, occurring within the first two weeks. Malnourished animals surviving for 60 days had wound strength equal to the control rats as determined by gut anastomosis bursting strength, skin wound breaking strength and wound hydroxyproline content. Neither diet nor suture material altered ultimate wound strength. Improved nutrition allowed more animals and wound to survive, but ultimate healing survivors was indistinguishable from that of normal controls. Thus early weakness probably results from slow healing rather than formation of poor scar. Nutrition plays an important role in early strength and survival, but not in ultimate wound healing. PMID:1211997

Temple, W J; Voitk, A J; Snelling, C F; Crispin, J S

1975-01-01

145

miRNA in Diabetic Wound Healing  

Cancer.gov

Impairment of dermal wound healing is a debilitating complication commonly encountered during diabetes mellitus. Dysregulated inflammatory and angiogenesis phases are key players in the impairment of diabetic wound healing. Emerging studies indicate that miRNAs play a key role in regulating several hubs that orchestrate the wound inflammation and angiogenesis processes. Our laboratory first reported dysfunction in wound macrophage efferocytosis function leading to impaired resolution of wound inflammation in diabetic wounds.

146

Contraindications and complications of laparoscopic cholecystectomy.  

PubMed

Laparoscopic cholecystectomy is a commonly performed procedure for the removal of symptomatic gallstones. Compared with open cholecystectomy, laparoscopic cholecystectomy is associated with less postoperative pain, earlier discharge from the hospital and a more rapid recovery. However, there are specific contraindications to the procedure, including empyema of the gallbladder, gangrenous cholecystitis, coagulopathy, portal hypertension and peritonitis. Complications from laparoscopic cholecystectomy include common duct injury, bleeding, bile leakage and wound infection. An understanding of these issues allows the family physician to more appropriately select patients for laparoscopic removal of the gallbladder. PMID:7977000

Rappaport, W D; Gordon, P; Warneke, J A; Neal, D; Hunter, G C

1994-12-01

147

Postoperative Delirium  

Microsoft Academic Search

This article reviews the incidence, pathophysiological hypotheses, and etiology of postoperative delirium, especially in the elderly. Preoperative, intraoperative, and postoperative risk factors for delirium following surgery are discussed. Results of various studies on postoperative delirium appear hardly comparable due to methodological and population differences. Therefore, it is difficult to draw any conclusions on postoperative delirium in general. Special attention is

Rose C. van der Mast

1999-01-01

148

Obesity and Surgical Wound Healing: A Current Review  

PubMed Central

Objective. The correlation between obesity and deficient wound healing has long been established. This review examines the current literature on the mechanisms involved in obesity-related perioperative morbidity. Methods. A literature search was performed using Medline, PubMed, Cochrane Library, and Internet searches. Keywords used include obesity, wound healing, adipose healing, and bariatric and surgical complications. Results. Substantial evidence exists demonstrating that obesity is associated with a number of postoperative complications. Specifically in relation to wound healing, explanations include inherent anatomic features of adipose tissue, vascular insufficiencies, cellular and composition modifications, oxidative stress, alterations in immune mediators, and nutritional deficiencies. Most recently, advances made in the field of gene array have allowed researchers to determine a few plausible alterations and deficiencies in obese individuals that contribute to their increased risk of morbidity and mortality, especially wound complications. Conclusion. While the literature discusses how obesity may negatively affect health on various of medical fronts, there is yet to be a comprehensive study detailing all the mechanisms involved in obesity-related morbidities in their entirety. Improved knowledge and understanding of obesity-induced physiological, cellular, molecular, and chemical changes will facilitate better assessments of surgical risks and outcomes and create efficient treatment protocols for improved patient care of the obese patient population. PMID:24701367

Pierpont, Yvonne N.; Dinh, Trish Phuong; Salas, R. Emerick; Johnson, Erika L.; Wright, Terry G.; Robson, Martin C.; Payne, Wyatt G.

2014-01-01

149

Obesity and surgical wound healing: a current review.  

PubMed

Objective. The correlation between obesity and deficient wound healing has long been established. This review examines the current literature on the mechanisms involved in obesity-related perioperative morbidity. Methods. A literature search was performed using Medline, PubMed, Cochrane Library, and Internet searches. Keywords used include obesity, wound healing, adipose healing, and bariatric and surgical complications. Results. Substantial evidence exists demonstrating that obesity is associated with a number of postoperative complications. Specifically in relation to wound healing, explanations include inherent anatomic features of adipose tissue, vascular insufficiencies, cellular and composition modifications, oxidative stress, alterations in immune mediators, and nutritional deficiencies. Most recently, advances made in the field of gene array have allowed researchers to determine a few plausible alterations and deficiencies in obese individuals that contribute to their increased risk of morbidity and mortality, especially wound complications. Conclusion. While the literature discusses how obesity may negatively affect health on various of medical fronts, there is yet to be a comprehensive study detailing all the mechanisms involved in obesity-related morbidities in their entirety. Improved knowledge and understanding of obesity-induced physiological, cellular, molecular, and chemical changes will facilitate better assessments of surgical risks and outcomes and create efficient treatment protocols for improved patient care of the obese patient population. PMID:24701367

Pierpont, Yvonne N; Dinh, Trish Phuong; Salas, R Emerick; Johnson, Erika L; Wright, Terry G; Robson, Martin C; Payne, Wyatt G

2014-01-01

150

Negative Pressure Wound Therapy  

PubMed Central

Executive Summary Objective This review was conducted to assess the effectiveness of negative pressure wound therapy. Clinical Need: Target Population and Condition Many wounds are difficult to heal, despite medical and nursing care. They may result from complications of an underlying disease, like diabetes; or from surgery, constant pressure, trauma, or burns. Chronic wounds are more often found in elderly people and in those with immunologic or chronic diseases. Chronic wounds may lead to impaired quality of life and functioning, to amputation, or even to death. The prevalence of chronic ulcers is difficult to ascertain. It varies by condition and complications due to the condition that caused the ulcer. There are, however, some data on condition-specific prevalence rates; for example, of patients with diabetes, 15% are thought to have foot ulcers at some time during their lives. The approximate community care cost of treating leg ulcers in Canada, without reference to cause, has been estimated at upward of $100 million per year. Surgically created wounds can also become chronic, especially if they become infected. For example, the reported incidence of sternal wound infections after median sternotomy is 1% to 5%. Abdominal surgery also creates large open wounds. Because it is sometimes necessary to leave these wounds open and allow them to heal on their own (secondary intention), some may become infected and be difficult to heal. Yet, little is known about the wound healing process, and this makes treating wounds challenging. Many types of interventions are used to treat wounds. Current best practice for the treatment of ulcers and other chronic wounds includes debridement (the removal of dead or contaminated tissue), which can be surgical, mechanical, or chemical; bacterial balance; and moisture balance. Treating the cause, ensuring good nutrition, and preventing primary infection also help wounds to heal. Saline or wet-to-moist dressings are reported as traditional or conventional therapy in the literature, although they typically are not the first line of treatment in Ontario. Modern moist interactive dressings are foams, calcium alginates, hydrogels, hydrocolloids, and films. Topical antibacterial agents—antiseptics, topical antibiotics, and newer antimicrobial dressings—are used to treat infection. The Technology Being Reviewed Negative pressure wound therapy is not a new concept in wound therapy. It is also called subatmospheric pressure therapy, vacuum sealing, vacuum pack therapy, and sealing aspirative therapy. The aim of the procedure is to use negative pressure to create suction, which drains the wound of exudate (i.e., fluid, cells, and cellular waste that has escaped from blood vessels and seeped into tissue) and influences the shape and growth of the surface tissues in a way that helps healing. During the procedure, a piece of foam is placed over the wound, and a drain tube is placed over the foam. A large piece of transparent tape is placed over the whole area, including the healthy tissue, to secure the foam and drain the wound. The tube is connected to a vacuum source, and fluid is drawn from the wound through the foam into a disposable canister. Thus, the entire wound area is subjected to negative pressure. The device can be programmed to provide varying degrees of pressure either continuously or intermittently. It has an alarm to alert the provider or patient if the pressure seal breaks or the canister is full. Negative pressure wound therapy may be used for patients with chronic and acute wounds; subacute wounds (dehisced incisions); chronic, diabetic wounds or pressure ulcers; meshed grafts (before and after); or flaps. It should not be used for patients with fistulae to organs/body cavities, necrotic tissue that has not been debrided, untreated osteomyelitis, wound malignancy, wounds that require hemostasis, or for patients who are taking anticoagulants. Review Strategy The inclusion criteria were as follows: Randomized controlled trial (RCT) with a sample size of 20 or more Human s

2006-01-01

151

Managing complications of posterior spinal instrumentation and fusion.  

PubMed

Complications of posterior spinal instrumentation for adolescent idiopathic scoliosis are often preventable. Preoperative planning helps to minimize intraoperative and postoperative problems. Late recurrence of rotational deformity (crankshaft) in skeletally immature patients can be prevented by adding anterior surgery. Intraoperative complications are minimized by controlled hypotensive anesthesia and sequencing of surgical steps to allow for autocoagulation, reducing blood loss. Use of spinal cord monitoring, Stagnara wakeup test, and careful distraction decreases the risk of neurologic deficit. Good hook-site preparation helps avoid dural tears. The incidence of postoperative pneumothorax and hemothorax is decreased by careful hook attachment, avoiding pleural penetration, judicious use of rib excision thoracoplasty, and roentgenographic verification of central venous pressure line position. Postoperative recommendations include bed position at 30 degrees, frequent log rolling, incentive spirometry, early sitting and standing, early Foley catheter and nasogastric tube removal, prophylactic antibiotics, and prompt attention to wound infections. Postoperative orthotic wear, prescribed exercise, and activity restriction decrease the risk of early instrumentation failure and help correct early postoperative trunk imbalance. The late complications include suspected pseudarthrosis; this should be surgically treated again if there is persistent pain or marked loss of curve correction. PMID:1395301

Wenger, D R; Mubarak, S J; Leach, J

1992-11-01

152

Management of "difficult" wounds.  

PubMed

Pressure sores (PSs) and wounds in immunocompromised children are rather rare conditions. No doubt, their management is often complex and difficult, even for experienced pediatric plastic surgeons. As there are no algorithms for standard care, the therapeutic approach is individual.Successful PS management always implies primary and secondary prevention. With a PS present, rapid relief of pressure is crucial. If local wound care fails to restore skin integrity within a short period of time, surgical defect closure is mandatory. Overall, full-thickness skin grafts and local flap surgery are the most suitable methods regarding result quality, procedure complexity, and risks. Negative pressure wound therapy (NPWT) plays an instrumental role in wound bed preparation before definitive coverage. Recurrence rate is high (the complication). It does not much depend on the surgical technique employed, but rather depends on whether the various pathogenic factors leading to PS can be eliminated or alleviated.In both temporarily and permanently immunocompromised children, wound healing is significantly impaired. At the same time, these patients have no or low host defense activity. Thus, they are at high risk not only for local wound infection but also for potentially life threatening septic complications. Rapid and definitive wound closure is therefore essential. When conservative therapy fails, simple surgical techniques granting rapid and definitive wound closure should be used. PMID:24008551

Neuhaus, Kathrin; Meuli, Martin; Koenigs, Ingo; Schiestl, Clemens

2013-10-01

153

The accelerating effect of negative pressure wound therapy with Prevena™ on the healing of a closed wound with persistent serous secretion.  

PubMed

Negative pressure wound therapy has been lately used on closed incisions in the immediate postoperative period to accelerate wound healing. However, there are no data in the literature regarding the use of this type of therapy for wounds with persistent secretion in the early postoperative care. We present the first report of persistent postoperative serous wound secretion in a patient after femoral nailing treated successfully with Prevena™ (KCI), a closed incision negative pressure management system (CINPWT). PMID:24393137

Altintas, Burak; Biber, Roland; Brem, Matthias H

2014-01-01

154

[Management of complications after residual tumor resection for metastatic testicular cancer].  

PubMed

Residual tumor resection (RTR) in patients with metastatic testicular cancer plays a pivotal role in a multimodal treatment. It can be performed unilaterally or as an extended bilateral RTR. Additional surgical procedures might be necessary, such as nephrectomy, splenectomy, partial colectomy, or vascular interventions with possible caval resection, cavotomy, or aortic resection with aortic grafting. Consequently, several complications can be seen in the intra- and postoperative course, most common of which are superficial wound infections, intestinal paralysis, lymphocele, and chylous ascites. We sought to describe complication management and how to prevent complications before they arise. PMID:25023235

Lusch, A; Zaum, M; Winter, C; Albers, P

2014-07-01

155

Successful treatment of an infected wound in infants by a combination of negative pressure wound therapy and arginine supplementation  

Microsoft Academic Search

ObjectiveWound dehiscence caused by surgical site infection (SSI) presents a complicated problem. Negative pressure wound therapy (NPWT) was developed to treat wound dehiscence. Nutritional treatment using arginine has also been recently shown to be effective for the treatment of pressure ulcers. Therefore, wound complications due to SSI were treated using NPWT combined with nutritional therapy with an arginine-rich supplement (ARS).

Kouji Masumoto; Kouji Nagata; Yoichiro Oka; Hiroki Kai; Sadako Yamaguchi; Mika Wada; Tsuyoshi Kusuda; Toshiro Hara; Shin-ichi Hirose; Akinori Iwasaki; Tomoaki Taguchi

2011-01-01

156

JAMA Patient Page: Postoperative Infections  

MedlinePLUS

... longer hospital stays, and increased health care costs. Postoperative infections may cause severe problems, including failure of the surgical procedure, other surgical complications, sepsis, organ failure, and even death. Some persons ...

157

Ultraviolet light and hyperpigmentation in healing wounds  

SciTech Connect

The concept of permanent hyperpigmentation in wounds following ultraviolet light exposure during the postoperative period has found a place in plastic surgical literature but has not been documented. This study evaluates the effect of ultraviolet light on healing wounds in paraplegics. It failed to confirm permanent alteration in pigmentation response to ultraviolet exposure and suggests that other factors are of greater importance in the development of hyperpigmentation in the healing wound.

Wiemer, D.R.; Spira, M.

1983-10-01

158

The enhanced healing of a high-risk, clean, sutured surgical incision by prophylactic negative pressure wound therapy as delivered by Prevena™ Customizable™: cosmetic and therapeutic results.  

PubMed

According to the literature, incisional closure complications may range from postoperative surgical site infections, representing 17-22% of health care-associated infections, surgical wound dehiscence and formation of haematomas or seromas, and can lead to delayed or impaired incision healing. These kinds of situations are more common when wounds are closed under tension or in specific patient morbidities. Obesity, in particular, is associated with an impaired blood flow to tissues, predisposing the patient to increased risk of wound complications by various mechanisms. Incisional complications can become relevant economic burdens for health care systems because of an increase in the average length of hospital stay and readmissions, and additional medical and surgical procedures. Thus, a preventive therapy may have a critical role in the management of healing. Negative pressure wound therapy (NPWT) technology as delivered by Prevena™ Customizable™ (Kinetic Concepts Inc., San Antonio, TX) has recently been the focus of a new investigation, as a prophylactic measure to prevent complications via immediate postoperative application in high-risk, clean, closed surgical incisions. The authors present a 62-year-old class II obese female, who underwent bilateral inguinal dermolipectomy. Prophylactic NPWT as delivered by Prevena™ was performed successfully over surgical incisions. Cosmetic and therapeutic results are shown. PMID:25234139

Scalise, Alessandro; Tartaglione, Caterina; Bolletta, Elisa; Calamita, Roberto; Nicoletti, Giovanni; Pierangeli, Marina; Grassetti, Luca; Di Benedetto, Giovanni

2014-09-19

159

Wound surgery.  

PubMed

The purpose of this article is to review the concepts behind, and practice of, wound surgery. The techniques of wound surgery, born of necessity in the art of military surgeons, have found their renaissance in the modern age of wound care driven by the economic and functional considerations inherent to the outcome-based management of chronic disease. Over 300 years of literature on wound healing has shown an innate ability of the wound (in the absence of infection and repeated trauma) to control its progress, largely through the local inflammatory cells. This article discusses several historical works on wound surgery and healing, topical wound therapy, minimal intervention, and emphasizes the closure of chronic wounds. PMID:21074031

Caldwell, Michael D

2010-12-01

160

Puncture Wounds  

MedlinePLUS

... of determining the severity of a puncture wound. Depth of the wound is one way to evaluate ... Reserved. | Privacy Statement | Disclaimer | Terms and Conditions | Site Map | Información en Español | 8725 West Higgins Road, Suite ...

161

Success in Esophageal Perforation Repair with open-wound Management after Revision Cervical Spine Surgery - A Case Report.  

PubMed

Study Design. Case report.Objective. To share our successful experience in treating one case of esophageal perforation following anterior revision cervical spine surgery with open-wound managementSummary of Background Data. Early diagnosis and surgical treatment is widely adopted in the management of esophageal complications after anterior cervical spine surgery, but the management of wound after surgical repair of esophageal perforation is rarely discussed.Methods. One patient underwent revision anterior cervical spine surgery because of displaced hardware and poor alignment of cervical spine. Esophageal perforation was incurred intraoperatively and found on the first postoperative day. Repair surgery was carried out immediately afterwards. During the surgery, esophageal perforation was closed with a suture, and reinforced with a sternocleidomastoid muscle flap. The wound was loosely closed with aspirating drainage. Two days after the surgery, the patient began to show signs of recurrent esophageal leakage and severe secondary wound infection. The wound was then re-opened completely before a continuous irrigation and drainage system was positioned in place.Result. In twelve weeks, the esophageal perforation healed without complications or loosening of instrumentation.Conclusion. Open-wound management succeeded in this patient after surgical repair of esophageal perforation caused by revision anterior cervical spine surgery. PMID:25398037

Ji, Hongquan; Liu, Dandan; You, Weitao; Zhou, Fang; Liu, Zhongjun

2014-11-13

162

Effectively Managing Infected Wounds with Hydrofera BlueTM and Negative Pressure Wound Therapy  

Microsoft Academic Search

SUMMARY: CASE #1: This 45-year-old female presented following surgical debridement of an infected wound that was closed in the Emergency Department following a traumatic event. Hydrofera BlueTM and NPWT was initiated immediately post-operatively.

Debra J. Peterson; Karre Hermann; Jeffrey A. Niezgoda

2005-01-01

163

[Postoperative hematomas after inguinal hernia repair].  

PubMed

It was done the analysis of the results of 625 open and endoscopic prosthetic and autoplastic hernia repairs made in a planned and emergency basis during the period from 2005 to 2012. The autoplastic group was divided into three subgroups: the plastic by Bassini, Shouldays and Postempski. The prosthesis group was divided into open and endoscopic subgroups. The open prosthesis group was also divided into subgroups in accordance with the options of hernia sac preparation (excised, reseted, untouched) and the reconstruction of the posterior wall of the inguinal canal (without reconstruction, with a single-layer and double-layer plastic). It was noted hematocele scrotum - 19 (3.04%), hematoma of the spermatic cord - 16 (2.56%), wound infiltration with a hemorrhagic component - 13 (2.08%). It was not noted the hemorrhagic complications in the subgroups of open prosthesis without hernia sac preparation. Reducing surgical aggression against inguinal hernias during the operation can reduce the frequency of hematomas. The absence of a clear classification of hematomas brings to difficulties in assessment of the role of specific surgical techniques in the development of postoperative complications after surgery for inguinal hernias. PMID:24429713

Cherepanin, A I; Pokrovski?, K A; Povetkin, A P; Antonov, O N; Baulina, E A

2014-01-01

164

Skin substitutes based on allogenic fibroblasts or keratinocytes for chronic wounds not responding to conventional therapy: a retrospective observational study.  

PubMed

Chronic wounds are an expression of underlying complex pathologies and have a high incidence. Skin substitutes may represent an alternative approach to treat chronic ulcers. The aim of this retrospective observational study was to evaluate the wound reduction using skin substitutes based on allogenic fibroblasts or keratinocytes in 30 patients not responding to conventional therapy. Wound bed was prepared, then keratinocytes on Laserskin(®) to treat superficial wounds or fibroblasts on Hyalograft 3D(R) to treat deep leg ulcers were applied, and finally wounds were treated with a secondary dressing composed of nanocrystalline silver. Once a week constructs were removed and new bioengineered products were applied, as well as nanocrystalline silver medication. In none of the cases under examination did any complications arise relating to the treatment. We also achieved a reduction in wound dimension and exudates, and an increase in wound bed score. Postoperative assessment shows a degree of healing that is statistically higher in the group treated with keratinocytes as compared with the fibroblast group. This retrospective study improves our understanding and defines the clinical indications for the various uses of the two types of skin substitutes. PMID:24517418

Pajardi, Giorgio; Rapisarda, Vicenzo; Somalvico, Francesco; Scotti, Andrea; Russo, Giulia Lo; Ciancio, Francesco; Sgrò, Arturo; Nebuloni, Manuela; Allevi, Raffaele; Torre, Maria L; Trabucchi, Emilio; Marazzi, Mario

2014-02-12

165

Modern wound care - practical aspects of non-interventional topical treatment of patients with chronic wounds.  

PubMed

The treatment of patients with chronic wounds is becoming increasingly complex. It was therefore the aim of the members of the working group for wound healing (AGW) of the German Society of Dermatology (DDG) to report on the currently relevant aspects of non-interventional, topical wound treatment for daily practice. -Beside necessary procedures, such as wound cleansing and débridement, we describe commonly used wound dressings, their indications and practical use. Modern antiseptics, which are currently used in wound therapy, usually contain polyhexanide or octenidine. Physical methods, such as negative-pressure treatment, are also interesting options. It is always important to objectify and adequately treat pain symptoms which often affect these patients. Modern moist wound therapy may promote healing, reduce complications, and improve the quality of life in patients with chronic wounds. Together with the improvement of the underlying causes, modern wound therapy is an important aspect in the overall treatment regime for patients with chronic wounds. PMID:24813380

Dissemond, Joachim; Augustin, Matthias; Eming, Sabine A; Goerge, Tobias; Horn, Thomas; Karrer, Sigrid; Schumann, Hauke; Stücker, Markus

2014-07-01

166

Gunshot Wounds  

PubMed Central

Penetrating chest trauma can cause a wide variety of cardiac injuries, including myocardial contusion, damage to the interventricular septum, laceration of the coronary arteries, and free-wall rupture. Herein, we describe the case of a 21-year-old man who presented with congestive heart failure, which was secondary to an old myocardial infarction and complicated by the delayed formation of a ventricular septal defect. All of these conditions were attributable to multiple gunshot wounds that the patient had sustained 6 months earlier. Left ventricular angiography showed an apical aneurysm; a large, muscular, ventricular septal defect; and 19 gunshot pellets in the chest wall. Three months after aneurysmectomy and surgical closure of the septal defect, the patient had recovered fully and was asymptomatic. This case reaffirms the fact that substantial cardiac injuries can appear months after chest trauma. The possibility of traumatic ventricular septal defect should be considered in all multiple-trauma patients who develop a new heart murmur, even when overt chest-wall injury is absent. PMID:22412248

Kumar, Sudeep; Moorthy, Nagaraja; Kapoor, Aditya; Sinha, Nakul

2012-01-01

167

Perioperative and postoperative morbidity after sacrocolpopexy according to age in Korean women  

PubMed Central

Objective This study aimed to compare perioperative and postoperative morbidity of older and younger women undergoing sacrocolpopexy (SCP). Methods A retrospective study included 271 patients who underwent laparotomic SCP for symptomatic pelvic organ prolapse from November 2008 to June 2013 at our institution. By the review of medical records, perioperative and postoperative data including the length of the surgery, estimated blood loss, blood transfusion, the length of hospital stay, wound complications and febrile morbidity were collected. In addition, cardiovascular, pulmonary, gastrointestinal, genitourinary, or neurological adverse events were retrieved. The need for an indwelling urinary catheter or performance of clean intermittent self-catheterization, mesh erosion rate and the number of days required for each were included in the postoperative outcomes. For the outcome variable analyzed in this study, the patients was dichomotized into women aged 65 and older and those younger than 65. Results One hundred and thirty-five (49.8%) patients were younger than 65 and 136 (50.2%) were aged 65 and older. Older women had higher body mass index, vaginal parity and prior surgery for hysterectomy than younger women (P<0.05). And older women had higher baseline comorbidities, such as hypertension, diabetes, cardiac disease (P<0.05), and their American society of Anesthesiologist class was higher (P<0.001). In the perioperative and postoperative complication, older group showed no differences in most of the operation-related complication rates, but gastrointestinal complication rate. Also, mesh erosion rate was not found to be significantly different between the two groups at the last visit. Conclusion Older women undergoing laparotomic SCP have similar perioperative and postoperative morbidities as younger women, suggesting surgeons can counsel older and younger women similarly in terms of operative risks. PMID:25629020

Oh, Sumin; Shin, So Hyun; Kim, Ji Young; Lee, Maria

2015-01-01

168

Complications from micronutrient deficiency following bariatric surgery.  

PubMed

We report a case of clinically significant micronutrient deficiencies following biliary pancreatic diversion (BPD) surgery. Our patient was admitted to hospital six years after BPD surgery following a low impact humeral fracture complicated by postoperative wound infection. On presentation she complained of a widespread rash and loss of night vision. Laboratory testing confirmed hypoalbuminaemia, deficiencies of vitamins A, E and D and of the trace elements copper, zinc and selenium. Bone densitometry confirmed osteoporosis. The skin rash was thought to be due to zinc deficiency and improved with conservative measures and trace element replacement. Her night blindness resolved 48 hours after receiving high dose parenteral vitamin A. Six months later she was readmitted to our intensive care unit with wound dehiscence at her fracture site and clinical features of sepsis and encephalopathy. This case highlights the importance of devising treatment and follow-up guidance prior to surgery and multidisciplinary team involvement including the patient so that long-term metabolic complications are avoided. PMID:24847133

Wilson, Helen O; Datta, Dev Bn

2014-11-01

169

Diabetic foot wounds: the value of negative pressure wound therapy with instillation.  

PubMed

Chronic wounds such as diabetic foot wounds are a tremendous burden to the health care system and often require a multidisciplinary approach to prevent amputations. Advanced technologies such as negative pressure wound therapy (NPWT) and bioengineered tissues have been successfully used in the treatment of these types of complex wounds. However, the introduction of NPWT with instillation (NPWTi) has provided an alternative treatment for treating complex and difficult-to-heal wounds. This article provides an overview of NPWT and the new NPWTi system and describes preliminary experience using NPWTi on patients with complicated infected diabetic foot wounds after surgical debridement and in a multidisciplinary setting. PMID:24251841

Dalla Paola, Luca

2013-12-01

170

A Real World, Observational Registry of Chronic Wounds and Ulcers  

ClinicalTrials.gov

Diabetic Foot; Varicose Ulcer; Pressure Ulcer; Surgical Wound Dehiscence; Vasculitis; Skin Ulcer; Leg Ulcer; Wounds and Injuries; Pyoderma; Peripheral Arterial Disease; Diabetic Neuropathies; Lymphedema; Venous Insufficiency; Diabetes Complications; Amputation Stump

2014-10-29

171

[Treatment of the infected wound with exposed silver-ring vascular graft and delayed Thiersch method of skin transplant covering ].  

PubMed

Although the incidence of prosthetic infection is low (1%-6%), the consequences (limb loss or death) are dramatic for a patient, with high mortality rate (25%-75%) and limb loss in 40%-75% of cases. In case of Szilagyi's grade III infection, standard procedure consists of the excision of prosthesis and wound debridement. Alternative method is medical treatment. This is a case report of a patient with prosthetic infection of Silver-ring graft, used for femoropopliteal reconstruction, in whom an extreme skin necrosis developed in early postoperative period. This complication was successfully treated medically. After repeated debridement and wound-packing, the wound was covered using Thiersch skin graft. PMID:16053180

Nenezi?, Dragoslav; Pandaitan, Simon; Ilijevski, Nenad; Mati?, Predrag; Gajin, Predag; Radak, Dorde

2005-01-01

172

Murine model of wound healing.  

PubMed

Wound healing and repair are the most complex biological processes that occur in human life. After injury, multiple biological pathways become activated. Impaired wound healing, which occurs in diabetic patients for example, can lead to severe unfavorable outcomes such as amputation. There is, therefore, an increasing impetus to develop novel agents that promote wound repair. The testing of these has been limited to large animal models such as swine, which are often impractical. Mice represent the ideal preclinical model, as they are economical and amenable to genetic manipulation, which allows for mechanistic investigation. However, wound healing in a mouse is fundamentally different to that of humans as it primarily occurs via contraction. Our murine model overcomes this by incorporating a splint around the wound. By splinting the wound, the repair process is then dependent on epithelialization, cellular proliferation and angiogenesis, which closely mirror the biological processes of human wound healing. Whilst requiring consistency and care, this murine model does not involve complicated surgical techniques and allows for the robust testing of promising agents that may, for example, promote angiogenesis or inhibit inflammation. Furthermore, each mouse acts as its own control as two wounds are prepared, enabling the application of both the test compound and the vehicle control on the same animal. In conclusion, we demonstrate a practical, easy-to-learn, and robust model of wound healing, which is comparable to that of humans. PMID:23748713

Dunn, Louise; Prosser, Hamish C G; Tan, Joanne T M; Vanags, Laura Z; Ng, Martin K C; Bursill, Christina A

2013-01-01

173

Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures  

Microsoft Academic Search

Background. Diabetes mellitus is a risk factor for deep sternal wound infection after open heart surgical procedures. We previously showed that elevated postoperative blood glucose levels are a predictor of deep sternal wound infection in diabetic patients. Therefore, we hypothesized that aggressive intravenous pharmacologic control of postoperative blood glucose levels would reduce the incidence of deep sternal wound infection.Methods. In

Anthony P Furnary; Kathryn J Zerr; Gary L Grunkemeier; Albert Starr

1999-01-01

174

Complications of Groin Hernia Repair: Their Prevention and Management  

PubMed Central

An estimated overall complication rate of approximately ten percent is found in the half million patients who annually undergo groin hernia repair in the United States. Certain features in the operative technique are emphasized which should prevent many of these complications. Intraoperative complications during the groin hernia repair are primarily hemorrhage and injury to the vas deferens, the three nerves in the area, the vascular supply of the testis, and the abdominal and pelvic viscera. Miscellaneous intraoperative complications relate to problems associated with the repair of massive hernias, missed hernia, and the loss of strangulated bowel into the abdominal cavity. Early postoperative complications may be either systemic or local with cardiac and respiratory conditions comprising the former group. The early local complications are primarily wound problems of infection, hematoma formation, and scrotal swelling involving the skin and testis. High ligation in excision of the sac in all hernias, repair of the defect in the plane of its occurrence, and suture of fascia to fascia in the same plane without tension are the basic tenets of inguinal hernia repair which should result in a low incidence of recurrence. The most effective prophylactic measures necessary for the prevention of complications considered are a thorough knowledge of inguinofemoral anatomy, mature surgical judgment, and meticulous surgical technique. PMID:691083

Gaines, Ray D.

1978-01-01

175

Surgical wound infections after peripheral vascular surgery.  

PubMed

Surgical wound infection is one of the most common complications after peripheral vascular surgery. It increases the affected patient's risk for major amputation as well as mortality. Furthermore, surgical wound infection is an additional cost. Wound infections after vascular surgery are of multifactorial nature and generally result from the interplay of patient- and procedure-related factors. The use of systemic antibiotic prophylaxis may be the most important method in preventing surgical wound infections. In this review article, we report the current literature of surgical wound infections after peripheral vascular surgery. PMID:24737857

Turtiainen, J; Hakala, T

2014-12-01

176

The role of postoperative prophylactic antibiotics in the treatment of facial fractures: a randomised, double-blind, placebo-controlled pilot clinical study. Part 3: Le Fort and zygomatic fractures in 94 patients.  

PubMed

The aim of this study was to evaluate the difference between the effect of a 5-day and a 1-day postoperative course of antibiotics on the incidence of infection after midfacial fractures. A total of 98 patients with displaced Le Fort or zygomatic fractures that required operation were randomly assigned into 2 groups, both of which were given amoxicillin/clavulanic acid 1.2g intravenously every 8h from the time of admission until 24h postoperatively. The 5-day group was then given amoxicillin/clavulanic acid 625 mg orally 8-hourly for another 4 days. The 1-day group was given placebo orally at the same time points. Patients were followed up 1, 2, 4, 6, and 12 weeks, and 6 months, postoperatively. The development of an infection of the wound was the primary end point. Ninety-four of the 98 patients completed the study. Two of the 45 patients in the 5-day group (4%) and 2/49 in the 1-day group (4%) developed postoperative wound infections. One in each group had a purulent infection, while the others had only wound breakdown. Two patients of the 5-day group and one in the 1-day group developed rashes on the trunk. There were no significant differences in the incidence of infection or side effects between the groups. In midfacial fractures a 1-day course of antibiotics postoperatively is as effective in preventing infective complications as a 5-day regimen. PMID:24602602

Soong, Poh Luon; Schaller, Benoit; Zix, Jürgen; Iizuka, Tateyuki; Mottini, Matthias; Lieger, Olivier

2014-04-01

177

Early Surgical Complications After Primary Cleft Lip Repair: A Report of 3108 Consecutive Cases.  

PubMed

Objective :? To analyze short term surgical complications after primary cleft lip repair. Patients and Design :? A total of 3108 consecutive lip repairs with 2062 follow-ups were reviewed retrospectively through medical records. Patients were aged 3 months to 75 years at the time of surgery, with a median of 7 years. Setting :? Guwahati Comprehensive Cleft Care Center, Assam, India. Intervention :? Primary cleft lip repair. Main Outcome :? Documented complications in terms of dehiscence, necrosis, infection, and suture granuloma were compiled. Logistic regression was used with dehiscence (yes/no) or infection (yes/no) as binary dependant variables. Age, cleft type, and surgeon (visiting/long term) were used as covariates. Results :? Among the 2062 patients who returned for early follow-up, 90 (4.4%) had one or more complications. Dehiscence (3.2%) and infection (1.1%) were the most common types of complication. Visiting surgeon, complete cleft, and bilateral cleft were significantly associated with wound dehiscence, and complete cleft was associated with wound infection according to the logistic regression analysis. Of patients with bilateral complete clefts, 6.9% suffered from some degree of wound dehiscence. Conclusion :? In a setting where presurgical molding is unavailable and patients present at all ages, lip wound dehiscence is a relatively common complication in patients with bilateral complete clefts. The risk of dehiscence, however, is reduced when these cases are assigned to surgeons with experience with these types of clefts. We also found that the incidence of wound infection can be kept relatively low, even without the use of postoperative antibiotics. PMID:25286156

Schönmeyr, Björn; Wendby, Lisa; Campbell, Alex

2014-10-01

178

Complex wounds.  

PubMed

Complex wound is the term used more recently to group those well-known difficult wounds, either chronic or acute, that challenge medical and nursing teams. They defy cure using conventional and simple "dressings" therapy and currently have a major socioeconomic impact. The purpose of this review is to bring these wounds to the attention of the health-care community, suggesting that they should be treated by multidisciplinary teams in specialized hospital centers. In most cases, surgical treatment is unavoidable, because the extent of skin and subcutaneous tissue loss requires reconstruction with grafts and flaps. New technologies, such as the negative pressure device, should be introduced. A brief review is provided of the major groups of complex wounds--diabetic wounds, pressure sores, chronic venous ulcers, post-infection soft-tissue gangrenes, and ulcers resulting from vasculitis. PMID:17187095

Ferreira, Marcus Castro; Tuma, Paulo; Carvalho, Viviane Fernandes; Kamamoto, Fábio

2006-12-01

179

Necrotizing scleritis as a complication of cosmetic eye whitening procedure  

PubMed Central

Background We report necrotizing scleritis as a serious complication of a cosmetic eye whitening procedure that involves the use of intraoperative and postoperative topical mitomycin C. Findings This is a single case report. A 59-year-old Caucasian male with a history of blepharitis status post uncomplicated LASIK refractive surgery reported chronic conjunctival hyperemia for 15 years prior to undergoing a cosmetic eye whitening procedure. He presented to our clinic 12 months after the cosmetic eye whitening procedure with progressive bilateral necrotizing scleritis and scleral calcification. Conclusions Chronic conjunctival hyperemia may prompt patients to seek surgical correction with cosmetic eye whitening procedures. However, conjunctival hyperemia secondary to tear deficiency and evaporative dry eye may predispose to poor wound healing. Serious complications including necrotizing scleritis may result from cosmetic eye whitening procedures and the use of topical mitomycin C. PMID:23514228

2013-01-01

180

Perioperative Complications of Total En Bloc Spondylectomy: Adverse Effects of Preoperative Irradiation  

PubMed Central

Background Total en bloc spondylectomy (TES) is associated with a high complication rate because it is technically demanding and involves patients compromised by cancer. Specifically, perioperative complications are more likely to occur in patients receiving preoperative irradiation. We examined the perioperative complications associated with TES in patients receiving preoperative irradiation. Methods Seventy-seven patients underwent TES between May 2010 and April 2013. We performed a retrospective review of prospectively collected data for 50 patients with metastatic tumors of the thoracic spine, excluding patients with primary spinal tumors, lumbar spinal metastasis, and combined anterior and posterior approach TES. Patients were divided into 2 groups: those with preoperative irradiation (RT-TES group, 18 patients) and those without preoperative irradiation (TES group, 32 patients). The following perioperative complications, occurring within 2 months of surgery, were compared between the groups: intraoperative dural injuries, epidural hematomas, deep surgical-site infections, postoperative cerebrospinal fluid leakage, wound dehiscence, pleural effusions, and neurological deficits. Results Significant differences in patient characteristics were not observed between the RT-TES and TES groups. Perioperative TES complications occurred in 20/50 patients (40.0%). The complication rate in the RT-TES group was 77.8% (14 out of 18), threefold higher than the 18.8% (6 out of 32) in the TES group (P<0.01). The incidence of complications, including intraoperative dural injuries, postoperative cerebrospinal fluid leakage, wound dehiscence, and pleural effusions, was significantly higher in the RT-TES group (P<0.01). Conclusion The perioperative complication rate associated with TES for spinal metastasis was significantly higher among patients receiving preoperative irradiation than among those not receiving preoperative irradiation. PMID:24893004

Yokogawa, Noriaki; Murakami, Hideki; Demura, Satoru; Kato, Satoshi; Yoshioka, Katsuhito; Hayashi, Hiroyuki; Ishii, Takayoshi; Igarashi, Takashi; Fang, Xiang; Tsuchiya, Hiroyuki

2014-01-01

181

Nursing care of donor site wounds.  

PubMed

The list of ideal donor site characteristics includes many items related to nursing care such as the ability of the dressing to minimize pain, permit patient mobility, and simplify postoperative care. Biobrane must adhere to the donor site wound bed and be allowed to dry without fluid accumulation. Coarse-mesh gauze wraps applied over the Biobrane in the operating room help maintain contact between Biobrane and the wound bed, protect the donor site from traumatic dislodgment in the early postoperative period, and serve to wick wound drainage in the first 24 hours. Twenty-four hours after surgery the nurse removes the outer dressing. The Biobrane is usually adherent to the wound, and the site is left open to dry. The primary goal of nursing care is to maintain sufficient airflow around the site. Nursing care of Biobrane-covered donor sites is uncomplicated but requires adherence to certain procedures to promote optimal donor site healing. PMID:7673321

Hansbrough, W

1995-01-01

182

Extensive intratemporal cholesteatomas: presentation, complications and surgical outcomes.  

PubMed

The purpose of the study was to review the clinical features, complications, surgical management and post-operative outcomes of medially invasive extensive cholesteatomas and intracranial complications of cholesteatoma. The retrospective review was carried out at a tertiary referral center and included 20 patients presenting with extensive intratemporal cholesteatomas between 2011 and 2013. Inclusion criteria were involvement of the labyrinth, facial nerve, posterior fossa dura and intracranial complications. The mean age of the patients was 20 years. Profuse foul-smelling otorrhoea and severe otalgia/temporal headache were the most common presenting features. Intracranial complications were observed in nine patients, most commonly temporal lobe abscess; 14/20 patients exhibited profound hearing loss. One case exhibited massive labyrinthine petrous apex cholesteatoma. Labyrinthine destruction was seen in all cases of facial nerve involvement. Management of intracranial complications preceded canal wall-down mastoidectomy with or without partial labyrinthectomy and subtotal petrosectomy (transotic) with blind sac closure for petrous cholesteatoma. Facial nerve infiltration was observed in one case, whereas eight cases exhibited gross dehiscence of the fallopian canal. Disease clearance was complete in all cases with two mortalities in patients with intracranial complications. Post-operative course was uncomplicated in all other patients apart from a case of wound dehiscence. All patients remain disease free after a minimum and maximum follow-up of 6 months and 2 years, respectively. Extensive intratemporal cholesteatomas and intracranial complications caused by them continue to pose a challenge to the management of otitis media in the current era and merit early recognition, surgical management and follow-up. PMID:24318471

Vashishth, Ashish; Singh Nagar, Tilak Raj; Mandal, Shantanu; Venkatachalam, Vellore Pattabhiram

2015-02-01

183

Granulocyte-colony stimulating factor in the prevention of postoperative infectious complications and sub-optimal recovery from operation in patients with colorectal cancer and increased preoperative risk (ASA 3 and 4)¶ Protocol of a controlled clinical trial developed by consensus of an international study group¶ Part one: rationale and hypothesis  

Microsoft Academic Search

General design: Presentation of a novel study pro- tocol to evalue the effectiveness of an immune modifier (rhG-CSF, filgrastim): prevention of postoperative infectious complications and sub-optimal recovery from operation in patients with colorectal cancer and increased preoperative risk (ASA 3 and 4). The rationale and hypothesis are present- ed in this part of the protocol of the randomised, placebo con-

W. Lorenz; B. Stinner; A. Bauhofer; M. Rothmund; I. Celik; A. Fingerhut; M. Koller; R. H. W. Lorijn; P. O. Nyström; H. Sitter; M. Schein; J. S. Solomkin; H. Troidl; J. Wyatt; D. H. Wittmann

2001-01-01

184

[Use of new materials in the treatment of chronic post-traumatic wounds].  

PubMed

Postoperative infection and the presence of osteosynthetic material in human body pose a major problem for patients and operators. Previously, it was considered that osteosynthetic material must be removed, and only then the expected full infection recovery could occur. However, removal of osteosynthetic material in unhealed fractures complicates bone fracture healing, as well as infection recovery. Nowadays, it is indicated to place an external bone fixator and in case of soft tissue recovery access to reosteosynthesis. The negative pressure wound therapy has brought new opportunities for treatment of this type of infections without the need of osteosynthetic material removal. Direct and indirect effects of negative pressure wound therapy create optimal healing conditions. Local use of new materials, transforming powder (Altrazeal) and topical hemoglobin spray (Granulox), provide and improve physiological conditions for appropriate and safe healing. PMID:25326994

Marinovi?, Marin; Spanjol, Josip; Fumi?, Nera; Bakota, Bore; Pin, Maja; Cukelj, Fabijan

2014-10-01

185

Antimicrobial and antiseptic strategies in wound management.  

PubMed

Wounds, especially chronic wounds, represent a global problem costing millions of dollars per year in developed countries and are characterised by microbial complications including local or overt infection, delayed healing and spread of multiresistant germs. Therefore, antimicrobial wound management is a major challenge that continues to require new solutions against microbes and their biofilms. As systemic antibiotics can barely penetrate into wound biofilms and topically applied ones can easily lead to sensitisation, antisepsis is the method of choice to treat germs in wounds. This brief review discusses the role of antiseptics in reducing bioburden in chronic wounds. Balancing antimicrobial potency and tolerability of antiseptic procedures is critical in wound therapy. However, antiseptics alone may not be able to achieve wound healing without addressing other factors regarding the patient's general health or the wound's physical environment. Although the precise role of bioburden in chronic wounds remains to be evaluated, planktonic as well as biofilm-bound microbes are indications for antiseptic intervention. Octenidine dihydrochloride and polyhexanide are the most effective, as well as best tolerated, antiseptics in wound management today, and new strategies to reduce bacterial wound burden and support the body's immune response are being developed. PMID:24251838

Daeschlein, Georg

2013-12-01

186

Magnetic resonance imaging of the postoperative spine.  

PubMed

Magnetic resonance (MR) imaging is an excellent technique for evaluating the postoperative spine when the patient has chronic or recurrent symptoms. Potential causes of pain following lumbar surgery include arachnoiditis, stenosis, epidural fibrosis and disc herniations, pseudomeningocele, and infection. The postoperative cervical spine may be complicated by hematoma, canal or foraminal stenosis, disc herniation, and cord abnormality. This article reviews standard imaging protocols, the normal postoperative appearance of the spine, and the characteristic imaging findings for each of the abnormal postoperative conditions. PMID:11371319

Ross, J S

2000-01-01

187

Dressings and Products in Pediatric Wound Care  

PubMed Central

Significance: The increasing complexity of medical and surgical care provided to pediatric patients has resulted in a population at significant risk for complications such as pressure ulcers, nonhealing surgical wounds, and moisture-associated skin damage. Wound care practices for neonatal and pediatric patients, including the choice of specific dressings or other wound care products, are currently based on a combination of provider experience and preference and a small number of published clinical guidelines based on expert opinion; rigorous evidence-based clinical guidelines for wound management in these populations is lacking. Recent Advances: Advances in the understanding of the pathophysiology of wound healing have contributed to an ever-increasing number of specialized wound care products, most of which are predominantly marketed to adult patients and that have not been evaluated for safety and efficacy in the neonatal and pediatric populations. This review aims to discuss the available data on the use of both more traditional wound care products and newer wound care technologies in these populations, including medical-grade honey, nanocrystalline silver, and soft silicone-based adhesive technology. Critical Issues: Evidence-based wound care practices and demonstration of the safety, efficacy, and appropriate utilization of available wound care dressings and products in the neonatal and pediatric populations should be established to address specific concerns regarding wound management in these populations. Future Directions: The creation and implementation of evidence-based guidelines for the treatment of common wounds in the neonatal and pediatric populations is essential. In addition to an evaluation of currently marketed wound care dressings and products used in the adult population, newer wound care technologies should also be evaluated for use in neonates and children. In addition, further investigation of the specific pathophysiology of wound healing in neonates and children is indicated to promote the development of wound care dressings and products with specific applications in these populations. PMID:24761363

King, Alice; Stellar, Judith J.; Blevins, Anne; Shah, Kara Noelle

2014-01-01

188

Local flap therapy for the treatment of pressure sore wounds.  

PubMed

The aim of this study was to analyse the effectiveness of an interdisciplinary cooperation between conservative and surgical disciplines for the treatment of pressure sores (PS). From January 2004 to December 2005, a single-centre study was performed with paraplegic and tetraplegic patients presenting with PS grades III-V. Outcome measures were defect size, grade, method of reconstruction, complication and recurrence rate as well as average length of hospitalisation. A total of 119 patients aged 22-84?years with totally 170 PS were included. The most common PS were located in the ischial region (47%), followed by the sacral (18%), trochanteric (11%), foot (9%) and the malleolar (8%) regions. Defect sizes ranged between 4 and 255?cm(2) . Grade IV was the most common PS (68%), followed by grade III (30%) and grade V (2%) PS. For wound closure, fasciocutaneous flaps were used most frequently (71%), followed by skin grafts (10%) and myocutaneous flaps (7%). Postoperative follow-up ranged between 6 and 38?months. The overall complication and recurrence rate was 26% and 11%, respectively. If no complication occurred, the average duration of hospitalisation stay after the first debridement was 98?±?62?days. In conclusion, our treatment concept is reliable, effective and results in a low recurrence rate. The complication rate, even though favourable when compared with the literature, still needs to be improved. PMID:24131657

Wettstein, Reto; Tremp, Mathias; Baumberger, Michael; Schaefer, Dirk J; Kalbermatten, Daniel F

2013-10-17

189

The Wound-Healing Process  

Microsoft Academic Search

Diabetes is on the rise in the United States and the rest of the world, and its complications are even more evident in the\\u000a aging population. Among the most severe complications of diabetes are impaired circulation and wound healing. The former condition,\\u000a together with peripheral neuropathy, contributes to an insensate, poorly vascularized lower extremity that is prone to the\\u000a development

Jeffrey M. Davidson; Luisa DiPietro

190

Management of Sports-Induced Skin Wounds  

PubMed Central

Skin wounds are common in sports but are rarely documented by the certified athletic trainer. The literature is unclear about wound types, and none of the articles reviewed reported frequencies. The purpose of this paper is to discuss the frequency of common athletic skin wounds and their specific management. Management of skin wounds can sometimes be problematic. Hydrogen peroxide has been used on wounds since 1947, yet some researchers report that hydrogen peroxide and iodophor solution can delay or interfere with wound healing, or cause damage to the wounded area if use is intense and prolonged. Occlusive dressings have been reported to have considerable advantage in maintaining a moist wound bed and in decreasing healing time. Infection rates beneath occlusive dressings, however, are similar to those associated with other types of dressings. Complications to wounds, with or without the use of occlusive dressings, such as keloids and seborrheic dermatitis, occur in low frequencies. Due to a lack of specific information about sports-induced skin wounds and their management, we recommend that standardized documentation for common wounds be developed along with further study of techniques for management. PMID:16558324

Foster, Danny T.; Rowedder, Laura J.; Reese, Steven K.

1995-01-01

191

Prevention and Management of Nonhealing Perineal Wounds  

PubMed Central

Complex perineal wounds are at risk for nonhealing. High-risk procedures include proctectomy for Crohn disease, anal cancer and radiated distal rectal cancers. A basic understanding of both patient and procedural risk factors is helpful in planning and executing operative procedures for these conditions and to minimize associated wound complications. Diabetes, obesity, and malnutrition may contribute to wound breakdown and failure to heal. Delaying operative intervention, adding nutritional supplementation, and employing intestinal diversion as well as myocutaneous flaps may help optimize conditions for wound healing. PMID:24436658

Kamrava, Allen; Mahmoud, Najjia N.

2013-01-01

192

Emerging topics in cutaneous wound repair.  

PubMed

The intervention strategies in various types of skin wounds include several treatment programs that depend on the identified disease. Several factors such as aging, defective nutrition, traumatism, atherosclerosis, and diabetes may contribute to the formation of a wound that has no tendency to heal due to a defective and complicated repair process. The numerous advances in the understanding of the wound-healing process in both acute and chronic lesions have been recently described. The purpose of this paper is to describe relatively new approaches as viable alternatives to current wound-healing therapies. The future challenges for both the best targeting and optimization of these potential treatments are also described. PMID:22758645

Valacchi, Giuseppe; Zanardi, Iacopo; Sticozzi, Claudia; Bocci, Velio; Travagli, Valter

2012-07-01

193

Radiology of colonic interposition and its associated complications  

Microsoft Academic Search

A retrospective review of the medical records, pathology reports, and radiographic studies of 81 patients who had undergone colonic interposition was undertaken, with special attention to postoperative complications. Both early (within 30 days postoperatively, 81 patients) and late (later than 30 days postoperatively, 57 patients) complications were reviewed. Early findings included anastomotic narrowing (18 patients), anastomotic leak (13), aspiration (11),

Lee R. Christensen; Jonathan Shapir

1986-01-01

194

Sutureless closure of scleral wounds in animal models by the use of laser welded biocompatible patches  

NASA Astrophysics Data System (ADS)

The common procedures used to seal the scleral or conjunctival injuries are based on the traditional suturing techniques, that may induce foreign body reaction during the follow up, with subsequent inflammation and distress for the patient. In this work we present an experimental study on the laser welding of biocompatible patches onto ocular tissues, for the closure of surgical or trauma wounds. The study was performed ex vivo in animal models (porcine eyes). A penetrating perforation of the ocular tissue was performed with a surgical knife. The wound walls were approximated, and a biocompatible patch was put onto the outer surface of the tissue, in order to completely cover the wound as a plaster. The patches were prepared with a biocompatible and biodegradable polymer, showing high mechanical strength, good elasticity, high permeability for vapour and gases and rather low biodegradation. During preparation, Indocyanine Green (ICG) was included in the biopolymeric matrix, so that the films presented high absorption at 810 nm. Effective adhesion of the membranes to the ocular tissues was obtained by using diode laser light emitted from an 810 nm diode laser and delivered by means of a 300 ?m core diameter optical fiber, to produce spots of local film/tissue adhesion, due to the photothermal effect at the interface. The result is an immediate closure of the wound, thus reducing post-operative complications due to inflammation.

Rossi, Francesca; Matteini, Paolo; Menabuoni, Luca; Lenzetti, Ivo; Pini, Roberto

2011-03-01

195

Wound Healing Essentials: Let There Be Oxygen  

PubMed Central

The state of wound oxygenation is a key determinant of healing outcomes. From a diagnostic standpoint, measurements of wound oxygenation are commonly used to guide treatment planning such as amputation decision. In preventive applications, optimizing wound perfusion and providing supplemental O2 in the peri-operative period reduces the incidence of post-operative infections. Correction of wound pO2 may, by itself, trigger some healing responses. Importantly, approaches to correct wound pO2 favorably influence outcomes of other therapies such as responsiveness to growth factors and acceptance of grafts. Chronic ischemic wounds are essentially hypoxic. Primarily based on the tumor literature, hypoxia is generally viewed as being angiogenic. This is true with the condition that hypoxia be acute and mild to modest in magnitude. Extreme near-anoxic hypoxia, as commonly noted in problem wounds, is not compatible with tissue repair. Adequate wound tissue oxygenation is required but may not be sufficient to favorably influence healing outcomes. Success in wound care may be improved by a personalized health care approach. The key lies in our ability to specifically identify the key limitations of a given wound and in developing a multifaceted strategy to specifically address those limitations. In considering approaches to oxygenate the wound tissue it is important to recognize that both too little as well as too much may impede the healing process. Oxygen dosing based on the specific need of a wound therefore seems prudent. Therapeutic approaches targeting the oxygen sensing and redox signaling pathways are promising. PMID:19152646

Sen, Chandan K.

2009-01-01

196

Negative Pressure Wound Therapy With Low Pressure and Gauze Dressings to Treat Diabetic Foot Wounds.  

PubMed

This study was a prospective cohort study to evaluate negative pressure wound therapy (NPWT) with low pressure and a gauze dressing to treat diabetic foot wounds. Thirty patients with diabetic foot wounds were consented to a prospective study to evaluate wound closure and complications to evaluate NPWT with low pressure (80 mmHg) and a gauze dressing interface (EZCare, Smith and Nephew) for up to 5 weeks. NPWT was changed 3 times a week. Study subjects were evaluated once a week for adverse events and wound measurements. Of study subjects, 43% attained at least a 50% wound area reduction after 4 weeks of therapy. Our results suggest that a high rate of wound closure could be expected with low pressure and a gauze interface. PMID:24876586

Lavery, Lawrence A; Murdoch, Douglas P; Kim, Paul J; Fontaine, Javier La; Thakral, Gaurav; Davis, Kathryn E

2014-02-18

197

Postoperative doppler evaluation of liver transplants.  

PubMed

Doppler ultrasound plays an important role in the postoperative management of hepatic transplantation, by enabling early detection and treatment of various vascular complications. This article describes the normal Doppler findings following liver transplantation and reviews the imaging appearances of various vascular complications associated with it. The article also discusses transient waveform abnormalities, often seen on a post-transplant Doppler examination, and the importance of differentiating them from findings suggestive of ominous vascular complications. PMID:25489129

Sanyal, Rupan; Zarzour, Jessica G; Ganeshan, Dakshina M; Bhargava, Puneet; Lall, Chandana G; Little, Mark D

2014-10-01

198

US of the Postoperative Penis  

Microsoft Academic Search

A variety of surgical procedures has been developed to manage different penile pathologies and malformations. Penile surgery\\u000a produces anatomical and vascular changes that can be successfully investigated with grey scale and color Doppler ultrasonography.\\u000a In particular, early and late surgical complications can be identified, and postoperative changes of the normal ultrasound\\u000a appearance of the penile envelopes, of the penile bodies

Michele Bertolotto; Paola Martingano; Andrea Spadacci; Maria Assunta Cova

199

[Postoperative delirium among older people].  

PubMed

Delirium (acute confusional state) is a common and disabling complication among surgical older people. It is often underdiagnosed and undertreated. Its incidence varies by type of intervention and it is associated with several complications such as functional impairment, cognitive dysfunction, prolonged hospitalization and institutionalization. These increase hospitalization costs and the risk of death. There are precipitating and predisposing risk factors, which increase the susceptibility for postoperative delirium. This condition should be considered as a syndrome of epidemiological importance, which needs to be prevented or treated in a timely manner through a multidisciplinary intervention. The perioperative care of elderly patients involves different medical specialties and is a subject of general knowledge. PMID:25117039

Vega P, Eduardo; Nazar J, Claudio; Rattalino F, Marcos; Pedemonte T, Juan; Carrasco G, Marcela

2014-04-01

200

Topically Applied Cmt2 Enhances Wound Healing in Streptozotocin Diabetic Rat Skin  

Microsoft Academic Search

Delayed wound healing is one of the complications of diabetes mellitus, exhibited by increased wound collagenase and decreased granulation tissues. The current study compared wound healing in normal and diabetic rats, and the effects of topically applied 1 % or 3% concentrations of chemically modified tetracycline-2 (CMT-2) on 6-mm circular full-thickness skin wounds healed by secondary intention. On day 7

N. S. Ramamurthy; A. J. Kucine; S. A. McClain; T. F. McNamara; L. M. Golub

1998-01-01

201

Complications of Medial Unicompartmental Knee Arthroplasty  

PubMed Central

Background We report intra- and postoperative complications of unicompartmental knee arthroplasty (UKA). Methods This study was conducted on 246 cases of UKA which were performed for degenerative osteoarthritis confined to the medial compartment, from May 2002 to May 2010, for which follow-up periods longer than one year were available. Complications were divided into intra- and postoperative complications. Pre- and postoperative clinical scores, the range of motion, and radiologic findings were analyzed. Results Complications developed in a total of 24 cases (9.8%, 24/246). Among them, 6 cases had intraoperative complications while 18 had postoperative complications. Among the 6 intraoperative complications, one fracture of the medial tibial condyle, two fractures of the intercondylar eminence, one rupture of the medial collateral ligament, one widening of the peg hole leading to femoral component malposition and late failure, and one total knee arthroplasty (TKA) conversion of a large bony defect of tibial avascular necrosis were observed. Among the 18 postoperative complications, four cases of aseptic loosening of the femoral component, one soft tissue impingement due to malalignment, nine cases of polyethylene bearing dislocation, one case of suprapatellar bursitis, one periprosthetic fracture, one TKA conversion due to medial component overhanging, and one TKA conversion due to pain of unexplained cause were observed. Conclusions The mid-term clinical outcomes of UKA were excellent in our study. However, the incidence of complications was very high (9.8%). To prevent intra- and postoperative complications, proper selection of the patients and accurate surgical techniques are required. PMID:25436058

Ji, Jong Hun; Park, Sang Eun; Song, In Soo; Kang, Hanvit; Ha, Ji Yoon

2014-01-01

202

[Complications in pediatric anesthesia].  

PubMed

As in adult anesthesia, morbidity and mortality could be significantly reduced in pediatric anesthesia in recent decades. This fact cannot conceal the fact that the incidence of anesthetic complications in children is still much more common than in adults and sometimes with a severe outcome. Newborns and infants in particular but also children with emergency interventions and severe comorbidities are at increased risk of potential complications. Typical complications in pediatric anesthesia are respiratory problems, medication errors, difficulties with the intravenous puncture and pulmonal aspiration. In the postoperative setting, nausea and vomiting, pain, and emergence delirium can be mentioned as typical complications. In addition to the systematic prevention of complications in pediatric anesthesia, it is important to quickly recognize disturbances of homeostasis and treat them promptly and appropriately. In addition to the expertise of the performing anesthesia team, the institutional structure in particular can improve quality and safety in pediatric anesthesia. PMID:25004872

Becke, K

2014-07-01

203

[Postoperative infection with Mycobacterium chelonae].  

PubMed

A 70-year-old patient developed Mycobacterium chelonae infection at a donor vein graft site following cardiac bypass surgery. The infection presented as fibrinous, necrotic ulcerations in the scar area. Mycobacterium chelonae and mycobacterium fortuitum are atypical mycobacteria and have been described previously causing infections after injections or surgical procedures. Infection of donor vein graft site is a rare complication after cardiac surgery. As mycobacterium chelonae cannot be cultivated on normal culture media, delayed wound healing might be disinterpretated as a primary wound healing disorder. Treatment of atypical myobacteriosis includes antibiotics, local heat therapy and surgical excision. Clarithromycin is the antibiotic of choice. We obtained complete healing after two months of Clarithromycin treatment, combined with heat therapy. PMID:9036143

Engelhardt, E; Feldmann, R; Skaria, A; Salomon, D

1996-11-01

204

Efficacy and safety using autotransfusion system with postoperative shed blood following total knee arthroplasty in haemophilia.  

PubMed

The purpose of this study was to evaluate the efficacy and safety of postoperative wound drain salvage and autotransfusion system in haemophilic patients undergoing elective total knee arthroplasty (TKA). No literature exists on reinfusing drained blood in patient with haemophilia undergoing TKA. Eighty-eight knees of 66 patients received cemented TKA due to end-stage haemophilic arthropathy (group I; with autotransfusion in 59 knees, group II; without autotransfusion in 29 knees). In group I, the postoperative shed blood was transfused within 6 h after surgery. The amount of blood drainage and reinfused blood, rate and amount of allogenic transfusion, postoperative change of haemoglobin level, prothrombin time (PT) and activated partial thromboplastin time were analysed. The mean postoperative blood drainage was 932 ± 479 mL in group I and 830 ± 492 mL in group II (P > 0.05). The mean volume of blood reinfused was 530 ± 265 mL in group I. Allogenic transfusion was needed in six knees (10.2%) of group I and eight knees (27.6%) of group II (P = 0.036). The mean volume of allogenic transfusion was 480 ± 49 mL in group I and 1041 ± 691 mL in group II (P > 0.05). Changes of all the laboratory results before and after TKA showed no statistically significant difference except PT was prolonged in group I (P = 0.008) at postoperative day 1. Moreover, there was no significant complication related to either reinfusion or allogenic transfusion in both groups. This study showed that reinfusion of drained blood is a simple, safe and efficacious method in patients with haemophilia undergoing TKA. PMID:23902302

Kang, D G; Khurana, S; Baek, J H; Park, Y S; Lee, S H; Kim, K I

2014-01-01

205

Superior mesenteric vein thrombosis – unusual management of unusual complication of Whipple procedure  

PubMed Central

INTRODUCTION Pancreatoduodenectomy is an extensive procedure carrying risk of a number of postoperative complications. Of these the most common are surgical site infections (SSI), bleeding, delayed gastric emptying, and anastomotic leakage. However, the most serious complications are ones, that are rare, clinically hardly diagnosed, and if untreated, leading to the death of a patient. Among the latter complications is thrombosis of superior mesenteric vein. Its clinical signs are unspecific and diagnostics complicated. Treatment requires aggressive approach. If this is absent, intestinal necrosis with septic state, Multiple Organ Dysfunction Syndrome (MODS) and Multiple Organ Failure (MOF) lead to a death of a patient. PRESENTATION OF CASE Authors present a case of a patient after pancreatoduodenectomy, complicated by the thrombosis of superior mesenteric vein. Patient was managed by resection of the necrotic bowel, venous decompression by venous bypass from superior mesenteric vein to the right ovarian vein, and open abdomen with negative pressure wound therapy (NPWT). Patient suffered severe abdominal sepsis with need for intensive organ support. Abdomen was definitely closed on fourth NPWT redress. Patient healed without any further complications, is well and was released to the ambulatory setting. DISCUSSION Superior mesenteric vein (VMS) thrombosis is a rare complication. It diagnosis requires high level of vigilance and once diagnosed, aggressive therapy is essential. Two goals of surgical treatment exist: resection of the necrotic bowel and facilitation of the blood outflow. CONCLUSION Mesenteroovarian anastomosis is one of the options in treatment of thrombosis of VMS if thrombectomy is not feasible. PMID:25255475

Hu?an, Martin; Bartko, Christian; Slyško, Roman; Seká?, Jaroslav; Prochotský, Augustín; Majeský, Ivan; Škultéty, Ján

2014-01-01

206

Management of complications after laparoscopic Nissen's fundoplication: a surgeon's perspective  

PubMed Central

Introduction Gastro-oesophageal reflux disease (GORD) is a common problem in the Western countries, and the interest in the minimal access surgical approaches to treat GORD is increasing. In this study, we would like to discuss the presentations and management of complications we encountered after Laparoscopic Nissen's fundoplication in our District General NHS Hospital. The aim is to recognise these complications at the earliest stage for effective management to minimise the morbidity and mortality. Methods 301 patients underwent laparoscopic treatment for GORD by a single consultant surgeon in our NHS Trust from September 1999. The data was prospectively collected and entered into a database. The data was retrospectively analysed for presentations for complications and their management. Results Surgery was completed laparoscopically in all patients, except in five, where the operation was technically difficult due to pre-existing conditions. The complications we encountered during surgery and follow-up period were major intra-operative bleeding (n = 1, 0.33%), severe post-operative nausea and vomiting (n = 1, 0.33%), wound infection (n = 3, 1%), port-site herniation (n = 1, 0.33%), wrap-migration (n = 2, 0.66%), wrap-ischaemia (n = 1, 0.33%), recurrent regurgitation (n = 4, 1.32%), recurrent heartburn (n = 29, 9.63%), tension pneumothorax (n = 2, 0.66%), surgical emphysema (n = 8, 2.66%), and port-site pain (n = 4, 1.33%). Conclusion Minimal access approach to treat GORD has presented with some specific and unique complications. It is important to recognise these complications at the earliest possible stage as some of these patients may present in an acute setting requiring emergency surgery. All members of the department, and not just the members of the specialised team, should be aware about these complications to minimise the morbidity and mortality. PMID:19193220

Singhal, Tarun; Balakrishnan, Santosh; Hussain, Abdulzahra; Grandy-Smith, Starlene; Paix, Andrew; El-Hasani, Shamsi

2009-01-01

207

Use of Cryopreserved, Particulate Human Amniotic Membrane and Umbilical Cord (AM/UC) Tissue: A Case Series Study for Application in the Healing of Chronic Wounds.  

PubMed

Human amniotic membrane and umbilical cord tissues (AM/UC) are fetal tissues that contain proteins, cytokines, and growth factors that, when transplanted, can modulate inflammation and promote healing. Lyophilized, particulate AM/UC tissues can be used as wound coverings for chronic dermal ulcers or defects to promote granulation tissue formation and rapid re-epithelialization. This study reviews a case series of 5 patients presenting with chronic nonhealing wounds that received particulate AM/UC tissues (NEOX® FLO, Amniox Medical, Atlanta, GA). For all cases, wounds were debrided in the office setting and a single application of lyophilized particulate was used with minimal additional dressings. The lyophilized AM/UC tissue was placed within the wound bed and a dressing consisting of Adaptic®, 2x2 or 4x4 (Systagenix, Quincy, MA), Kling® (Johnson & Johnson, New Brunswick, NJ), and ACE™ (3M, St. Paul, MN) wrap were applied. Dressings were kept in place until weekly follow-up appointments in which a new Adaptic, 2x2 and Kling were applied. Overall, healing of wounds was noted to have a mean of 5 weeks to complete epithelialization. Upon complete healing patients were able to return to planned postoperative care and rehabilitation. Wound complications occur despite the best standard of care. Chronic wounds that remain weeks after surgery inhibit patients from progressing to physical rehabilitation and significantly affect patients both physically and mentally. These case presentations demonstrate how use of human AM/UC tissue may help wounds heal quickly and help patients return to normal function. PMID:25396322

Swan, Jennifer

2014-11-01

208

Scars and Wounds  

MedlinePLUS

... more References Previous Topic Prostheses Next Topic Seizures Scars and wounds A wound is a physical injury ... protect it from infection and help it heal. Scars are healed wounds. What to look for Redness ...

209

Wound care centers  

MedlinePLUS

A wound care center, or clinic, is a medical facility for treating wounds that don't heal. You have a ... a team of health care providers trained in wound care. Your team may include: Physicians who oversee your ...

210

Proper Care for Wounds  

MedlinePLUS Videos and Cool Tools

... Motor Vehicle Safety En Español About Emergencies Wound Care Proper Care For Wounds Most cuts are minor but it is still important to properly care for them. Wound Care Dr. David Ross, emergency ...

211

Integrated negative pressure wound therapy system with volumetric automated fluid instillation in wounds at risk for compromised healing.  

PubMed

Nearly all wounds are at risk for compromised healing due to excessive exudation, oedema, contaminants and presence of inflammatory mediators. Compromised wounds have the potential to develop complications, such as infection, which may lead to delayed wound healing, prolonged hospitalisation and more frequent readmissions. It is generally believed that the wound advances from contamination to colonisation when the bacteria on the wound's surface begin to replicate and increase their metabolic activity. Heavy bacterial bioburden increases the metabolic requirements, stimulates a proinflammatory environment and encourages the in-migration of monocytes, macrophages and leukocytes - all of which can negatively impact wound healing. Bacteria also secrete harmful cytokines which can lead to vasoconstriction and decreased blood flow. Thus, controlling or preventing infections is essential for normal wound healing process to occur. While the mainstay of treating wound infection has historically included intravenous, oral and/or topical antimicrobials in addition to frequent gauze dressing changes, a shift towards wound management with advanced modalities, such as negative pressure wound therapy (NPWT), has occurred during the past decade. This review will provide expert opinion and scientific support for the use of NPWT with instillation (NPWTi; V.A.C. Instill® Wound Therapy and V.A.C. VeraFlo™ Therapy, KCI USA, Inc., San Antonio, TX) for the treatment of at-risk and complicated wounds. PMID:22727137

Gabriel, Allen

2012-08-01

212

Role of Fixation and Postoperative Regimens in the Long-Term Outcomes of Distal Chevron Osteotomy: A Randomized Controlled Two-by-Two Factorial Trial of 100 Patients.  

PubMed

The necessity of chevron osteotomy fixation is controversial and evidence for the effectiveness of postoperative regimens is limited. In a prospective, randomized study, we compared the long-term results of 2 operative techniques (osteotomy fixation versus no fixation) and 2 postoperative regimens (a soft cast versus an elastic bandage) in 100 patients who underwent surgery for hallux valgus. Clinical evaluations with the American Orthopaedic Foot and Ankle Society (AOFAS) scale scoring were performed at baseline and 6 weeks, 6 months, 1 year, and a mean of 7.9 years postoperatively. The mean AOFAS function score were better in the group treated without osteotomy fixation and with an elastic bandage at 6 weeks postoperatively, but the differences then disappeared. The total AOFAS scores improved significantly in all 4 subgroups during the first 12 months; however, in the long term, some deterioration occurred. In the AOFAS scores, the average function, alignment, and total points were significantly worse when the preoperative hallux valgus angles exceeded 30°. The incidence of complication was low (1%); there was 1 superficial wound infection. The AOFAS score did not differ statistically among the groups in our population. An elastic bandage for postoperative treatment is recommended. The risk of recurrence is greater and functional result worse if the preoperative hallux valgus angle exceeds 30°. PMID:25441855

Pentikäinen, Ilkka; Piippo, Jouni; Ohtonen, Pasi; Junila, Juhani; Leppilahti, Juhana

2014-10-24

213

Dermal wound transcriptomic responses to Infection with Pseudomonas aeruginosa versus Klebsiella pneumoniae in a rabbit ear wound model  

PubMed Central

Background Bacterial infections of wounds impair healing and worsen scarring. We hypothesized that transcriptome analysis of wounds infected with Klebsiella pneumoniae (K.p.) or Pseudomonas aeruginosa (P.a.) would indicate host-responses associated with the worse healing of P.a.- than K.p.-infected wounds. Methods Wounds created on post-operative day (POD) 0 were infected during the inflammatory phase of healing on POD3 and were harvested on POD4 for microarray and transcriptome analysis. Other wounds received topical antibiotic after infection for 24 hours to promote biofilm development, and were harvested on POD6 or POD12. Results Wounds infected for 24 hours, relative to uninfected wounds, elevated transcripts of immune-response functions characteristic of infiltrating leukocytes. But P.a.-infected wounds elevated many more transcripts and to higher levels than K.p.-infected wounds. Coincidently, suppressed transcripts of both wounds enriched into stress-response pathways, including EIF2 signaling; however, this was more extensive for P.a.-infected wounds, including many-fold more transcripts enriching in the ‘cell death’ annotation, suggesting resident cutaneous cell toxicity in response to a more damaging P.a. inflammatory milieu. The POD6 wounds were colonized with biofilm but expressed magnitudes fewer immune-response transcripts with no stress-response enrichments. However, elevated transcripts of P.a.-infected wounds were inferred to be regulated by type I interferons, similar to a network unique to P.a.-infected wounds on POD4. On POD12, transcripts that were more elevated in K.p.-infected wounds suggested healing, while transcripts more elevated in P.a.-infected wounds indicated inflammation. Conclusions An extensive inflammatory response of wounds was evident from upregulated transcripts 24 hours after infection with either bacterium, but the response was more intense for P.a.- than K.p.-infected wounds. Coincidently, more extensive down-regulated transcripts of P.a.-infected wounds indicated a stronger “integrated stress response” to the inflammatory milieu that tipped more toward cutaneous cell death. Unique to P.a.-infected wounds on POD4 and POD6 were networks inferred to be regulated by interferons, which may result from intracellular replication of P.a. These data point to specific downregulated transcripts of cells resident to the wound as well as upregulated transcripts characteristic of infiltrating leukocytes that could be useful markers of poorly healing wounds and indicators of wound-specific treatments for improving outcomes. PMID:25035691

2014-01-01

214

CO2 Microlaser Treatment For Post Operative Complication Following Radical Middle Ear Surgery  

NASA Astrophysics Data System (ADS)

It has been difficult to treat chronic otorrhea of post-operative complication following middle ear surgery. Low power CO2 microlaser surgery was applied in 14 cases of infectious chronic otorrher assocoated with radical mastoidectomy of middle ear cholesteatoma. Laser was irradiated at the low level from 1 to 5 watts by defocused beam.Otorrhea was completely stopped in 7 cases and remarkedly decreased in 6 cases. This treatment showed remarkable improvement of infectious region in the middle ear cavity and induced good reepithelization within 3 weeks without any operative complication. This results indicated low power CO2 laser treatment was very safe and usefull for removal infectious soft tissue as well as wound healing in the opened middle ear cavity compared with conventional treatment.

Fujiwara, Hisao

1989-09-01

215

Obesity and early complications following reduction mammaplasty: an analysis of 4545 patients from the 2005-2011 NSQIP datasets.  

PubMed

Reduction mammoplasty is a proven treatment for symptomatic macromastia, but the association between obesity and early postoperative complications is unclear. The purpose of this study was to perform a population level analysis in an effort to determine the impact of obesity on early complications after reduction mammaplasty. This study examined the 2005-2011 NSQIP datasets and identified all patients who underwent reduction mammoplasty. Patients were then categorised according to the World Health Organisation obesity classification. Demographics, comorbidities, and perioperative risk factors were identified among the NSQIP variables. Data was then analysed for surgical complications, wound complications, and medical complications within 30 days of surgery. In total, 4545 patients were identified; 54.4% of patients were obese (BMI > 30 kg/m(2)), of which 1308 (28.8%) were Class I (BMI = 30-34.9 kg/m(2)), 686 (15.1%) were Class II (BMI = 35-39.9 kg/m(2)), and 439 (9.7%) were Class III (BMI > 40 kg/m(2)). The presence of comorbid conditions increased across obesity classifications (p < 0.001), with significant differences noted in all cohort comparisons except when comparing class I to class II (p = 0.12). Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. Examining any complication, a significant increase was noted with increasing obesity class (p < 0.001). This was further isolated when comparing morbidly obese patients to non-obese (p < 0.001), class I (p < 0.001), and class II (p = 0.01) patients. This population-wide analysis - the largest and most heterogeneous study to date - has demonstrated that increasing obesity class is associated with increased early postoperative complications. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. PMID:24506446

Nelson, Jonas A; Fischer, John P; Chung, Cyndi U; West, Ari; Tuggle, Charles T; Serletti, Joseph M; Kovach, Stephen J

2014-10-01

216

Effectiveness of pre-peritoneal continuous wound infusion with lidocaine for pain control following ovariohysterectomy in dogs.  

PubMed

This study compared the post-operative analgesic efficacy of continuous lidocaine administration with that of intramuscular (IM) methadone in dogs undergoing ovariohysterectomy. Thirty-eight dogs were divided randomly into two groups. Following surgery, the lidocaine group (L) received a continuous lidocaine infusion (2?mg/kg/h) through a wound catheter inserted in the pre-peritoneal space; the control group (C) received methadone (0.2?mg/kg IM). A dynamic and interactive visual analogue scale (DIVAS), the Scale-Form Glasgow Composite Measure Scale (CMPS-SF), mechanical wound thresholds, heart rate, respiratory rate and blood pressure were assessed pre-operatively and 2, 4, 6, 18, and 24?h after surgery. The presence of the wound catheter prevented the evaluator from remaining blinded to group allocations. Plasma lidocaine and cortisol levels were measured 2, 6, 18, and 24?h after surgery. There were no intergroup differences in any pain assessment scale scores at any time point. Stable intravenous lidocaine levels were observed. Four animals in the control group but none in the lidocaine group required rescue analgesia. There were no differences in complication rates between groups. Continuous locoregional lidocaine delivered via a wound catheter between the parietal peritoneum and abdominal muscle offers effective analgesia in dogs during ovariohysterectomy and appears to be a promising analgesic option in veterinary surgery. PMID:25257353

Morgaz, Juan; Muñoz-Rascón, Pilar; Serrano-Rodríguez, Juan Manuel; Navarrete, Rocío; Domínguez, Juan Manuel; Fernández-Sarmiento, José Andrés; Gómez-Villamandos, Rafael J; Serrano, Juan Manuel; Granados, María Del Mar

2014-12-01

217

A Look at Bioengineering: Wound Dressings  

E-print Network

A Look at Bioengineering: Wound Dressings................................................................................................................................................. 3 Wound dressing kit contents ............................................................................................................. 4 INTRODUCTION Wounds and Wound Dressings 101

Virginia Tech

218

Topical antimicrobial toolkit for wound infection.  

PubMed

Increased bacterial burden and formation of biofilm has been recognized as one of the key factors contributing to delayed wound healing. There is a toolbox of topical antimicrobial wound dressings that incorporate silver, iodine, polyhexamethylene biguanide, methylene blue/gentian violet, and honey. This article reviews a diverse range of evidence to discuss the advantages and disadvantage of topical antimicrobial dressings. Discussion will provide guidance on when and how to use topical antimicrobial dressings to achieve optimal outcomes and cost-effective wound care. Chronic wounds do not follow a predictable and expected healing trajectory, and they may persist for months or years due to underlying disease processes, recurrent injury, and comorbidities.1 With an aging population and increased prevalence of chronic diseases, the majority of wounds are refractory to healing, placing a significant burden on the health system and individual patients. Bacterial burden and biofilm have been recognized as key factors contributing to persistent inflammation, tissue destruction, delayed wound healing, and other serious complications (especially in individuals who are frail and immune-compromised).2 It has been demonstrated that when bacterial growth reaches a critical threshold of 105 bacteria per gram of tissue, bacterial toxins can cause tissue damage in the superficial wound compartment, delaying healing.2 In the literature, this phenomenon is referred to as critical colonization, increased bacterial burden, superficial infection, or localized infection. According to a recent review, over 50% of chronic wounds exhibit signs and symptoms that are consistent with localized infection.3. PMID:25433174

Woo, Kevin Y; Alam, Tarik; Marin, Joseph

2014-11-01

219

Preoperative risk factors for postoperative delirium  

Microsoft Academic Search

The objective of this article was to estimate the incidence of delirium in a sample of patients undergoing elective surgery and to identify the preoperative factors most closely associated with developing this complication. Consecutive patients (n=500) underwent a full preoperative medical evaluation including assessment of cognitive and functional status. Daily evaluation on postoperative days 1 through 4 included medical record

David Litaker; Joseph Locala; Kathleen Franco; David L. Bronson; Ziad Tannous

2001-01-01

220

Video-assisted thoracic surgery complications  

PubMed Central

Video-assisted thoracic surgery (VATS) is a miniinvasive technique commonly applied worldwide. Indications for VATS are very broad and include the diagnosis of mediastinal, lung and pleural diseases, as well as large resection procedures such as pneumonectomy. The most frequent complication is prolonged postoperative air leak. The other significant complications are bleeding, infections, postoperative pain and recurrence at the port site. Different complications of VATS procedures can occur with variable frequency in various diseases. Despite the large number of their types, such complications are rare and can be avoided through the proper selection of patients and an appropriate surgical technique.

Kozak, Józef

2014-01-01

221

Video-assisted thoracic surgery complications.  

PubMed

Video-assisted thoracic surgery (VATS) is a miniinvasive technique commonly applied worldwide. Indications for VATS are very broad and include the diagnosis of mediastinal, lung and pleural diseases, as well as large resection procedures such as pneumonectomy. The most frequent complication is prolonged postoperative air leak. The other significant complications are bleeding, infections, postoperative pain and recurrence at the port site. Different complications of VATS procedures can occur with variable frequency in various diseases. Despite the large number of their types, such complications are rare and can be avoided through the proper selection of patients and an appropriate surgical technique. PMID:25561984

?ochowski, Mariusz P; Kozak, Józef

2014-12-01

222

Single dose cefotaxime plus metronidazole versus three dose cefuroxime plus metronidazole as prophylaxis against wound infection in colorectal surgery: multicentre prospective randomised study.  

PubMed Central

OBJECTIVE--To establish whether a single preoperative dose of cefotaxime plus metronidazole was as effective as a standard three dose regimen of cefuroxime plus metronidazole in preventing wound infection after colorectal surgery. DESIGN--Prospective randomised allocation to one of two prophylactic antibiotic regimens in a parallel group trial. Group sequential analyses of each 250 patients were performed. SETTING--14 District general and teaching hospitals. PATIENTS--1018 Adults having colorectal operations were randomised, of whom 943 were evaluated. Demographic features, conditions requiring surgery, and operative procedures were similar in the two groups. Most patients had surgery for carcinoma of the colon or rectum. INTERVENTIONS--Group 1 received cefotaxime 1 g intravenously plus metronidazole 500 mg intravenously preoperatively. Group 2 received cefuroxime 1.5 g intravenously plus metronidazole 500 mg intravenously preoperatively, followed by cefuroxime 750 mg intravenously plus metronidazole 500 mg intravenously eight hours and 16 hours postoperatively. MAIN OUTCOME MEASURES--Development of surgical wound infection (as evidenced by the presence of pus), death, or discharge from hospital. RESULTS--Wound condition was scored on a five point scale on alternate days until discharge or for up to 20 days postoperatively. Wound infection rates were: group 1, 32/453 (7.1%; 95% confidence interval 4.7% to 9.4%); group 2, 33/454 (7.3%; 95% confidence interval 4.9% to 9.6%). Death rates (group 1: 26/470 (5.5%); group 2: 31/471 (6.6%], the incidence of postoperative complications, the median duration of hospital stay (12 days), and antibiotic tolerance were all similar in the two groups. Pooled data from groups 1 and 2 showed that wound infections were more frequent when minor faecal contamination had occurred at operation and when the duration of operation exceeded 90 minutes (greater than 90 min 11.2% of cases; less than 90 min 4.8%) and were associated with an extended hospital stay. CONCLUSIONS--A single preoperative dose of cefotaxime plus metronidazole is an efficacious as a three dose regimen of cefuroxime plus metronidazole in preventing wound infection after colorectal surgery and has practical advantages in eliminating the need for postoperative antibiotics. PMID:2105115

Rowe-Jones, D C; Peel, A L; Kingston, R D; Shaw, J F; Teasdale, C; Cole, D S

1990-01-01

223

Assessing the complications and effectiveness of open carpal tunnel release in a tertiary care centre in a developing country  

PubMed Central

INTRODUCTION Open surgical release for carpal tunnel syndrome is not devoid of complications and its quantitative assessment with the Boston questionnaire in a developing country had not been conducted, where, lack of facilities and surgical technique can influence the outcome. PRESENTATION OF CASE This was a prospective study in which all cases of carpal tunnel syndrome undergoing open release between June 2007 and June 2012 and who returned for follow up were included. Each patient was requested to fill out the Boston questionnaire twice both pre and post op at 3 months. All complications were recorded as well as bio-data of patients and co morbidities. Follow up was at 2 weeks and at 3 months. Those reporting complications at 3 months were further followed up until 6 months. 373 patients were included in the study. Twenty four patients developed complications. Of these, 12 experienced pain resulting from reflex sympathetic dystrophy. Three patients developed wound dehiscence, 2 cases acquired infections, 4 patients developed immediate post-operative haemorrhage and in 3 patients there was late recurrence of median nerve compression. The symptom severity score pre-operatively was 3.30 (±0.60) and it improved to 1.65 (±0.75) post-operatively indicating a significant change (p < 0.0001). The preoperative functional status score was 2.58 (±0.75) and post-op it became 1.60 (±0.80) again implying a good improvement with an effect size of 1.3. DISCUSSION All of the complications produced were well managed. The complication incidence was low. The open release procedure produced good improvement in hand function and in decreasing the symptom severity. CONCLUSION Conducting open release for carpal tunnel syndrome in a tertiary referral centre in a developing country offers a good outcome. PMID:24667074

Rahman, Khaleeq ur; Rahman, Shafiq; Khan, Adnan; Khan, Nauman Aman; Khan, Farman Ullah; khan, Rehman Ali; Farooq, Shama; Khan, Hamid

2014-01-01

224

A Rare Complication of Septorhinoplasty  

PubMed Central

Summary: Septoplasty and septorhinoplasty are common procedures. A 28-year-old woman underwent the procedure and presented postoperatively with headache and vomiting and had developed a large pneumocephalus. We describe the case in detail and analyze the possible causes and ways to prevent such a complication. PMID:25587507

2014-01-01

225

Risks and complications in rhinoplasty  

PubMed Central

Rhinoplasty is regarded to be associated with many risks as the expectations of patient and physician are not always corresponding. Besides of postoperative deformities many other risks and complications have to be considered. Reduction-rhinoplasty e.g. can cause breathing disturbances which are reported in 70% of all revision-rhinoplasty-patients. One has to be aware however that scars and loss of mucosal-sensation can also give the feeling of a “blocked nose”. The main risks of autogenous transplants are dislocation and resorption, while alloplasts can cause infection and extrusion. In this respect silicone implants can have a complication rate between 5-20%. Less complications are reported with other materials like Gore-Tex. Complications of skin and soft tissues can be atrophy, fibrosis, numbness, cysts originating from displaced mucosa or subcutaneous granulomas caused by ointment material. Postoperative swelling depends mainly on the osteotomy technique. Percutaneous osteotomies cause less trauma, but may result in visible scars. Infections are rare but sometimes life-threatening (toxic-shock-syndrome). The risk is higher, when sinus surgery and rhinoplasty are combined. Osteotomies can also cause injuries of the orbital region. Necrosis of eye-lids by infections and blindness by central artery occlusion are known. There are reports on various other risks like rhinoliquorrhea, brain damage, fistulas between sinus-cavernosus and carotid artery, aneurysms and thrombosis of the cavernous sinus. Discoloration of incisors are possible by damage of vessels and nerves. Rhinoplasty can also become a court-case in dissatisfied patients, a situation that may be called a “typical complication of rhinoplasty”. It can be avoided by proper patient selection and consideration of psychological disturbances. Postoperative deformities are considered as main risks of rhinoplasty, causing revision surgery in 5% to 15% of the cases. The analysis of postoperative deformities allowes the identification of specific risks. The most frequent postoperative deformity is the “pollybeak” when a deep naso-frontal angle, cartilaginous hump and reduced tip projection are present preoperatively. The pollybeak is the indication in about 50% of all revision rhinoplasties. Other frequent postoperative deformities are a pendant and wide nasal tip, retractions of the columella base or irregularities of the nasal dorsum. These deformities are very often combined and caused by a loss of septal support. This is why the stability of the caudal septum in septorhinoplasty is the key for a predictable result. Maintaining the position of the tip and the columella is one of the main issues to avoid typical postoperative deformities. The risks for rhinoplasty-complications can be reduced with increasing experience. A prerequisite is continuing education and an earnest distinction between complication and mistake. PMID:22073084

Rettinger, Gerhard

2008-01-01

226

Surgery-Related Complications and Sequelae in Management of Tuberculosis of Spine  

PubMed Central

Study Design Medical record-based survey. Purpose To survey the overall incidence of the intra- and postoperative complications and sequelae, and to propose the preventive measures to reduce complications in the spinal tuberculosis surgery. Overview of Literature There is no study focused on the surgery-related complications and sequelae, with some touching lightly on the clinical problems. Methods There were 901 patients in this study, including 92 paraplegics. One hundred eighty-six patients had no visible deformity, while those of 715 patients were visible. Six hundred fifty-nine patients had slight to moderate non-rigid kyphosis, and 56 had severe rigid kyphosis. Sixty-seven out of 92 paraplegics had slight to moderate non-rigid kyphosis, and 25 had severe kyphosis. There were 134 cervical and cervicodorsal lesions, 518 thoracic and thoracolumbar lesions, and 249 lumbar and lumbosacral lesions. Seven hundred sixty-four patients had primarily anterior surgeries, and 137 had posterior surgeries. Instrumentation surgery was combined in 174 patients. Results There were intra- and postoperative complications: direct large vessel and neurological injuries (cord, roots, nerves), late thrombophlebitis, various thoracic cavity problems, esophagus and ureter injuries, peritoneum perforation, ileus, wound infections, stabilization failure, increase of deformity and late adjacent joint and bone problems. Thrombophlebitis and sympatheticolysis symptoms and signs in the lower limbs were the most common complications related with anterior lumbar and lumbosacral surgeries. Kyphosis increased in 31.5% of the non-instrumented anterior surgery cases (42% in children and 21% in adults). Conclusions The safe, effective and most familiar surgical procedure should be adopted to minimize complications and sequelae. Cosmetic spinal surgery should be withheld if functional improvement could not be expected. PMID:25187860

Moon, Myung-Sang; Moon, Young-Wan; Moon, Hanlim; Kim, Sung-Sim

2014-01-01

227

Predicting pulmonary complications after pneumonectomy for lung cancer  

Microsoft Academic Search

Objectives: Patients undergoing pneumonectomy for lung cancer are thought to be at high risk for the development of postoperative pulmonary complications (PC) and these complications are associated with high mortality rates. The purpose of this study was to identify independent factors associated with increased risk for the development of postoperative PC after pneumonectomy for lung cancer, and to assess the

Francisco Javier Algar; Antonio Alvarez; Angel Salvatierra; Carlos Baamonde; José Luis Aranda; Francisco Javier López-Pujol

2003-01-01

228

The Role of Wound Healing and Its Everyday Application in Plastic Surgery: A Practical Perspective and Systematic Review  

PubMed Central

Background: After surgery it is often recommended that patients should refrain from strenuous physical activity for 4–6 weeks. This recommendation is based on the time course of wound healing. Here, we present an overview of incisional wound healing with a focus on 2 principles that guide our postoperative recommendations: the gain of tensile strength of a wound over time and the effect of mechanical stress on wound healing. Methods: A systematic search of the English literature was conducted using OVID, Cochrane databases, and PubMed. Inclusion criteria consisted of articles discussing the dynamics of incisional wound healing, and exclusion criteria consisted of articles discussing nonincisional wounds. Results: Experiments as early as 1929 laid the groundwork for our postoperative activity recommendations. Research using animal models has shown that the gain in tensile strength of a surgical wound is sigmoidal in trajectory, reaching maximal strength approximately 6 weeks postoperatively. Although human and clinical data are limited, the principles gained from laboratory investigation have provided important insights into the relationship among mechanical stress, collagen dynamics, and the time course of wound healing. Conclusion: Our postoperative activity recommendations are based on a series of animal studies. Clinical research supporting these recommendations is minimal, with the most relevant clinical data stemming from early motion protocols in the orthopedic literature. We must seek to establish clinical data to support our postoperative activity recommendations so that we can maximize the physiologic relationships between wound healing and mechanical stress. PMID:25289204

Ireton, Jordan E.; Unger, Jacob G.

2013-01-01

229

Automated Assessment of Wound Pathology in Clinical Practice  

Microsoft Academic Search

\\u000a Diabetes and its complications is increasing world-wide, making the identification and of disease progression and appropriate\\u000a management increasingly difficult. Ulceration of the lower limb is a common complication of diabetes and requires careful\\u000a assessment and follow-up of the wound characteristics. The lack of wound specialists and economic factors such as time to\\u000a attend an appointment in metropolitan clinics as well

H. F. Jelinek; M. Prinz; H. Farquhar; T. Wild

230

Enhancement of lysine acetylation accelerates wound repair.  

PubMed

In physiopathological conditions, such as diabetes, wound healing is significantly compromised and chronic complications, including ulcers, may occur. In a mouse model of skin repair, we recently reported that wound treatment with Sirtuin activators and class I HDAC inhibitors induced keratinocyte proliferation and enhanced healing via a nitric oxide (NO) dependent mechanism. We observed an increase in total protein acetylation in the wound area, as determined by acetylation of ?-tubulin and histone H3 Lysine 9. We reasoned that this process activated cell function as well as regulated gene expression to foster tissue repair. We report here that the direct activation of P300/CBP-associated factor (PCAF) by the histone acetylase activator pentadecylidenemalonate 1b (SPV-106) induced Lysine acetylation in the wound area. This intervention was sufficient to enhance repair process by a NO-independent mechanism. Hence, an impairment of PCAF and/or other GCN5 family acetylases may delay skin repair in physiopathological conditions. PMID:24265859

Spallotta, Francesco; Cencioni, Chiara; Straino, Stefania; Sbardella, Gianluca; Castellano, Sabrina; Capogrossi, Maurizio C; Martelli, Fabio; Gaetano, Carlo

2013-09-01

231

Delayed Presentation of Deep Sternal Wound Infection  

PubMed Central

Deep sternal wound infections (DSWI) are infections of the sternum, mediastinum, or the muscle, fascia and soft tissue that overlie the sternum, typically occurring within a month of cardiac surgery. They are infrequent though severe complications of cardiac surgery. Diagnosis is made by the clinical presentation of fever, chest pain, or sternal instability in the setting of wound drainage, positive wound cultures, or chest radiographic findings. We describe the case of an elderly man presenting 6 months after cardiac surgery with DSWI. Due to the atypical nature of such a late presentation, definitive therapy was delayed. Given a severely ill patient with multiple risk factors for poor wound healing, the clinician must maintain a high index of suspicion for DSWI despite a delayed presentation. PMID:24672598

Joseph, Linda; Jeanmonod, Rebecca K.

2014-01-01

232

Human amniotic membrane: a versatile wound dressing.  

PubMed Central

Human amniotic membrane proved to be a versatile and useful temporary biologic dressing in studies involving 120 patients. Wounds, both traumatic and nontraumatic in origin, responded to a protocol that allowed coverage of tissues as diverse as exposed bowel, pleura, pericardium, blood vessels, tendon, nerve and bone. Wounds unresponsive to usual therapeutic measures responded to membrane application. Ease of availability, negligible cost and facilitated wound healing make this temporary biologic dressing generally superior to either cadaver skin allograft or pigskin xenograft. Human amniotic membrane dressings are therefore a useful adjunct in the care of the complicated wound. Images FIG. 1A FIG. 1B FIG. 1C FIG. 2A FIG. 2B FIG. 3 PMID:647542

Gruss, J. S.; Jirsch, D. W.

1978-01-01

233

Systematic review of the use of honey as a wound dressing  

Microsoft Academic Search

OBJECTIVE: To investigate topical honey in superficial burns and wounds though a systematic review of randomised controlled trials. DATA SOURCES: Cochrane Library, MEDLINE, EMBASE, PubMed, reference lists and databases were used to seek randomised controlled trials. Seven randomised trials involved superficial burns, partial thickness burns, moderate to severe burns that included full thickness injury, and infected postoperative wounds. REVIEW METHODS:

Owen A Moore; Lesley A Smith; Fiona Campbell; Kate Seers; Henry J McQuay; R Andrew Moore

2001-01-01

234

World J Urol. Author manuscript Analysis of complications from 600 retroperitoneoscopic procedures of  

E-print Network

; adverse effects ; Postoperative Complications ; Retroperitoneal Space ; surgery ; Urologic Diseases ; surgery ; Urologic Surgical Procedures ; adverse effects Author Keywords Nephrectomy ; complicationsWorld J Urol. Author manuscript Page /1 10 Analysis of complications from 600 retroperitoneoscopic

Paris-Sud XI, Université de

235

Post-operative delirium in elderly patients  

PubMed Central

Delirium is a common, but an often underdiagnosed complication in the elderly following major surgery. Recognising delirium in early stages and diagnosing the condition based on established criteria can improve the outcome and management. Managing delirium with environmental, supportive and pharmacological interventions will possibly reduce the incidence and side-effects associated with post-operative delirium. The purpose of this article is to provide an over view of the current knowledge about the disease, diagnosis, pathogenesis, preventive strategies, and treatment of post-operative delirium. PMID:25024465

Vijayakumar, B; Elango, P; Ganessan, R

2014-01-01

236

Combination Short-Course Preoperative Irradiation, Surgical Resection, and Reduced-Field High-Dose Postoperative Irradiation in the Treatment of Tumors Involving the Bone  

SciTech Connect

Purpose: To assess the feasibility and outcomes of combination short-course preoperative radiation, resection, and reduced-field (tumor bed without operative field coverage) high-dose postoperative radiation for patients with solid tumors mainly involving the spine and pelvis. Methods and Materials: Between 1982 and 2006, a total of 48 patients were treated using this treatment strategy for solid tumors involving bone. Radiation treatments used both photons and protons. Results: Of those treated, 52% had chordoma, 31% had chondrosarcoma, 8% had osteosarcoma, and 4% had Ewing's sarcoma, with 71% involving the pelvis/sacrum and 21% elsewhere in the spine. Median preoperative dose was 20 Gy, with a median of 50.4 Gy postoperatively. With 31.8-month median follow-up, the 5-year overall survival (OS) rate is 65%; 5-year disease-free survival (DFS) rate, 53.8%; and 5-year local control (LC) rate, 72%. There were no significant differences in OS, DFS, and LC according to histologic characteristics. Between primary and recurrent disease, there was no significant difference in OS rates (74.4% vs. 51.4%, respectively; p = 0.128), in contrast to DFS (71.5% vs. 18.3%; p = 0.0014) and LC rates (88.9% vs. 30.9%; p = 0.0011) favoring primary disease. After resection, 10 patients experienced delayed wound healing that did not significantly impact on OS, DFS, or LC. Conclusion: This approach is promising for patients with bone sarcomas in which resection will likely yield close/positive margins. It appears to inhibit tumor seeding with an acceptable rate of wound-healing complications. Dose escalation is accomplished without high-dose preoperative radiation (likely associated with higher rates of acute wound healing delays) or large-field postoperative radiation only (likely associated with late normal tissue toxicity). The LC and DFS rates are substantially better for patients with primary than recurrent sarcomas.

Wagner, Timothy D. [Department of Radiation Oncology, Brooke Army Medical Center, Fort Sam Houston, TX (United States)], E-mail: timothy.wagner@amedd.army.mil; Kobayashi, Wendy; Dean, Susan; Goldberg, Saveli I. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Kirsch, David G. [Department of Radiation Oncology, Duke University School of Medicine, Durham, NC (United States); Suit, Herman D. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Hornicek, Francis J.; Pedlow, Francis X.; Raskin, Kevin A.; Springfield, Dempsey S. [Orthopaedic Oncology, Department of Orthopaedics, Massachusetts General Hospital, Boston, MA (United States); Yoon, Sam S. [Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA (United States); Gebhardt, Marc C. [Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA (Israel); Mankin, Henry J. [Orthopaedic Oncology, Department of Orthopaedics, Massachusetts General Hospital, Boston, MA (United States); DeLaney, Thomas F. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)

2009-01-01

237

G-CSF enhances resolution of Staphylococcus aureus wound infection in an age-dependent manner.  

PubMed

This study tested the hypothesis that heightened bacterial colonization and delayed wound closure in aged mice could be attenuated by granulocyte colony-stimulating factor (G-CSF) treatment. Previously, we reported that aged mice had elevated bacterial levels, protracted wound closure, and reduced wound neutrophil accumulation after Staphylococcus aureus wound infection relative to young mice. In aseptic wound models, G-CSF treatment improved wound closure in aged mice to rates observed in young mice. Given these data, our objective was to determine if G-CSF could restore age-associated differences in wound bacterial burden and closure by increasing wound neutrophil recruitment. Young (3- to 4-month) and aged (18- to 20-month) BALB/c mice received three dorsal subcutaneous injections of G-CSF (250 ng/50 ?L per injection) or saline control (50 ?L per injection) 30 min after wound infection. Mice were killed at days 3 and 7 after wound infection, and bacterial colonization, wound size, wound leukocyte accumulation, and peripheral blood were evaluated. At days 3 and 7 after wound infection, bacterial colonization was significantly reduced in G-CSF-treated aged mice to levels observed in saline-treated young animals. Wound size was reduced in G-CSF-treated aged animals, with no effect on wound size in G-CSF-treated young mice. Local G-CSF treatment significantly enhanced neutrophil wound accumulation in aged mice, whereas there was no G-CSF-induced change in young mice. These data demonstrate that G-CSF enhances bacterial clearance and wound closure in an age-dependent manner. Moreover, G-CSF may be of therapeutic potential in the setting of postoperative wound infection or chronic nonhealing wounds in elderly patients. PMID:23856924

Brubaker, Aleah L; Kovacs, Elizabeth J

2013-10-01

238

Improved wound management by regulated negative pressure-assisted wound therapy and regulated, oxygen- enriched negative pressure-assisted wound therapy through basic science research and clinical assessment.  

PubMed

Regulated negative pressure-assisted wound therapy (RNPT) should be regarded as a state-of-the-art technology in wound treatment and the most important physical, nonpharmaceutical, platform technology developed and applied for wound healing in the last two decades. RNPT systems maintain the treated wound's environment as a semi-closed, semi-isolated system applying external physical stimulations to the wound, leading to biological and biochemical effects, with the potential to substantially influence wound-host interactions, and when properly applied may enhance wound healing. RNPT is a simple, safe, and affordable tool that can be utilized in a wide range of acute and chronic conditions, with reduced need for complicated surgical procedures, and antibiotic treatment. This technology has been shown to be effective and safe, saving limbs and lives on a global scale. Regulated, oxygen-enriched negative pressure-assisted wound therapy (RO-NPT) is an innovative technology, whereby supplemental oxygen is concurrently administered with RNPT for their synergistic effect on treatment and prophylaxis of anaerobic wound infection and promotion of wound healing. Understanding the basic science, modes of operation and the associated risks of these technologies through their fundamental clinical mechanisms is the main objective of this review. PMID:23162229

Topaz, Moris

2012-05-01

239

Supplemental Intravenous Crystalloid Administration Does Not Reduce the Risk of Surgical Wound Infection  

PubMed Central

Wound perfusion and oxygenation are important determinants of the development of postoperative wound infections. Supplemental fluid administration significantly increases tissue oxygenation in surrogate wounds in the subcutaneous tissue of the upper arm in perioperative surgical patients. We tested the hypothesis that supplemental fluid administration during and after elective colon resections decreases the incidence of postoperative wound infections. Patients undergoing open colon resection were randomly assigned to small (n=124, 8 mL·kg-1·h-1) or large volume (n=129, 16-18 mL·kg-1·h-1) fluid management. Our major outcomes were two distinct criteria for diagnosis of surgical wound infections: 1) purulent exudate combined with a culture positive for pathogenic bacteria and 2) Center for Disease Control criteria for diagnosis of surgical wound infections. All wound infections diagnosed using either criterion by a blinded observer in the 15 days following surgery were considered in the analysis. Wound healing was evaluated with the ASEPSIS scoring system. Of the patients given small fluid administration, 14 had surgical wound infections; 11 given large fluid therapy had infections, P=0.46. ASEPSIS wound healing scores were similar in both groups: 7±16 (small volume) vs. 8±14 (large volume), P=0.70. Our results suggest that supplemental hydration in the range tested does not impact wound infection rate. PMID:16244030

Kabon, Barbara; Akça, Ozan; Taguchi, Akiko; Nagele, Angelika; Jebadurai, Ratnaraj; Arkilic, Cem F.; Sharma, Neeru; Ahluwalia, Arundhathi; Galandiuk, Susan; Fleshman, James; Sessler, Daniel I.; Kurz, Andrea

2005-01-01

240

Difficult wounds: an update.  

PubMed

The purpose of this collective review is to describe revolutionary advances in the treatment of Gardner's syndrome (GS), pseudofolliculitis barbae, nasal septal perforation, factitious wounds, and hidradenitis suppurativa (HS). Gardner's syndrome or familial polyposis has various manifestations that appear to be controlled by a single genetic locus. Apart from the large bowel adenomas, which are always present, a common extracolonic symptom of Gardner's syndrome is the occurrence of epidermal cysts. These cysts can be seen before the intestinal polyps are evident. Because epidermal cysts in patients with Gardner's syndrome are always benign, we excise these cysts using incisions that are commonly used for rhytidectomy. Pseudofolliculitis barbae, a pseudofolliculitis caused by ingrown hairs, effects 85% of blacks who shave their beards. When this disease is allowed to progress to keloid formation, we use a surgical approach that includes excision of the keloidal scar, meticulous debridement of all residual ingrown hairs in the underlying wound, and coverage of the defect with a split-thickness skin graft. More recently, laser therapy has revolutionized the treatment of pseudofolliculitis barbae and has enabled a cure for the first time for those plagued with this disorder and for whom a beardless face is acceptable. Nasal septal perforation is a well recognized complication of septal surgery. Other iatrogenic causes of perforation include cryosurgery, electrocoagulation for epitaxis, nasotracheal intubation, or nose packing. In recent years drugs such as cocaine account for an increasing number of perforations. It has only been with the use of an external approach for the repair of the nasal septal defect that surgical closure has become easier and more reliable. The external approach allows for greater surgical closure and enables the surgeon to use both hands with the aid of binocular vision to mobilize and suture local mucosal advancement flaps and the intraseptal connective tissue grafts. More recently, surgeons have repaired large septal perforations with a radial forearm free flap. Because of its availability and deep emotional significance, the skin is a common site for self-destructive behavior with the development of factitious skin wounds. When suspected, psychiatric care must proceed immediately. Second, the ulcer can then be healed by appropriate techniques and wound repair. It is important to emphasize that the treating physician must first confront the patient, and then a psychiatrist should provide appropriate psychotherapy. Hidradenitis suppurativa is an inflammatory disease of the skin and subcutaneous tissue that occurs in apocrine-gland-bearing areas distributed in the axilla, mammary nipple areola, mons pubis, groin, scrotum, perineum, perianal region, and umbilicus. The condition has an insidious onset. The susceptibility of women's axillary skin to hidradenitis suppurativa may be related, in part, to the practice of axillary removal of hair with a safety razor. Consequently, the use of safety razors must be avoided and replaced with the use of an electric razor. The method of treatment will vary with the stage of the disease. Treatment of the chronic stage of axillary hidradenitis suppurativa is primarily surgical. More recently, carbon dioxide laser treatment, with healing by secondary intention, is proving to be a rapid, efficient, and economic treatment of this difficult wound. PMID:16022640

Edlich, Richard F; Winters, Kathryne L; Britt, L D; Long, William B; Gubler, K Dean; Drake, David B

2005-01-01

241

Complications of Breast-cancer Radiotherapy  

Microsoft Academic Search

Although the beneficial effect of postoperative radiotherapy for breast cancer is well documented, this treatment may be related to a number of complications, which may affect patient quality of life and possibly survival. Among significant long-term irradiation sequelae are cardiac and lung damage, lymphoedema, brachial plexopathy, impaired shoulder mobility and second malignancies. The risk of these complications, particularly high with

E. Senkus-Konefka; J. Jassem

2006-01-01

242

Two-port laparoscopic adnexal surgery with a multichannel port using a wound retractor: is it safe and minimally scarring?  

PubMed

This study aimed to explore and evaluate the feasibility and safety of laparoscopic adnexal surgery using a two-port technique with a multichannel port, using a wound retractor, as previously reported. A series of patients undergoing two-port laparoscopy for a benign pelvic mass were enrolled in this study. To perform two-port laparoscopic surgery, the ancillary 5-mm trocar was inserted at the left iliac fossa under laparoscopic view after umbilical trocar insertion. The inserted umbilical trocar was removed and the skin incision was extended about 1.5 cm with index-finger-passable width. An Alexis wound retractor XS (Applied Medical, Santa Rancha Margarita, CA) was inserted through the umbilical wound. Two trocars were inserted into two fingers of a no. 6 surgical rubber glove and ligated with rubber bands. The wrist portion of the rubber glove covered the wound retractor, and the edge of the wound retractor was clamped with three Babcock clamps to prevent carbon-dioxide gas leakage. Both a 10-mm laparoscope and atraumatic forceps were inserted through the umbilical multichannel port. Laparoscopic adnexal surgery was performed in the usual manner. A total of 19 patients were enrolled. The operative procedures were adnexectomy (n = 8), myomectomy (n = 1), and ovarian cystectomy and/or salpingectomy (n = 10). There were no operative complications, conversion to laparotomy, or additional trocar insertions. The mean operation time was 81.3 +/- 28.7 min. The pathologic diagnosis were mature cystic teratoma (n = 6), benign cyst (n = 4), endometrial cyst (n = 3), serous cystadenoma (n = 3), mucinous cystadenoma (n = 1), leiomyoma (n = 1), and tubo-ovarian abscess (n = 1). The mean postoperative hospital stay was 4.0 +/- 1.3 days. This two-port method seems to be safe and needs no additional cost from the use of the conventional laparoscopic instruments. It is also cosmetically effective and highly appreciated by patients, leaving minimal abdominal scarring. PMID:19694570

Yi, Sang-Wook

2009-12-01

243

Post-operative depletion of platelet count is associated with anastomotic insufficiency following intrahepatic cholangiojejunostomy: a case–control study from the results of 220 cases of intrahepatic cholangiojejunostomy  

PubMed Central

Background Post-operative anastomotic insufficiency following major hepato-biliary surgery has significant impacts on the post-operative course. Recent reports have revealed that platelets play an important role in liver regeneration and wound healing. From these experimental and clinical results on platelet function, we hypothesized that post-operative platelet depletion (to <10?×?104/?L) would be associated with delayed liver regeneration as well as anastomotic insufficiency of intrahepatic cholangiojejunostomy. However, little information is available regarding correlations between platelet count and these complications. The purposes of the present study were, firstly, to evaluate the incidence of anastomotic insufficiency following intrahepatic cholangiojejunostomy and, secondly, to evaluate whether platelet depletion represents a risk factor for anastomotic insufficiency in intrahepatic cholangiojejunostomy. Methods Participants in this study comprised 220 consecutive patients who underwent intrahepatic cholangiojejunostomy following hepato-biliary resection for biliary malignancies between September 1998 and December 2010. Anastomotic insufficiency was confirmed by cholangiographic demonstration of leakage from the anastomosis using contrast medium introduced via a biliary drainage tube or prophylactic drain placed during surgery. Results Anastomotic insufficiency of the intrahepatic cholangiojejunostomy occurred in 13 of 220 patients (6%). Thirteen of the 220 patients, including one with anastomotic insufficiency, died during the study. Uni- and multivariate analyses both revealed that platelet depletion on post-operative day 1 (<10?×?104/?L) correlated with anastomotic insufficiency. Conclusion Post-operative platelet depletion was closely associated with anastomotic insufficiency following intrahepatic cholangiojejunostomy. This correlation has been established, but the underlying mechanisms have not. PMID:25323783

2014-01-01

244

Accidents and complications in selective and proximal gastric vagotomy.  

PubMed

In 3 years 266 consecutive patients were electively operated on for ulcer disease with either selective vagotomy (SV) with drainage (159) or proximal gastric vagotomy (PGV) without drainage (107). The total number of operative accidents was 15 (6 percent), similar to that of truncal vagotomy. Perforation of the stomach occurred in six SV and in one PGV. The perforation went unobserved in two patients, of whom one died. Esophageal perforations were not observed. Bleeding from the lesser omentum or from the spleen was seen in seven patients, requiring reoperation in one. Postoperative surgical complications were seen in 25 patients (9 percent): clinical gastric retention was observed in nine patients, five with SV and four with PGV, and 13 had wound abscesses or dehiscence. Fifty-nine patients had other complications, of which 52 were radiologically demonstrated atelectases, mostly without any clinical significance. The total mortality rate was 1.1 percent, similar to that of truncal vagotomy. The duration of the two operative procedures did not differ, and the greater care required for preservation of the nerve of Latarjet tended to diminish the number of operative accidents. PMID:1109513

Kalaja, E; Clemmesen, I; Banke, L; Kragelund, E; Christiansen, P M

1975-01-01

245

Aging and Wound Healing  

Microsoft Academic Search

Impaired wound healing in the elderly presents a major clinical and economic problem. With the aging population growing in both number and percentage, the importance of understanding the mechanisms underlying age-related impairments in healing is increased. Normal skin exhibits characteristic changes with age that have implications for wound healing. Additionally, the process of wound healing is altered in aged individuals.

Ankush Gosain; Luisa A. DiPietro

2004-01-01

246

VLAP: results immediately post-op  

NASA Astrophysics Data System (ADS)

Visual laser ablation of the prostate (VLAP) has been shown to be as effective with fewer complications than TURP in the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia. Questions have been raised about VLAP regarding prolonged irritative and obstructive voiding symptoms postoperatively. It is postulated that these symptoms are due to the slow slough of necrotic debris following VLAP. In an effort to improve upon the technique of VLAP, patients underwent lasing of the prostate in the routine manner (2, 4, 8, and 10 o'clock positions with sixty watts for sixty seconds) using Nd:YAG free beam energy. A bladder neck incision was then performed using a contact laser fiber. International prostate symptom score assessments were done preoperatively; one week and six weeks postoperatively. Post void residual urine volumes and prostate size were also evaluated. The findings indicate that symptom scores and post void residual urine volumes have significantly improved within ten days postoperatively using this technique.

Cowles, Robert S.

1996-05-01

247

Complications in periocular rejuvenation.  

PubMed

Thorough preoperative evaluation with meticulous surgical planning to achieve facial aesthetic balance between the forehead, eyelids, and midface is imperative to avoid or decrease potential functional and/or cosmetic complications in cosmetic periocular surgery. Before performing surgery, the physician should be aware of the patient's history of dry eyes, previous facial trauma, previous injection of Botox Cosmetic, history of previous laser-assisted in situ keratomileusis, and past facial surgery. A full evaluation should be performed on the upper eyelid/brow region to assess for the presence of brow ptosis, brow/eyelid asymmetry, dermatochalasis/pseudodermatochalasis, eyelid ptosis, and deep superior sulcus. On the lower eyelid/cheek examination, special attention should be directed to the diagnosis of underlying negative vector, dry eyes, prominent eyes, lower lid retraction, ectropion, lateral canthal dystopia, lower eyelid laxity, scleral show, and lagophthalmos, with a rejuvenation goal that focuses on obtaining a youthful fullness through repositioning and reinforcing efforts to avoid the negative effects of hollowness. Intraoperative and postoperative medical and surgical management of cosmetic periocular surgery complications focus on decreasing the risk of postoperative ptosis, lagophthalmos, lid retraction, and lid asymmetry, with special attention to limiting the risk of visual loss secondary to orbital hemorrhage. PMID:20659676

Mack, William P

2010-08-01

248

Postoperative radiotherapy for endometrial cancer  

PubMed Central

Purpose To investigate the prognostic factors and effectiveness of postoperative radiotherapy alone for endometrial carcinoma. Materials and Methods Sixty four patients with stage I-III endometrial cancer (EC) treated with postoperative radiotherapy alone between January 1989 and December 2008 at the Keimyung University Dongsan Medical Center were chosen for the present study. Typically, total hysterectomy, salpingo-oophorectomy and lymphadenectomy were performed on the patient's pelvis. Total dose from 50.4 Gy to 63 Gy was irradiated at pelvis or extended field. Thirteen patients were treated with Co-60 or Ir-192 intracavitary radiotherapy. Follow-up periods were from 7 to 270 months, with a median of 56 months. Results Five year overall survival (OS) rate was 58.7%, respectively. Five year disease-free survival (DFS) rate was 59.2%, respectively. In univariate analysis for OS and DFS, stage, menopausal age, type of operation, serosal invasion, and lymph node involvement were found to be statistically significant. Histologic type was marginally significant. In multivariate analysis for OS and DFS, stage, types of operation, histologic type were also found to be statistically significant. Treatment failure occurred in 14 patients. The main pattern of failure was found to be distant metastasis. Time to distant metastasis was from 3 to 86 months (median, 12 months). There were no grade 3 or 4 complications. Conclusion Stage, types of operation, and histologic type could be the predictive prognostic factors in patients. We contemplated postoperative radiation as effective and safe treatment method for EC. Additional treatment would be needed to reduce distant metastasis. PMID:23170289

Choi, Eun Cheol; Kim, Ok Bae; Byun, Sang Jun; Park, Seung Gyu; Kwon, Sang Hoon

2012-01-01

249

Extended negative pressure wound therapy-assisted dermatotraction for the closure of large open fasciotomy wounds in necrotizing fasciitis patients  

PubMed Central

Background Necrotizing fasciitis (NF) is a rapid progressive infection of the subcutaneous tissue or fascia and may result in large open wounds. The surgical options to cover these wounds are often limited by the patient condition and result in suboptimal functional and cosmetic wound coverage. Dermatotraction can restore the function and appearance of the fasciotomy wound and is less invasive in patients with comorbidities. However, dermatotraction for scarred, stiff NF fasciotomy wounds is often ineffective, resulting in skin necrosis. The authors use extended negative pressure wound therapy (NPWT) as an assist in dermatotraction to close open NF fasciotomy wounds. The authors present the clinical results, followed by a discussion of the clinical basis of extended NPWT-assisted dermatotraction. Methods A retrospective case series of eight patients with NF who underwent open fasciotomy was approved for the study. After serial wound preparation, dermatotraction was applied in a shoelace manner using elastic vessel loops. Next, the extended NPWT was applied over the wound. The sponge was three times wider than the wound width, and the transparent covering drape almost encircled the anatomical wound area. The negative pressure of the NPWT was set at a continuous 100 mmHg by suction barometer. The clinical outcome was assessed based on wound area reduction after treatment and by the achievement of direct wound closure. Results After the first set of extended NPWT-assisted dermatotraction procedures, the mean wound area was significantly decreased (658.12 cm2 to 29.37 cm2; p?=?0.002), as five out of eight patients achieved direct wound closure. One patient with a chest wall defect underwent latissimus dorsi musculocutaneous flap coverage, with primary closure of the donor site. Two Fournier’s gangrene patients underwent multiple sets of treatment and finally achieved secondary wound closure with skin grafts. The patients were followed up for 18.3 months on average and showed satisfactory results without wound recurrence. Conclusions Extended NPWT-assisted dermatotraction advances scarred, stiff fasciotomy wound margins synergistically in NF and allows direct closure of the wound without complications. This method can be another good treatment option for the NF patient with large open wounds whose general condition is unsuitable for extensive reconstructive surgery. PMID:24731449

2014-01-01

250

Value of incisional negative pressure wound therapy in orthopaedic surgery.  

PubMed

Soft tissue and wound treatment after orthopaedic interventions (especially after trauma) is still an enormously challenging situation for every surgeon. Since development of negative pressure wound therapy (NPWT), new indications have been consistently added to the original field of application. Recently, NPWT has been applied directly over high-risk closed surgical incisions. Review of the literature indicates that this therapy has shown positive effects on incisions after total ankle replacement or calcaneal fractures, preventing haematoma and wound dehiscence. In those cases reduced swelling, decreased pain and healing time of the wound were seen. Additionally, NPWT applied on incisions after acetabular fractures showed a decreased rate of infection and wound healing problems compared with published infection rates. Even after total hip arthroplasty, incisional NPWT reduced incidence of postoperative seroma and improved wound healing. In patients with tibial plateau, pilon or calcaneus fractures requiring surgical stabilisation after blunt trauma, reduced risk of developing acute and chronic wound dehiscence and infection was observed when using incisional NPWT. To conclude, incisional NPWT can help to reduce risk of delayed wound healing and infection after severe trauma and orthopaedic interventions. PMID:24851728

Brem, Matthias H; Bail, Hermann J; Biber, Roland

2014-06-01

251

Controlling postoperative ileus by vagal activation.  

PubMed

Postoperative ileus is a frequently occurring surgical complication, leading to increased morbidity and hospital stay. Abdominal surgical interventions are known to result in a protracted cessation of bowel movement. Activation of inhibitory neural pathways by nociceptive stimuli leads to an inhibition of propulsive activity, which resolves shortly after closure of the abdomen. The subsequent formation of an inflammatory infiltrate in the muscular layers of the intestine results in a more prolonged phase of ileus. Over the last decade, clinical strategies focusing on reduction of surgical stress and promoting postoperative recovery have improved the course of postoperative ileus. Additionally, recent experimental evidence implicated antiinflammatory interventions, such as vagal stimulation, as potential targets to treat postoperative ileus and reduce the period of intestinal hypomotility. Activation of nicotinic receptors on inflammatory cells by vagal input attenuates inflammation and promotes gastrointestinal motility in experimental models of ileus. A novel physiological intervention to activate this neuroimmune pathway is enteral administration of lipid-rich nutrition. Perioperative administration of lipid-rich nutrition reduced manipulation-induced local inflammation of the intestine and accelerated recovery of bowel movement. The application of safe and easy to use antiinflammatory interventions, together with the current multimodal approach, could reduce postoperative ileus to an absolute minimum and shorten hospital stay. PMID:20379998

Lubbers, Tim; Buurman, Wim; Luyer, Misha

2010-04-14

252

Serum cholesterol levels and postoperative atrial fibrillation  

PubMed Central

Background Post-operative atrial fibrillation is an important complication after coronary bypass surgery. As inflammation and oxidative stress were makedly encountered in the etiology, high cholesterol was also defined to provoke atrial fibrillation. In this present study, the relationship between postoperative atrial fibrillation and preoperative serum lipid levels were evaluated. Methods A total of 100 patients, who were operated at the department of Cardiovascular Surgery of our hospital were included to the study analysis. Patients, who had preoperative atrial fibrillation, thyroid dysfunction, or left atrial dilatation (above 4.5 cm) were excluded from the study. Patients were divided into two groups with postoperative atrial fibrillation development (Group I n?=?36), and without atrial fibrillation development (Group II n?=?64). Preoperative routine blood analyses, ECG, echocardiography were evaluated. Patients were followed for atrial fibrillation development for one month starting from the intensive care unit at the postoperative period. Serum lipid profiles and thyroid function were measured. For homogenization of inflammatory factors and oxidative stress, treatments other than statins, betablockers, calcium channel blockers, aspirin, ACE inhibitors, and ARB were stopped for 10 days. Atrial fibrillation for at least ?5 minutes in the intensive care unit was accepted as postoperative atrial fibrillation. Results Demographic data were similiar between groups (p?>?0.05). There was no difference in TC levels between groups, whereas LDL-C levels were statistically lower in patients developing post-operative atrial fibrillation (106.67?±?28.36 vs 118.75?±?27.75; P?postoperative atrial fibrillation development. High levels of LDL-C in the preoperative period could be predictor of atrial fibrillation development in the post operative period. PMID:24712763

2014-01-01

253

SPECIAL FEATURES OF THE COURSE IN INJURIES AND BURNS OF THE EYE, COMPLICATED BY RADIATION DISEASE  

Microsoft Academic Search

It was experimentally proved that healing of wounds in radiated animals ; is complicated by the development of a wound infection, especially during the ; climax period, i.e., 2 to 3 weeks after infection. This fact raised the question ; whether radiation disease influences also the healing process of wounds and burns ; ot the eye. Based on experiments on

Polyak

1958-01-01

254

The use of collatamp g, local gentamicin-collagen sponge, in reducing wound infection.  

PubMed

Abstract We conducted a retrospective study to examine the role of Collatamp G in reducing postoperative surgical site infection (SSI) in patients with different wound classes. Ninety-two patients (62 men and 30 women; mean age, 58 years; range, 29-88 years) who had undergone surgery between December 2009 and November 2011 in Tan Tock Seng Hospital and who had application of Collatamp G in their wound before closure were included in the study. The primary endpoint was the development of any superficial wound infection within 1 month postoperatively. Of 92 patients studied, 9 (10%) developed a superficial wound infection. Two of 43 patients with clean-contaminated wounds (5%), 2 of 19 with contaminated wounds (11%), and 5 of 30 with dirty-infected wounds (16%) developed infection. Use of the larger size Collatamp G (10 × 10 cm) also appears to have a lower incidence of SSI compared with the smaller Collatamp G (5 × 5 cm); 4% and 12%, respectively. Our data suggest that postoperative SSI was reduced in the group of patients with dirty-infected wound class. SSI appears to be decreased with use of the larger size Collatamp G. PMID:25216422

Chia, Clement L K; Shelat, Vishal G; Low, Wilson; George, Sheena; Rao, Jaideepraj

2014-01-01

255

Wound currents and wound healing in the newt, Notophthalmus viridescens  

Microsoft Academic Search

Wounded amphibian skin heals initially by a migration of epithelial cells from the cut edge towards the center of the wound. The density of currents leaving wounds made in Notophthalmus viridescens skin was manipulated in order to determine whether electrical fields associated with these currents might have a significant role in promoting this cell migration during wound healing. Wounds were

Lynette R. Robinson Rhodes; John J. Turek; Edward J. Cragoe Jr; Joseph W. Vanable Jr

1990-01-01

256

Diabetes Complications  

MedlinePLUS

... the potential complications of type 1 diabetes are: Cardiovascular disease Cardiovascular disease, a range of blood vessel system diseases that ... with diabetes. The two most common types of cardiovascular disease are coronary heart disease, caused by fatty deposits ...

257

Negative pressure wound therapy, silver coated foam dressing and conventional bandages in open wound treatment in dogs. A retrospective comparison of 50 paired cases.  

PubMed

Objectives: To evaluate negative pressure wound therapy (NPWT) for treatment of complicated wounds in dogs. Study type: Retrospective multicentre study. Materials and methods: Dogs (n = 50) undergoing open wound treatment were classified according to treatment method used: bandage (Group A, n = 7), NPWT (Group B, n = 18), and foam dressing (Group C, n = 25). Pairs of patients matched based on wound conformation, localization, and underlying cause were compared between Group A and C (n = 7 pairs) and between groups B and C (n = 18 pairs) in terms of duration of previous treatment, time to closure, and complications. Results: Signalment, antibiotic medications, antiseptic treatment, and bacterial status of wounds were comparable between groups. The duration of previous treatment was significantly higher in patients assigned to Group B (p = 0.04) compared to Group C, while no significant difference was found between groups A and B. Total time to wound closure was significantly shorter in Group C compared to Group A (p = 0.02) and in Group B compared to Group C (p = 0.003). Wounds treated with NPWT suffered significantly less complications (p = 0.008) and were significantly less septic during treatment (p = 0.016) than wounds treated with a foam dressing. Conclusion: This study shows that time to healing was halved in NPWT treated patients compared to foam dressing treated patients, which in turn healed faster than patients treated with conventional bandage, underlining the value of NPWT therapy for the treatment of complicated wounds. PMID:25449799

Nolff, M C; Fehr, M; Bolling, A; Dening, R; Kramer, S; Reese, S; Meyer-Lindenberg, A

2014-12-01

258

Negative pressure wound therapy to prevent seromas and treat surgical incisions after total hip arthroplasty  

Microsoft Academic Search

Purpose  The purpose of this study was to evaluate the use of negative pressure wound therapy (NPWT) to improve wound healing after\\u000a total hip arthroplasty (THA) and its influence on the development of postoperative seromas in the wound area.\\u000a \\u000a \\u000a \\u000a \\u000a Materials  The study is a prospective randomised evaluation of NPWT in patients with large surgical wounds after THA, randomising patients\\u000a to either a

Milena Pachowsky; Johannes Gusinde; Andrea Klein; Siegfried Lehrl; Stefan Schulz-Drost; Philipp Schlechtweg; Johannes Pauser; Kolja Gelse; Matthias H. Brem

259

Perioperative complications associated with intracranial procedures in patients with nonsyndromic single-suture craniosynostosis.  

PubMed

Within the diagnosis "craniosynostosis," there is a subset of patients who present with isolated, nonsyndromic, single-suture involvement. This study evaluates perioperative complications in this specific subset of patients over 4 decades at a single institution. To do so, we performed a retrospective review on consecutive patients undergoing correction of single-suture synostosis from May 1977 to January 2013 at a tertiary pediatric craniofacial center. Demographic information, operative details, and perioperative course were collected. Complications were categorized as either major or minor. A ? test and Fisher exact test were used to compare all categorical variables. Continuous variables were analyzed using Wilcoxon rank-sum and Kruskal-Wallis tests.Seven hundred forty-six patients underwent surgical correction of nonsyndromic craniosynostosis. Of these, there were 307 (41.2%) sagittal, 201 (26.9%) metopic, and 238 (31.9%) unicoronal. Thirty-four patients had complications (4.6%). Eight were considered major (1.1%), including one postoperative mortality in a patient with hypoplastic left-sided heart syndrome. Minor complications occurred in 26 patients (3.5%) and included subgaleal hematoma (n = 3), seroma (n = 4), and superficial wound infection (n = 5). Metopic and sagittal suture involvement was significantly associated with a higher complication rate (P = 0.04). A child with isolated single suture synostosis and any comorbidity had a significantly greater risk of any complication (P < 0.001; odds ratio, 3.8) and specifically an increased risk of major complication (P = 0.031; odds ratio, 6.0). Subclassification of patients by time period yielded no statistically significant changes in perioperative morbidity. To conclude, these data allow us to counsel families more accurately with regard to morbidity and mortality and may potentially serve as a benchmark for future quality improvement work. PMID:25534064

Tahiri, Youssef; Paliga, James Thomas; Wes, Ari M; Whitaker, Linton A; Bartlett, Scott P; Taylor, Jesse A

2015-01-01

260

Insulin and wound healing.  

PubMed

Skin is a dynamic and complex organ that relies on the interaction of different cell types, biomacromolecules and signaling molecules. Injury triggers a cascade of events designed to quickly restore skin integrity. Depending on the size and severity of the wound, extensive physiological and metabolic changes can occur, resulting in impaired wound healing and increased morbidity resulting in higher rates of death. While wound dressings provide a temporary barrier, they are inherently incapable of significantly restoring metabolic upsets, post-burn insulin resistance, and impaired wound healing in patients with extensive burns. Exogenous insulin application has therefore been investigated as a potential therapeutic intervention for nearly a century to improve wound recovery. This review will highlight the important achievements that demonstrate insulin's ability to stimulate cellular migration and burn wound recovery, as well as providing a perspective on future therapeutic applications and research directions. PMID:24810536

Hrynyk, Michael; Neufeld, Ronald J

2014-12-01

261

Factors Affecting Wound Healing  

PubMed Central

Wound healing, as a normal biological process in the human body, is achieved through four precisely and highly programmed phases: hemostasis, inflammation, proliferation, and remodeling. For a wound to heal successfully, all four phases must occur in the proper sequence and time frame. Many factors can interfere with one or more phases of this process, thus causing improper or impaired wound healing. This article reviews the recent literature on the most significant factors that affect cutaneous wound healing and the potential cellular and/or molecular mechanisms involved. The factors discussed include oxygenation, infection, age and sex hormones, stress, diabetes, obesity, medications, alcoholism, smoking, and nutrition. A better understanding of the influence of these factors on repair may lead to therapeutics that improve wound healing and resolve impaired wounds. PMID:20139336

Guo, S.; DiPietro, L.A.

2010-01-01

262

Delayed incidental diagnosis of postoperative extradural hematoma following ventriculoperitoneal shunt  

PubMed Central

Ventriculo peritoneal (VP) shunt uncommonly complicates as intracranial hematomas which can still occur in patients with a functioning VP shunt leading to a delay in the diagnosis which can be extremely dangerous and lead to adverse outcomes. We report a case of an incidental diagnosis of delayed post-operative EDH following VP shunt in an young adult patient with a right cerebellar lesion and highlight the need for meticulous post-operative neurological examination. PMID:25552861

Byrappa, Vinay; Redhu, Shruti; Varadarajan, Bhadrinarayan

2015-01-01

263

Postoperative delirium following gastrointestinal surgery in elderly patients  

Microsoft Academic Search

Postoperative delirium is a common complication which can interfere with the surgical treatment and recovery of elderly patients,\\u000a and is likely to prolong their hospitalization. Unfortunately, there is as yet no completely effective pre- and\\/or post operative\\u000a technique of patient care to reduce or prevent postoperative delirium. In this study, 36 patients aged over 70 years undergoing\\u000a gastrointestinal operations were

Tetsuya Kaneko; Sadamu Takahashi; Takuji Naka; Yasuaki Hirooka; Yuichi Inoue; Nobuaki Kaibara

1997-01-01

264

Telemedicine for wound management  

PubMed Central

The escalating physiological, psychological, social and financial burdens of wounds and wound care on patients, families and society demand the immediate attention of the health care sector. Many forces are affecting the changes in health care provision for patients with chronic wounds, including managed care, the limited number of wound care therapists, an increasingly ageing and disabled population, regulatory and malpractice issues, and compromised care. The physician is also faced with a number of difficult issues when caring for chronic wound patients because their conditions are time consuming and high risk, represent an unprofitable part of care practice and raise issues of liability. Telemedicine enhances communication with the surgical wound care specialist. Digital image for skin lesions is a safe, accurate and cost-effective referral pathway. The two basic modes of telemedicine applications, store and forward (asynchronous transfer) and real-time transmission (synchronous transfer, e.g. video conference), are utilized in the wound care setting. Telemedicine technology in the hands of an experienced physician can streamline management of a problem wound. Although there is always an element of anxiety related to technical change, the evolution of wound care telemedicine technology has demonstrated a predictable maturation process. PMID:23162242

Chittoria, Ravi K.

2012-01-01

265

Volatile organic compounds emitted after leaf wounding: On-line analysis by proton-transfer-reaction mass spectrometry  

Microsoft Academic Search

Volatile organic compounds (VOCs) released from vegetation, including wound-induced VOCs, can have important effects on atmospheric chemistry. The analytical methods for measuring wound-induced VOCs, especially the hexenal family of VOCs (hexenals, hexenols, and hexenyl esters), are complicated by their chemical instability and the transient nature of their formation after leaf and stem wounding. Here we demonstrate that formation and emission

Ray Fall; Thomas Karl; Armin Hansel; Alfons Jordan; Werner Lindinger

1999-01-01

266

POTENCY, CONTINENCE AND COMPLICATION RATES IN 1,870 CONSECUTIVE RADICAL RETROPUBIC PROSTATECTOMIES  

Microsoft Academic Search

PurposeWe update results in a series of consecutive patients treated with anatomic radical retropubic prostatectomy regarding recovery of erections, urinary continence and postoperative complications.

WILLIAM J. CATALONA; GUSTAVO F. CARVALHAL; DOUGLAS E. MAGER; DEBORAH S. SMITH

1999-01-01

267

[Complications of ileal lymphoma].  

PubMed

Non-Hodgkin lymphoma of the ileum accounts for some 3% of all extranodal onset lymphoma and 20% of gastrointestinal lymphoma given that the ileum is more frequently affected than the jejunum and duodenum. The large majority of primary extranodal lymphomas present a diffuse histological structure and in particular involve the cervico-fascial and gastrointestinal regions. Moreover, it is not uncommon to find an association between gastroenteric involvement and Waldeyer's ring (cervico-fascial region). Primary intestinal involvement may not present specific symptoms and remain silent for some time. It is manifested by the onset of complications caused by occlusion and perforation. Two cases of ileal lymphoma were treated at the Institute of Emergency Surgery of Catania University between 1992 and 1993. They were complicated by intestinal perforation and occlusion respectively. Both patients underwent emergency intestinal resection. Surgery represents the elective treatment for primary forms, followed by polychemotherapy and radiotherapy. Prognosis depends on the spread of disease and the hystotype. The administration of NTP and somatopstatin resulted in a shorter postoperative period with fewer surgical complications. PMID:8710149

Vadalà, G; Salice, M; L'Anfusa, G; Caragliano, P; Vadalà, F; Mangiameli, A

1995-11-01

268

[Post-operative pain management in orthopaedic surgery and traumatology].  

PubMed

Provision of sufficient post-operative pain therapy is an obligation in the clinical management of patients. A wide range of medical, technical and organizational options is used to improve post-operative pain management in orthopaedic surgery. Measurement of pain is as important as the correct use of analgesics and application techniques. Standardized pain therapy algorithms should facilitate autonomous treatment of patients. Additional procedures like patient-controlled analgesia or local catheter for pain are necessary for individualized or operation-specific pain therapy. The balanced combination in postoperative pain therapy could reduce side effects and complication rates, increase mobility and enhance patient satisfaction. PMID:16435112

Giesa, M; Jage, J; Meurer, A

2006-02-01

269

Effect of low-power density laser radiation on heatling of open skin wounds in rats  

SciTech Connect

Researchers performed a study to determine whether laser radation of low-power density would affect the healing of open skin wounds in rats. The wounds were irradiated daily with a helium-neon laser and an argon laser at a constant power density of 45 mW/sq cm. The rate of wound closure was followed by photographing the wounds in a standardized way. The collagen hydroxyproline concentration in the scar tissue was determined on the 18th postoperative day. Helium-neon laser radiation had a statistically significant stimulating effect on collagen synthesis in the wound, with a maximum effect at an energy density of 4 joules/sq cm. The rate of wound closure was enhanced significantly between the third and 12th postoperative days. The argon laser exposure produced a significant increase in collagen concentration both in irradiated and nonirradiated contralateral wounds. However, an acceleration of the healing rate was not registered in this case. The wound contraction up to the fourth day of the experiment was inhibited under helium-neon and argon laser exposure to 20 joules/sq cm. The described effects were not specific for the laser light. There may be a wavelength-selective influence of coherent light on the metabolic and proliferation processes in wound healing, with the associated problem of the possible carcinogenic effects of laser radiation.

Kana, J.S.; Hutschenreiter, G.; Haina, D.; Waidelich, W.

1981-03-01

270

Local anesthetic wound infiltration for pain management after periacetabular osteotomy  

PubMed Central

Background and purpose To our knowledge, there is no evidence to support the use of local infiltration analgesia (LIA) for postoperative pain relief after periacetabular osteotomy (PAO). We investigated the effect of wound infiltration with a long-acting local anesthetic (ropivacaine) for postoperative analgesia after PAO. Patients and methods We performed a randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov: NCT00815503) in 53 patients undergoing PAO to evaluate the effect of local anesthetic infiltration on postoperative pain and on postoperative opioid consumption. All subjects received intraoperative infiltration followed by 5 postoperative injections in 10-hour intervals through a multi-holed catheter placed at the surgical site. 26 patients received ropivacaine and 27 received saline. The intervention period was 2 days and the observational period was 4 days. All subjects received patient-controlled opioid analgesia without any restrictions on the total daily dose. Pain was assessed at specific postoperative time points and the daily opioid usage was registered. Results Infiltration with 75 mL (150 mg) of ropivacaine did not reduce postoperative pain or opioid requirements during the first 4 days. Interpretation The clinical importance of ropivacaine as single component in postoperative treatment of pain is questionable, and we are planning further studies to explore the potential of LIA in larger volume—and also a multimodal regimen—to treat pain in this category of patients. PMID:24650022

2014-01-01

271

Understanding methods of wound debridement.  

PubMed

Autolytic debridement describes the body's natural method of wound-bed cleansing, helping it to prepare the wound bed for healing. In acute wounds, autolytic debridement occurs automatically and often does not require intervention, as during the inflammatory stage of a wound, neutrophils and macrophages digest and removes devitalised tissue, cell debris and contaminants, clearing the wound of any cellular barriers to healing. In chronic wounds, by contrast, healing is often delayed, frequently because of inadequate debridement. The autolytic process becomes overwhelmed by high levels of endotoxins released from damaged tissue (Broadus, 2013). Therefore wound debridement becomes an integral part of chronic-wound management and practitioners involved in wound care must be fully competent at wound-bed assessment and have an awareness of the options available for debridement. This article will review wound-bed assessment, highlighting variations in devitalised tissue, and explore options available for wound debridement, taking into consideration patients’ pain and quality of life. PMID:25075385

Atkin, Leanne

272

Difficult leg wounds successfully closed with decortication, bioresorbable ECM and NPWT.  

PubMed

Complications of a missed compartment syndrome are severe. This case demonstrates the difficulty in dealing with such complications, including the difficult situation of being faced with limb salvage when amputation is the best option. Through a short case description and several images, it is demonstrated how even the most difficult wounds in cases like this can be dealt with and achieve a non-painful limb salvage. In particular, an extreme technique of decorticating the bone and applying bioresorbable extracellular matrix with negative pressure wound therapy was applied in order to achieve final wound closure and pain relief. This case demonstrates integration of multiple modalities for complex wound closure. PMID:24049815

Heiney, J; Redfern, R

2013-06-01

273

Association of Preoperative Biliary Drainage With Postoperative Outcome Following Pancreaticoduodenectomy  

PubMed Central

Objective To determine whether preoperative biliary instrumentation and preoperative biliary drainage are associated with increased morbidity and mortality rates after pancreaticoduodenectomy. Summary Background Data Pancreaticoduodenectomy is accompanied by a considerable rate of postoperative complications and potential death. Controversy exists regarding the impact of preoperative biliary instrumentation and preoperative biliary drainage on morbidity and mortality rates after pancreaticoduodenectomy. Methods Two hundred forty consecutive cases of pancreaticoduodenectomy performed between January 1994 and January 1997 were analyzed. Multiple preoperative, intraoperative, and postoperative variables were examined. Pearson chi square analysis or Fisher’s exact test, when appropriate, was used for univariate comparison of all variables. Logistic regression was used for multivariate analysis. Results One hundred seventy-five patients (73%) underwent preoperative biliary instrumentation (endoscopic, percutaneous, or surgical instrumentation). One hundred twenty-six patients (53%) underwent preoperative biliary drainage (endoscopic stents, percutaneous drains/stents, or surgical drainage). The overall postoperative morbidity rate after pancreaticoduodenectomy was 48% (114/240). Infectious complications occurred in 34% (81/240) of patients. Intraabdominal abscess occurred in 14% (33/240) of patients. The postoperative mortality rate was 5% (12/240). Preoperative biliary drainage was determined to be the only statistically significant variable associated with complications (p = 0.025), infectious complications (p = 0.014), intraabdominal abscess (p = 0.022), and postoperative death (p = 0.037). Preoperative biliary instrumentation alone was not associated with complications, infectious complications, intraabdominal abscess, or postoperative death. Conclusions Preoperative biliary drainage, but not preoperative biliary instrumentation alone, is associated with increased morbidity and mortality rates in patients undergoing pancreaticoduodenectomy. This suggests that preoperative biliary drainage should be avoided whenever possible in patients with potentially resectable pancreatic and peripancreatic lesions. Such a change in current preoperative management may improve patient outcome after pancreaticoduodenectomy. PMID:10450725

Povoski, Stephen P.; Karpeh, Martin S.; Conlon, Kevin C.; Blumgart, Leslie H.; Brennan, Murray F.

1999-01-01

274

Biomechanics and Wound Healing in the Cornea  

PubMed Central

The biomechanical and wound healing properties of the cornea undermine the predictability and stability of refractive surgery and contribute to discrepancies between attempted and achieved visual outcomes after LASIK, surface ablation and other keratorefractive procedures. Furthermore, patients predisposed to biomechanical failure or abnormal wound healing can experience serious complications such as keratectasia or clinically significant corneal haze, and more effective means for the identification of such patients prior to surgery are needed. In this review, we describe the cornea as a complex structural composite material with pronounced anisotropy and heterogeneity, summarize current understanding of major biomechanical and reparative pathways that contribute to the corneal response to laser vision correction, and review the role of these processes in ectasia, intraocular pressure measurement artifact, diffuse lamellar keratitis (DLK) and corneal haze. The current understanding of differences in the corneal response after photorefractive keratectomy (PRK), LASIK and femtosecond-assisted LASIK are reviewed. Surgical and disease models that integrate corneal geometric data, substructural anatomy, elastic and viscoelastic material properties and wound healing behavior have the potential to improve clinical outcomes and minimize complications but depend on the identification of preoperative predictors of biomechanical and wound healing responses in individual patients. PMID:16720023

Dupps, William J.; Wilson, Steven E.

2009-01-01

275

Postoperative pseudoepileptic seizures in a known epileptic: complications in recovery.  

PubMed

A 47-yr-old woman underwent general anaesthesia for a squint correction. She had previously suffered a cerebral venous thrombosis, presenting as grand mal seizures during recovery from general anaesthesia for minor surgery. Subsequently, she was affected by Jacksonian limb seizures and petit mal epilepsy and had required long-term rehabilitation, and anticonvulsant and anticoagulant therapy. On arrival in recovery on this occasion, with a laryngeal mask airway (LMA) in place, she started to convulse. The seizures were initially treated with midazolam i.v., but they recurred. Whilst observing the seizure pattern and excluding the differential diagnoses, evidence emerged that psychological factors had played a large part in her clinical picture. Her differential diagnosis had recently been amended to include 'pseudoseizures'. A firm, supportive approach caused the 'convulsions' to cease within a few hours. PMID:14504168

Ng, L; Chambers, N

2003-10-01

276

Vulnerable populations: considerations for wound care.  

PubMed

Race/ethnicity, immigration, health insurance, and literacy--along with patient-provider communication and understanding of and adherence to treatment protocols--are societal factors that affect the provision of optimal healthcare. Wound care practitioners should be aware of the need to address these factors in vulnerable groups, including the effects of racial/ethnic care disparities, immigration, low income, uninsured or underinsured status, and literacy/health literacy on health and wound care. The literature shows that care is not always perceived to be or equitably provided across different ethnic and economically diverse populations. Hence, clinicians must strive to listen to and interact non-judgmentally with vulnerable patients. Each patient's physical and psychosocial concerns must be assessed without malice and clinicians must work with community, state, and federal agencies to enhance access to necessary services. Wound care patient teaching materials need to be developed that consider the literacy and language skills of the community served. Once the type of wound and its appropriate treatment are determined, wound care practitioners must consider patient teaching, vulnerability, cultural, and economic constraints of care, along with strategies for prevention of complications and hospitalizations. PMID:19471046

Pieper, Barbara

2009-05-01

277

Delayed Wound Repair in Sepsis Is Associated with Reduced Local Pro-Inflammatory Cytokine Expression  

PubMed Central

Sepsis is one of the main causes for morbidity and mortality in hospitalized patients. Moreover, sepsis associated complications involving impaired wound healing are common. Septic patients often require surgical interventions that in-turn may lead to further complications caused by impaired wound healing. We established a mouse model to the study delayed wound healing during sepsis distant to the septic focus point. For this reason cecal ligation and puncture (CLP) was combined with the creation of a superficial wound on the mouse ear. Control animals received the same procedure without CPL. Epithelialization was measured every second day by direct microscopic visualization up to complete closure of the wound. As interplay of TNF-?, TGF-?, matrix metalloproteinases (MMP), and tissue inhibitors of metalloproteinases (TIMP) is important in wound healing in general, TNF-?, TGF-?, MMP7, and TIMP1 were assessed immunohistochemical in samples of wounded ears harvested on days 2, 6, 10 and 16 after wounding. After induction of sepsis, animals showed a significant delay in wound epithelialization from day 2 to 12 compared to control animals. Complete wound healing was attained after mean 12.2± standard deviation (SD) 3.0 days in septic animals compared to 8.7± SD 1.7 days in the control group. Septic animals showed a significant reduction in local pro-inflammatory cytokine level of TNF-? on day 2 and day 6 as well as a reduced expression of TGF-? on day 2 in wounds. A significant lower expression of MMP7 as well as TIMP1 was also observed on day 2 after wounding. The induction of sepsis impairs wound healing distant to the septic focus point. We could demonstrate that expression of important cytokines for wound repair is deregulated after induction of sepsis. Thus restoring normal cytokine response locally in wounds could be a good strategy to enhance wound repair in sepsis. PMID:24086305

Sommer, Katharina; Sander, Anna Lena; Albig, Michael; Weber, Roxane; Henrich, Dirk; Frank, Johannes; Marzi, Ingo; Jakob, Heike

2013-01-01

278

Wound repair and regeneration  

Microsoft Academic Search

The repair of wounds is one of the most complex biological processes that occur during human life. After an injury, multiple biological pathways immediately become activated and are synchronized to respond. In human adults, the wound repair process commonly leads to a non-functioning mass of fibrotic tissue known as a scar. By contrast, early in gestation, injured fetal tissues can

Geoffrey C. Gurtner; Sabine Werner; Yann Barrandon; Michael T. Longaker

2008-01-01

279

How wounds heal  

MedlinePLUS

... as various veins. Obesity increases the risk of infection after surgery. Being overweight can also put tension on stitches, ... drugs can slow healing. Smoking can delay healing after surgery. ... such as infection and wounds breaking open. Slow-to-heal wounds ...

280

Surgical wound care - closed  

MedlinePLUS

... Skin glue Proper wound care can help prevent infection and reduce scarring as your surgical wound heals. ... When you come home after surgery, you may have a dressing on your ... don't catch on clothing Protect the area as it heals Soak ...

281

Prevalence of Immune Disease in Patients with Wounds Presenting to a Tertiary Wound Healing Center  

PubMed Central

Chronic leg ulcers are a significant cause of morbidity and mortality and account for considerable healthcare and socioeconomic costs. Leg ulcers are a recognized complication of immune disease, and the purpose of this study was to establish the prevalence of immune disease in a cohort of patients with chronic wounds, and to compare wound outcomes in the subjects with and without immune disease. Retrospective chart review was completed on consecutive patients scheduled with the plastic surgeon in the Georgetown University Center for Wound Healing between January 1 and March 31, 2009. Of the 520 patients scheduled for appointments, 340 were eligible for inclusion. The prevalence of immune disease was higher than expected with 78 of 340 patients (23%) having associated immune disease. At presentation, wounds in patients with immune disease had a significantly larger mean surface area (33.4cm2 (69.05) compared to 22.5 cm2 (63.65), p=0.02). Split thickness skin graft (STSG) and bioengineered alternative tissue (BAT) graft data was available on 177 grafts from 55 subjects. There was a significantly lower response rate to STSG in subjects with immune disease (50% compared to 97%, p=0.0002), but response rates to BAT were not different. The association between immune diseases and chronic wounds may provide unique insights into pathways of wound healing, and warrants further study. PMID:22168783

Shanmugam, Victoria K.; Schilling, Amber; Germinario, Anthony; Mete, Mihyre; Kim, Paul; Steinberg, John; Attinger, Christopher E.

2012-01-01

282

Negative pressure wound therapy as an adjunct in healing of chronic wounds.  

PubMed

Negative pressure wound therapy (NPWT) has emerged as a cutting-edge technology and provides an alternative solution to the problem of wounds. This study was undertaken to assess the efficacy of this technique in the treatment of chronic wounds. A prospective clinical study was used to evaluate our experience in use of NPWT in the healing of pressure ulcers and chronic wounds over 2?years. The primary end point of the study group was the time taken for appearance of healthy granulation tissue and full reepithelialisation without drainage. All patients with sepsis were excluded from the study. The statistical analysis of the data was carried out. Of the 60 patients studied, 41 had associated comorbidities including diabetes mellitus. The commonest site of occurrence was the lower limb. Coverage in the form of a flap was required at presentation in 63·33% of patients. However, after initiation of NPWT, none of them required the procedure and they healed spontaneously either by secondary intention or by skin grafting. The time taken for appearance of healthy granulation tissue was 14·36?±?4·24?days. Complete healing of wounds occurred by 33·1?±?10·22?days. There was a statistically significant difference in the volume of the wounds before and after the intervention (P?=?0·000). Complications resulting from NPWT were minimal. This technique is an excellent adjunct to surgical debridement. PMID:23855645

Langer, Vijay; Bhandari, Prem S; Rajagopalan, Satyamoorthy; Mukherjee, Mrinal K

2013-07-16

283

[Stab wounds in children].  

PubMed

Injuries are the most serious health risk in children. Injuries are the main cause of death and long term disabilities in children. Fortunately, stab wounds in children are very rare in our country, but they are, in most cases, very serious injuries. Presenting 3 case reports, this article aims to show the danger of stab wounds and how easily sharp objects can penetrate human tissue. In two out of the three case reports, a foreign object was remained inside the wound. When dealing with such injuries, this possibility must be considered the wound must be carefully inspected. When a revision is necessary, it should be carried out using minimally invasive methods in order to save the child from suffering extensive wounding which would result from the classical open approach revision. PMID:22746076

Kucera, A; Zeman, L; Vyhnánek, M; Petr?, O; Kavalcová, L; Snajdauf, J

2012-01-01

284

Complications and subsequent removal of retained shunt hardware after endoscopic third ventriculostomy: case series.  

PubMed

This case series highlights multiple complications and subsequent removal of retained shunt hardware in pediatric patients after successful endoscopic third ventriculostomy (ETV). Removal or retention of existing shunt hardware following ETV represents an important dilemma. Prior studies have reported infections and organ perforation related to nonfunctioning shunts but none in the context of successful ETV. Data obtained in 3 children with hydrocephalus treated at the authors' institution were retrospectively reviewed after the patients experienced complications due to retained shunt hardware following ETV. Etiologies of hydrocephalus included tectal glioma and intraventricular hemorrhage. All 3 patients had a history of multiple shunt revisions and underwent urgent ETV in the setting of a shunt malfunction. In each case, the entire shunt system was left in situ, but it became the source of subsequent complications. Two of the 3 patients presented with the shunt infected by gram-negative bacilli 10 days and 4.5 months postoperatively, respectively. The remaining patient experienced wound dehiscence over the shunt valve 4.5 months after ETV. In all patients, the complications were managed successfully by removing the shunt hardware. None of the patients required repeat shunt insertion from the time of removal throughout the follow-up period (mean 24 months, range 9-36 months). During the study period, a total of 6 patients with indwelling shunt hardware underwent ETV with the expectation of being shunt independent. Among these 6 patients, 3 experienced no complications from the retained hardware whereas 3 patients (50%) ultimately experienced adverse consequences related to retained hardware. This case series illustrates complications involving retained shunt hardware after successful ETV. These examples support consideration of shunt removal at the time of ETV in the appropriate context. PMID:23560795

Pindrik, Jonathan; Jallo, George I; Ahn, Edward S

2013-06-01

285

The use of an antimicrobial primary wound contact layer as liner and filler with NPWT.  

PubMed

In negative pressure wound therapy (NPWT), wound fillers are used to ensure that the negative pressure is applied across the entire wound surface. At present, foam and gauze are the most commonly used fillers. Both ensure equal distribution of negative pressure, but foam is more absorbent, while gauze is more malleable and conformable. There is no strong clinical research evidence demonstrating the superiority of one type of wound filler over another. However, there are reports that foam can cause pain and trauma at dressing change as a result of ingrowth of tissue into its open pore structure. For this reason, when foam is used as a filler, a liner may also be applied as a wound contact layer. This supplement describes preliminary clinical evidence on the use of Cutimed Sorbact as an alternative to foam and gauze during NPWT. Seven cases in which it was successfully used on complex pre- and postoperative wounds are described PMID:25507332

Jeffery, Steven L A

2014-08-01

286

The use of an antimicrobial primary wound contact layer as liner and filler with NPWT.  

PubMed

In negative pressure wound therapy (NPWT), wound fillers are used to ensure that the negative pressure is applied across the entire wound surface. At present, foam and gauze are the most commonly used fillers. Both ensure equal distribution of negative pressure, but foam is more absorbent, while gauze is more malleable and conformable. There is no strong clinical research evidence demonstrating the superiority of one type of wound filler over another. However, there are reports that foam can cause pain and trauma at dressing change as a result of ingrowth of tissue into its open pore structure. For this reason, when foam is used as a filler, a liner may also be applied as a wound contact layer. This supplement describes preliminary clinical evidence on the use of Cutimed Sorbact as an alternative to foam and gauze during NPWT. Seven cases in which it was successfully used on complex pre- and postoperative wounds are described PMID:25420348

Jeffery, Steven L A

2014-08-01

287

Complications and Functional Results of Surgery for Locally Advanced Prostate Cancer  

PubMed Central

The role of surgery in clinical stage T3 prostate cancer (cT3 PCa) is still subject to debate. We reviewed the records of 139 consecutive patients who underwent a radical prostatectomy (RP) for cT3 PCa with a mean follow-up of 8 years. All data related to surgical and perioperative complications were collected. Continence and erectile function were assessed at 12 months postoperatively and long-term oncologic outcomes were analyzed. Rectal injury and injury of the obturator nerve occurred both in 0.7% of cases. No serious in-hospital complications were noted and no reintervention was needed. Lymphatic leakage was noted in 2.2% of patients and 1.4% experienced prolonged drainage of urine. In 7.2%, wound-related problems occurred. Anastomotic stricture occurred in 2.9%. These complication rates were not different compared to surgical series of RP in localized PCa. At 12 months, complete continence was 87.8% and erectile function had fully recovered in 6% and 10% of patients who underwent a non-nerve sparing or unilateral nerve-sparing procedure, respectively. 10-year estimated biochemical PFS, clinical PFS, CSS and OS were 51.8%, 85.6%, 94.6% and 85.9%, respectively. In cT3 PCa, RP is technically feasible with morbidity comparable to RP in clinically localized PCa. Long-term oncologic control was excellent. PMID:22291698

Joniau, S. G.; Van Baelen, A. A.; Hsu, C. Y.; Van Poppel, H. P.

2012-01-01

288

Wound construction in manual small incision cataract surgery  

PubMed Central

The basis of manual small incision cataract surgery is the tunnel construction for entry to the anterior chamber. The parameters important for the structural integrity of the tunnel are the self-sealing property of the tunnel, the location of the wound on the sclera with respect to the limbus, and the shape of the wound. Cataract surgery has gone beyond just being a means to get the lens out of the eye. Postoperative astigmatism plays an important role in the evaluation of final outcome of surgery. Astigmatic consideration, hence, forms an integral part of incisional considerations prior to surgery. PMID:19075401

Haldipurkar, S S; Shikari, Hasanain T; Gokhale, Vishwanath

2009-01-01

289

Emergency Open Incarcerated Hernia Repair with a Biological Mesh in a Patient with Colorectal Liver Metastasis Receiving Chemotherapy and Bevacizumab Uncomplicated Wound Healing  

PubMed Central

Bevacizumab is a humanized monoclonal antibody targeting vascular endothelial growth factor (VEGF), often used in combinational chemotherapy regimens for the treatment of patients with colorectal liver metastases. However adverse events have been attributed to the use of bevacizumab including gastrointestinal perforations, thrombotic events, hypertension, bleeding, and wound healing complications. 53-year-old male, with a history of colorectal cancer with liver metastasis, receiving a combination of cytotoxic chemotherapy (FOLFIRI, irinotecan with fluorouracil and folinic acid) with bevacizumab presented as an emergency with an incarcerated incisional hernia. The last administration of chemotherapy and bevacizumab had taken place 2 weeks prior to this presentation. As the risk of strangulation of the bowel was increased, a decision was made to take the patient to theatre, although the hazard with respect to wound healing, haemorrhage, and infection risk was high due to the recent administration of chemotherapy with bevacizumab. The patient underwent an open repair of the incarcerated recurrent incisional hernia with placement of a biological mesh, and the postoperative recovery was uncomplicated with no wound healing or bleeding problems. PMID:25614840

Giakoustidis, Alexandros; Morrison, Dawn; Giakoustidis, Dimitrios

2014-01-01

290

Emergency open incarcerated hernia repair with a biological mesh in a patient with colorectal liver metastasis receiving chemotherapy and bevacizumab uncomplicated wound healing.  

PubMed

Bevacizumab is a humanized monoclonal antibody targeting vascular endothelial growth factor (VEGF), often used in combinational chemotherapy regimens for the treatment of patients with colorectal liver metastases. However adverse events have been attributed to the use of bevacizumab including gastrointestinal perforations, thrombotic events, hypertension, bleeding, and wound healing complications. 53-year-old male, with a history of colorectal cancer with liver metastasis, receiving a combination of cytotoxic chemotherapy (FOLFIRI, irinotecan with fluorouracil and folinic acid) with bevacizumab presented as an emergency with an incarcerated incisional hernia. The last administration of chemotherapy and bevacizumab had taken place 2 weeks prior to this presentation. As the risk of strangulation of the bowel was increased, a decision was made to take the patient to theatre, although the hazard with respect to wound healing, haemorrhage, and infection risk was high due to the recent administration of chemotherapy with bevacizumab. The patient underwent an open repair of the incarcerated recurrent incisional hernia with placement of a biological mesh, and the postoperative recovery was uncomplicated with no wound healing or bleeding problems. PMID:25614840

Giakoustidis, Alexandros; Morrison, Dawn; Neofytou, Kyriakos; Giakoustidis, Dimitrios; Mudan, Satvinder

2014-01-01

291

Postoperative Vision Loss after Reverse Shoulder Arthroplasty  

PubMed Central

We report a case which highlights the rare but devastating complication of postoperative vision loss (POVL) in orthopaedic surgery. Though documented previously, it has not been reported in shoulder arthroplasty surgery of which we present the first case. The aetiology of POVL is difficult to elucidate due to its elusive nature. We explain the risks associated with regional blocks used for such surgery and how this may be related to POVL. We must be vigilant of the possible causes of POVL as curative treatment is often not possible and hence must take preventative measures which we have recommended. Fortunately, the patient fully recovered at 10 months postoperatively with excellent function of her reverse shoulder arthroplasty. PMID:25610682

Scadden, John

2014-01-01

292

[Surgical and infectious complications after kidney transplantation].  

PubMed

Analysis of 100 consecutive cadaverous renal transplants revealed significantly better long-term graft function and patient survival rates and lower incidence of surgical postoperative complications in the second 50 transplants in comparison with the first 50 transplants. The incidence of infectious complications declined with the decrease in the corticosteroids dosage. Severe mycotic infections were prevented by prophylactic administration of antimycotic drugs and by shortening the period of prophylactic antibiotic treatment to 24 hours. PMID:2336590

Valenta, J; Klecka, J; Podzimek, A; Opatrný, K

1990-01-01

293

Integrins in Wound Healing.  

PubMed

Significance: Regulation of cell adhesions during tissue repair is fundamentally important for cell migration, proliferation, and protein production. All cells interact with extracellular matrix proteins with cell surface integrin receptors that convey signals from the environment into the nucleus, regulating gene expression and cell behavior. Integrins also interact with a variety of other proteins, such as growth factors, their receptors, and proteolytic enzymes. Re-epithelialization and granulation tissue formation are crucially dependent on the temporospatial function of multiple integrins. This review explains how integrins function in wound repair. Recent Advances: Certain integrins can activate latent transforming growth factor beta-1 (TGF-?1) that modulates wound inflammation and granulation tissue formation. Dysregulation of TGF-?1 function is associated with scarring and fibrotic disorders. Therefore, these integrins represent targets for therapeutic intervention in fibrosis. Critical Issues: Integrins have multifaceted functions and extensive crosstalk with other cell surface receptors and molecules. Moreover, in aberrant healing, integrins may assume different functions, further increasing the complexity of their functionality. Discovering and understanding the role that integrins play in wound healing provides an opportunity to identify the mechanisms for medical conditions, such as excessive scarring, chronic wounds, and even cancer. Future Directions: Integrin functions in acute and chronic wounds should be further addressed in models better mimicking human wounds. Application of any products in acute or chronic wounds will potentially alter integrin functions that need to be carefully considered in the design. PMID:25493210

Koivisto, Leeni; Heino, Jyrki; Häkkinen, Lari; Larjava, Hannu

2014-12-01

294

Postoperative management after loop ileostomy closure: are we keeping patients in hospital too long?  

PubMed Central

INTRODUCTION Recent studies have shown that closure of loop ileostomy can be performed in the day-case setting, reducing the length and cost of hospitalisation. By analysing our patients who have undergone reversal, we aimed to determine the length of hospital stay and potential factors behind stays beyond 24 h. PATIENTS AND METHODS A database of patients undergoing closure of loop ileostomy at one colorectal unit was examined. The times taken to discharge, morbidity and re-admission rates were recorded. RESULTS Eighty patients underwent reversal of ileostomy between January 2001 and January 2006. Median age was 63 years (range, 22–81 years). The median length of stay was 4 days (range, 2–32 days). The median length of stay in patients without complications was 4 days. Many appeared able to be discharged earlier. Seventy-two patients (90%) were able to tolerate a solid diet within 48 h and 54 (67.5%) had bowel function within 3 days. Six patients went home before bowel function; none of these were re-admitted. Twenty patients (25%) developed complications, which included wound infection (8%), small bowel obstruction/ileus (6%), enterocutaneous fistula (1%), anastomotic leak (1%), and late abdominal wall abscess (1%). Of the patients, 16% stayed longer than 5 days despite having no postoperative complications. CONCLUSIONS The majority of patients undergoing loop ileostomy reversal at our institution can be discharged earlier than they are at present. Support in the community and the implementation of modified UK day-case surgery protocols are suggested to help shorten patients' length of stay. PMID:20056062

Baraza, W; Wild, J; Barber, W; Brown, S

2010-01-01

295

Human acellular dermal wound matrix: evidence and experience.  

PubMed

A chronic wound fails to complete an orderly and timely reparative process and places patients at increased risk for wound complications that negatively impact quality of life and require greater health care expenditure. The role of extracellular matrix (ECM) is critical in normal and chronic wound repair. Not only is ECM the largest component of the dermal skin layer, but also ECM proteins provide structure and cell signalling that are necessary for successful tissue repair. Chronic wounds are characterised by their inflammatory and proteolytic environment, which degrades the ECM. Human acellular dermal matrices, which provide an ECM scaffold, therefore, are being used to treat chronic wounds. The ideal human acellular dermal wound matrix (HADWM) would support regenerative healing, providing a structure that could be repopulated by the body's cells. Experienced wound care investigators and clinicians discussed the function of ECM, the evidence related to a specific HADWM (Graftjacket® regenerative tissue matrix, Wright Medical Technology, Inc., licensed by KCI USA, Inc., San Antonio, TX), and their clinical experience with this scaffold. This article distills these discussions into an evidence-based and practical overview for treating chronic lower extremity wounds with this HADWM. PMID:24283346

Kirsner, Robert S; Bohn, Greg; Driver, Vickie R; Mills, Joseph L; Nanney, Lillian B; Williams, Marie L; Wu, Stephanie C

2013-11-28

296

Shedding Light on a New Treatment for Diabetic Wound Healing: A Review on Phototherapy  

PubMed Central

Impaired wound healing is a common complication associated with diabetes with complex pathophysiological underlying mechanisms and often necessitates amputation. With the advancement in laser technology, irradiation of these wounds with low-intensity laser irradiation (LILI) or phototherapy, has shown a vast improvement in wound healing. At the correct laser parameters, LILI has shown to increase migration, viability, and proliferation of diabetic cells in vitro; there is a stimulatory effect on the mitochondria with a resulting increase in adenosine triphosphate (ATP). In addition, LILI also has an anti-inflammatory and protective effect on these cells. In light of the ever present threat of diabetic foot ulcers, infection, and amputation, new improved therapies and the fortification of wound healing research deserves better prioritization. In this review we look at the complications associated with diabetic wound healing and the effect of laser irradiation both in vitro and in vivo in diabetic wound healing. PMID:24511283

Houreld, Nicolette N.

2014-01-01

297

Diabetic Wound Care  

MedlinePLUS

... foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma, as well as duration ... Appropriate debridement of wounds Treating any infection Reducing friction and pressure Restoring adequate blood flow Additional information ...

298

Postoperative endophthalmitis: caution is the watchword.  

PubMed

Postoperative endophthalmitis is the most feared complication following cataract surgery. It can be caused by infection entering the eye during surgery or by inadequately cleaned instruments. Sterile phaco handpieces might retain remnants of soft lens matter or visco-elastic which might later contaminate other patients, causing inflammation in their eyes. The costs of an endophthalmitis outbreak are heavy, including poor patient outcomes, temporary theatre closure, rising waiting lists and damage to a hospital's reputation. This article raises awareness of endophthalmitis and provides useful recommendations for ophthalmic theatre personnel. PMID:16729598

Field, Dorothy; Merrick, Edward

2006-01-01

299

Early Postoperative 24-Hour Continuous Jejunostomy Feeding in Esophagectomy Patients  

PubMed Central

Esophagectomy can result in various postoperative nutrition-related complications that may impair the nutritional status of the patient. In our institution, we usually initiate 16-hour continuous jejunostomy feeding using an enteral feeding pump on postoperative day 2 as a routine protocol after esophagectomy. The target calorie intake was achieved in 6-7 days with this protocol, which is longer than that required with other recently reported feeding protocols. Accordingly, early jejunostomy feeding protocol, which starts on postoperative day 1 and continues for 24 hours was attempted. In the present report, we described 3 cases of early 24-hour continuous jejunostomy feeding after esophagectomy. The use of this new protocol reduced the duration required to achieve the target calorie intake as less than 5 days without any enteral feeding-related complications. PMID:24527423

Lim, Jeong Hyun; Ju, Dal Lae; Hwang, Yoohwa

2014-01-01

300

Bilateral postoperative maxillary cysts after orthognathic surgery: A case report.  

PubMed

Postoperative maxillary cysts are locally aggressive lesions, usually developing as delayed complications many years after radical antral surgery. This report describes a case of bilateral postoperative maxillary cysts following orthognathic surgery performed approximately 21 years previously. The patient complained of stinging pain on her right cheek. Radiographic examination revealed low-attenuation lesions on both maxillary sinuses with discontinuously corticated margins without distinct expansion or bone destruction. The cysts were enucleated with the removal of metal plates and screws for pain relief. Histopathological examination confirmed the diagnosis of postoperative maxillary cysts lined by ciliated, pseudostratified columnar cells. The patient has remained asymptomatic thus far, and there was no evidence of local recurrence at 21 months of postoperative follow-up. PMID:25473641

Lee, Jung-Hye; Huh, Kyung-Hoe; Yi, Won-Jin; Heo, Min-Suk; Lee, Sam-Sun; Choi, Soon-Chul

2014-12-01

301

n-Butyl cyanoacrylate adhesive for skin closure of abdominal wounds: preliminary results.  

PubMed Central

Tissue adhesives offer significant potential advantages over traditional methods of wound closure. A new n-butyl 2-cyanoacrylate adhesive formulation was utilised for the closure of abdominal wounds after general and laparoscopic gastrointestinal surgery. One hundred and two patients with 240 wounds were recruited. Wounds were classified as > 10 cm, n = 39; 5-9 cm, n = 27; and < 5 cm, n = 176. Complications included one small seroma and two partial superficial dehiscences. There were no incidences of wound infection. This preliminary study indicates that this tissue adhesive can safely and effectively be utilised for general abdominal wound closure. It should now be subjected to the rigorous of a randomised controlled trial to compare its performance against the more traditional methods of wound closure. PMID:9432925

Qureshi, A.; Drew, P. J.; Duthie, G. S.; Roberts, A. C.; Monson, J. R.

1997-01-01

302

Acute postoperative delirium: Definitions, incidence, recognition, and interventions  

Microsoft Academic Search

Emergence excitement or delirium is a common postanesthesia complication. Often, the emergence excitement resolves quickly, and the patient's continued recovery is uneventful. Although the initial period of excitement may be short lived and resolve without long-term sequela, some patients may experience acute postoperative delirium, a phenomenon that is more difficult to assess and of potentially longer duration. Although patients are

Denise O'Brien

2002-01-01

303

ASA classification and perioperative variables as predictors of postoperative outcome  

Microsoft Academic Search

In a prospective study of 6301 surgical patients in a university hospital, we examined the strength of association between ASA physical status classi- fication and perioperative risk factors, and post- operative outcome, using both univariate analysis and calculation of the odds ratio of the risk of developing a postoperative complication by means of a logistic regression model. Univariate analysis showed

U. WOLTERS; T. WOLF; H. STÜTZER; T. SCHRÖDER

1996-01-01

304

[Hyponatremia and convulsions in the postoperative period in children].  

PubMed

Four children undergoing surgery presented with seizures and hyponatremia 12 hours after anesthesia. One child died with cerebral oedema, the others recovered. The respective roles of hypo-osmolar perfusions and ADH secretion are discussed. Ionogram before surgery, supervision of weight and diuresis and correct fluid management should prevent these postoperative complications. PMID:3060040

Teyssier, G; Rayet, I; David, T; Serio, A; Damon, G; Freycon, F

1988-01-01

305

The use of hyperspectral imaging (HSI) in wound healing  

NASA Astrophysics Data System (ADS)

A hyperspectral imaging system (HsI), described previously, was utilized to evaluate and monitor wounds and their healing surgery and post-operatively. Briefly, the system consists of a DLP® based spectral light modulator providing active spectral illumination that is synchronized with a digital focal plan array for collecting spectroscopic images that are processed for mapping the percentage of oxyhemoglobin at each detector pixel non-invasively and at near video rates ~8 chemically encode images per second.

La Fontaine, Javier; Lavery, Lawrence; Zuzak, Karel

2014-03-01

306

Complications in colorectal surgery: risk factors and preventive strategies  

PubMed Central

Backround Open or laparoscopic colorectal surgery comprises of many different types of procedures for various diseases. Depending upon the operation and modifiable and non-modifiable risk factors the intra- and postoperative morbidity and mortality rate vary. In general, surgical complications can be divided into intraoperative and postoperative complications and usually occur while the patient is still in the hospital. Methods A literature search (1980-2009) was carried out, using MEDLINE, PubMed and the Cochrane library. Results This review provides an overview how to identify and minimize intra- and postoperative complications. The improvement of different treatment strategies and technical inventions in the recent decade has been enormous. This is mainly attributable to the increase in the laparoscopic approach, which is now well accepted for many procedures. Training of the surgeon, hospital volume and learning curves are becoming increasingly more important to maximize patient safety, surgeon expertise and cost effectiveness. In addition, standardization of perioperative care is essential to minimize postoperative complications. Conclusion This review summarizes the main perioperative complications of colorectal surgery and influencable and non-influencable risk factors which are important to the general surgeon and the relevant specialist as well. In order to minimize or even avoid complications it is crucial to know these risk factors and strategies to prevent, treat or reduce intra- and postoperative complications. PMID:20338045

2010-01-01

307

Prophylactic Consecutive Administration of Haloperidol Can Reduce the Occurrence of Postoperative Delirium in Gastrointestinal Surgery  

Microsoft Academic Search

Postoperative delirium has in recent years been a common complication which can interfere with the recovery of patients after surgery. Unfortunately there is still no medical procedure available which can completely prevent the occurrence of postoperative delirium. Haloperidol is a psychopharmacological agent that has been used to treat the delirium and agitation, especially in geriatric patients. To assess the effectiveness

Tetsuya Kaneko; Jianhui Cai; Takanori Ishikura; Makoto Kobayashi; Takuji Naka; Nobuaki Kaibara

308

Measures of Executive Function and Depression Identify Patients at Risk for Postoperative Delirium  

Microsoft Academic Search

Background: Postoperative delirium is associated with in- creased morbidity and mortality. Preexisting cognitive impair- ment and depression have been frequently cited as important risk factors for this complication. This prospective cohort study was designed to determine whether individuals who perform poorly on preoperative cognitive tests and\\/or exhibited depres- sive symptoms would be at high risk for the development of postoperative

Nathaniel H. Greene; Deborah K. Attix; B. Craig Weldon; Patrick J. Smith; David L. McDonagh; Terri G. Monk

2009-01-01

309

Topical use of antifibrinolytic agents reduces postoperative bleeding: a double-blind, prospective, randomized study  

Microsoft Academic Search

Objective: Postoperative bleeding is still one of the most common complications of cardiac surgery. Antifibrinolytic agents successfully reduce bleeding, but there are controversies concerning adverse effects after their systemic use. By topical application of antifibrinolytic agents in pericardial cavity, most of these effects are avoided. We compared the effects of topically applied aprotinin, tranexamic acid and placebo on postoperative bleeding

Davor Baric; Bojan Biocina; Daniel Unic; Zeljko Sutlic; Igor Rudez; Vesna Bacic Vrca; Kristina Brkic; Mira Ivkovic

2007-01-01

310

Topical use of antifibrinolytic agents reduces postoperative bleeding: a double-blind, prospective, randomized study  

Microsoft Academic Search

Objective: Postoperative bleeding is still one of the most common complications of cardiac surgery. Antifibrinolytic agents successfully reduce bleeding, but there are controversies concerning adverse effects after their systemic use. By topical application of antifibrinolytic agents in pericardial cavity, most of these effects are avoided. We compared the effects of topically applied aprotinin, tranexamic acid and placebo on postoperative bleeding

Davor Bari; Bojan Biocina; Daniel Uni; Zeljko Sutlic; Igor Rude; Vesna Bacic Vrca; Kristina Brkic; Mira Ivkovic

311

Postoperative perforation of the Schneiderian membrane in maxillary sinus augmentation: a case report.  

PubMed

Perforation of the Schneiderian membrane constitutes a major intraoperative complication of maxillary sinus floor elevation with graft materials, but postoperative perforation of the sinus membrane is very rare. This case report demonstrates that conservative treatment involving drainage and the administration of systemic antibiotics can be used to successfully treat postoperative sinus membrane perforation with infection of the graft material. PMID:25020219

Jo, Kyu-Hong; Yoon, Kyu-Ho; Cheong, Jeong-Kwon; Jeon, In-Seong

2014-07-01

312

Complications following Surgery for Lumbar Stenosis in a Veteran Population  

PubMed Central

Study Design Secondary analysis of the prospectively collected Veterans Affairs National Surgical Quality Improvement Program (VASQIP) database. Objective Determine rates of major medical complications, wound complications, and mortality among patients undergoing surgery for lumbar stenosis; and examine risk factors for these complications. Summary of Background Data Surgery for spinal stenosis is concentrated among older adults, for whom complications are more frequent than among middle-aged patients. Many studies have focused on infections or device complications, but fewer have focused on major cardiopulmonary complications, using prospectively collected data. Methods We identified patients who underwent surgery for a primary diagnosis of lumbar stenosis between 1998 and 2009 from the VASQIP database. We created a composite of major medical complications, including acute myocardial infarction, stroke, pulmonary embolism, pneumonia, systemic sepsis, coma, and cardiac arrest. Results Among 12,154 eligible patients, major medical complications occurred in 2.1% ; wound complications in 3.2%; and 90-day mortality in 0.6%. Major medical complications, but not wound complications, were strongly associated with age. American Society of Anesthesiologists (ASA) class was a strong predictor of complications. Insulin use, chronic corticosteroid use, and preoperative functional status were also significant predictors. Fusion procedures were associated with higher complication rates than decompression alone. In logistic regressions, ASA class and age were the strongest predictors of major medical complications (OR for ASA class 4 vs. classes 1 or 2: 2.97, 95% CI 1.68, 5.25, p=0.0002). After adjustment for comorbidity, age, and functional status, fusion procedures remained associated with higher medical complication rates than decompression alone (OR 2.85, 95% CI 2.14, 3.78, p<0.0001). Conclusion ASA class, age, type of surgery, insulin or corticosteroid use, and functional status were independent risk factors for major medical complications. These factors may help in selecting patients and planning procedures, improving patient safety. PMID:23778366

Deyo, Richard A.; Hickam, David; Duckart, Jonathan P.; Piedra, Mark

2013-01-01

313

Cytotoxicity and wound healing properties of PVA/ws-chitosan/glycerol hydrogels made by irradiation followed by freeze-thawing  

NASA Astrophysics Data System (ADS)

Hydrogels based on poly(vinyl alcohol), water-soluble chitosan and glycerol made by irradiation followed by freeze-thawing were evaluated as wound dressing. MTT assay suggested that the extract of hydrogels was nontoxic towards L929 mouse fibroblasts. Compared to gauze dressing, the hydrogel can accelerate the healing process of full-thickness wounds in a rat model. Wounds treated with hydrogel healed at 11th day postoperatively and histological observation showed that mature epidermal architecture was formed. These indicate that it is a good wound dressing.

Yang, Xiaomin; Yang, Kang; Wu, Shengwei; Chen, Xiliang; Yu, Feng; Li, Jungang; Ma, Mingwang; Zhu, Zhiyong

2010-05-01

314

Use of an Acellular Regenerative Tissue Matrix Over Chronic Wounds  

PubMed Central

Objectives: Bioengineered skin grafts, including acellular dermal matrices, may be effective in treating lower extremity and trunk wounds that are not responsive to traditional wound management. Acellular dermal wound matrix is derived from human acellular dermal wound matrix (HADWM) tissue and provides a scaffold that supports cellular repopulation and revascularization. The major structural components of the dermis are retained during processing, and a single application has been shown to help achieve wound closure. Methods: This patient case series examined the use of HADWM on lower extremity and trunk wounds in 11 patients (6 male and 5 female) with a mean age of 55 years (range: 31–83 years). Wounds were debrided 1 to 2 times, followed by placement of HADWM (range: 4–330 cm2) on wounds that varied from the dorsal surface of the foot, lower abdomen, and lower extremity to the Achilles flap. A nonadherent layer in conjunction with bacitracin was placed over HADWM. Negative pressure wound therapy (NPWT) was placed over the HADWM and initiated continuously at ?125 mm Hg for 1 to 2 weeks. After the application of NPWT, HADWM was covered with various gauze dressings using mineral oil. Results: All patients completed their treatment successfully, and follow-up ranged from 1 week to 6 months. One patient experienced an infection, which resulted in partial graft loss that required replacement with HADWM and NPWT. No additional complications occurred in the other patients. Conclusions: This patient case series demonstrated successful use of HADWM and NPWT, which further supports published studies documenting HADWM success in chronic wounds. PMID:24324850

Stacey, D. Heath

2013-01-01

315

Outcome of pyometra in female dogs and predictors of peritonitis and prolonged postoperative hospitalization in surgically treated cases  

PubMed Central

Background One of the most common diseases in intact bitches is pyometra– a potentially life-threatening disease associated with a variety of clinical and laboratory findings. The aims of the present study were to describe complications of the disease and to investigate clinically useful indicators associated with peritonitis and/or prolonged postoperative hospitalization. Results A retrospective study was performed using records from 356 bitches diagnosed with pyometra during the years 2006–2007 at the University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden. Of the 356 bitches, 315 were surgically treated by ovariohysterectomy, 9 were medically treated and 32 were euthanized without treatment. In the surgically treated bitches, univariable associations between clinical and laboratory data, risk for prolonged hospitalization (? 3 days) and/or signs of peritonitis, were analyzed by Chi-square and Fisher’s exact test. Logistic regression models were used to assess multivariable associations. The most common complication observed in surgically treated bitches was peritonitis (40 bitches), followed by urinary tract infection (19 bitches), wound infection (8 bitches), uveitis (6 bitches), and cardiac arrhythmia (5 bitches). Leucopenia and fever/hypothermia were associated with increased risk for peritonitis (18-fold and three-fold, respectively). Moderate to severe depression of the general condition, pale mucous membranes and leucopenia were associated with increased risk (seven-fold, three-fold, and over three-point-five-fold, respectively) for prolonged postoperative hospitalization. Conclusions Several clinically useful indicators were identified. Leucopenia was the most important marker, associated with 18-fold increased risk for peritonitis and an over three-point-five increased risk for prolonged hospitalization. Fever/hypothermia, depression and pale mucous membranes were associated with increased risk for peritonitis and/or prolonged hospitalization. The results of the present study may be valuable for identifying peritonitis and predicting increased morbidity in surgically treated bitches with pyometra. PMID:24393406

2014-01-01

316

Prevention and management of complications in body contouring surgery.  

PubMed

This patient safety article discusses strategies to prevent, diagnose, and manage complications from body contouring surgery. Preoperative, intraoperative, and postoperative approaches to avoiding, identifying, and treating complications are addressed. Individual complications, such as hematoma, seroma, infection, dehiscence, suture extrusion, deep venous thrombosis, and pulmonary embolism are discussed and a review of complication rates in the body contouring literature is provided. The article addresses procedure-specific complications and pearls to avoiding complications in these cases. Difficult problems such as skin relaxation and management of the disappointed patient are also discussed. PMID:25283464

Gusenoff, Jeffrey A

2014-10-01

317

Complications of posterior cruciate ligament surgery.  

PubMed

In addition to standard risks associated with all orthopedic surgical procedures, posterior cruciate ligament (PCL) reconstruction poses some relatively unique potential complications. These complications arise from a combination of several factors: the relative infrequency of PCL injuries, the lack of knowledge and experience in treating them, the proximity of neurovascular structures to the PCL, and the technically demanding nature of reconstructive procedures. This article discusses the anatomy, pathogenesis, and prevention of intraoperative and postoperative complications of PCL surgery including neurovascular injury, osteonecrosis, fracture, motion loss, and persistent laxity. PMID:21079507

Zawodny, Sarah R; Miller, Mark D

2010-12-01

318

Early local complications following colostomy closure in cancer patients  

Microsoft Academic Search

Early surgical complications following colostomy closure in 65 cancer patients operated on at the Istituto Nazionale Tumori\\u000a of Milan were evaluated retrospectively. The overall complication rate was 24.6 per cent, including infections (13.8 per cent),\\u000a fistulas (6.1 per cent), wound dehiscence (3.0 per cent), and distal stenosis (1.5 per cent). Type and rate of complications\\u000a were analyzed to find a

Federico Bozzetti; Maurizio Nava; Rosaria Bufalino; Velio Menotti; Raffaele Marolda; R. Doci; Leandro Gennari

1983-01-01

319

Hyperspectral characterization of an in vitro wound model  

NASA Astrophysics Data System (ADS)

Wound healing is a complex process not fully understood. There is a need of better methods to evaluate the different stages of healing, and optical characterization is a promising tool in this respect. In this study hyperspectral imaging was employed to characterize an in vitro wound model. The wound model was established by first cutting circular patches of human abdominal skin using an 8mm punch biopsy tool, and then creating dermal wounds in the center of the skin patches using a 5mm tool. The wounds were incubated in medium with 10% serum and antibiotics. Hyperspectral images were collected every three days using a push broom hyper spectral camera (Hyspex VNIR1600). The camera had a spectral resolution of 3.7 nm and was fitted with a close up lens giving a FOV of 2.5 cm and a spatial resolution of 29 micrometer. Samples for histology were collected throughout the measurement period, which was 21 days in total. Data were processed in ENVI and Matlab. A successful classification based on hyperspectral imaging of the implemented model is presented. It was not possible to see the healing zone in the in vitro model with the naked eye without dying. The hyperspectral results showed that newly formed epithelium could be imaged without any additional contrast agents or dyes. It was also possible to detect non-viable tissue. In vitro wound models and hyperspectral imaging can thus be employed to gain further insight in the complicated process of healing in different kinds of wounds.

Randeberg, Lise L.; Hegstad, Janne-Lise; Paluchowski, Lukasz; Milani?, Matija; Pukstad, Brita S.

2014-03-01

320

A Chemical Biological Strategy to Facilitate Diabetic Wound Healing  

PubMed Central

A complication of diabetes is the inability of wounds to heal in diabetic patients. Diabetic wounds are refractory to healing due to the involvement of activated matrix metalloproteinases (MMPs), which remodel the tissue resulting in apoptosis. There are no readily available methods that identify active unregulated MMPs. With the use of a novel inhibitor-tethered resin that binds exclusively to the active forms of MMPs, coupled with proteomics, we quantified MMP-8 and MMP-9 in a mouse model of diabetic wounds. Topical treatment with a selective MMP-9 inhibitor led to acceleration of wound healing, re-epithelialization, and significantly attenuated apoptosis. In contrast, selective pharmacological inhibition of MMP-8 delayed wound healing, decreased re-epithelialization, and exhibited high apoptosis. The MMP-9 activity makes the wounds refractory to healing, whereas that of MMP-8 is beneficial. The treatment of diabetic wounds with a selective MMP-9 inhibitor holds great promise in providing heretofore-unavailable opportunities for intervention of this disease. PMID:24053680

Gooyit, Major; Peng, Zhihong; Wolter, William R.; Ping, Hualiang; Ding, Derong; Hesek, Dusan; Lee, Mijoon; Boggess, Bill; Champion, Matthew M.; Suckow, Mark A.; Mobashery, Shahriar; Chang, Mayland

2013-01-01

321

Open bite as a complication of total temporomandibular joint replacement: a case report.  

PubMed

Temporomandibular joint total joint replacement, like any surgery, can be associated with either intraoperative or postoperative complications. Intraoperative complications may include injuries to local anatomical structures (e.g., blood vessels, nerves, middle ear, and external auditory canal), or poor positioning and/or adaptation of the prosthesis components to the host bone. Postoperative complications may include infection, hematoma, heterotopic bone formation, implant failure, pain, salivary fistula, foreign body or allergic reactions, and malocclusion. This article reports the occurrence of a postoperative open-bite malocclusion complication, the result of maxillary artery hemorrhage. PMID:22986256

Machon, Vladimir; Hirjak, Dusan; Foltan, Rene

2012-10-01

322

Complications of diverticular disease: surgical laparoscopic treatment  

PubMed Central

Surgical treatment of complicated colonic diverticular disease is still debatable. The aim of our study was to evaluate the outcome of laparoscopic colon resection in patients with diverticulitis and with complications like colon-vescical fistula, peridiverticular abscess, perforation or stricture. All patients underwent laparoscopic colectomy within 8 years period. Main data recorded were age, sex, return of bowel function, operation time, duration of hospital stay, ASA score, body mass index (BMI), early and late complications. During the study period, 33 colon resections were performed for diverticulitis and complications of diverticulitis. We performed 5 associated procedures. We had 2 postoperative complications; 1 of these required a redo operation with laparotomy for anastomotic leak and 3 patients required conversion from laparoscopic to open colectomy. The most common reasons for conversion were related to the inflammatory process with a severe adhesion syndrome. Mean operative time was 229 minutes, and average postoperative hospital stay was 9,8 days. Laparoscopic surgery for complications of diverticular disease is safe, effective and feasible. Laparoscopic colectomy has replaced open resection as standard surgery for recurrent and complicated diverticulitis in our institution. PMID:24979103

ANANIA, G.; VEDANA, L.; SANTINI, M.; SCAGLIARINI, L.; GIACCARI, S.; RESTA, G.; CAVALLESCO, G.

2014-01-01

323

Silicone intubation of the lacrimal system: pitfalls, problems and complications.  

PubMed

The Quickert-Dryden method of silicone intubation of the lacrimal system has been modified to make it easier to perform and to avoid postoperative complications encountered by me during my experiences with 23 patients. Problems with the technique are identified and management of complications is discussed. PMID:1267321

Lauring, L

1976-04-01

324

Solutions to intraoperative wound classification miscoding in a subset of american college of surgeons national surgical quality improvement program patients.  

PubMed

Intraoperative wound classification is a predictor of postoperative infection. Therefore, accurately assigning the correct classification to a surgical wound is of particular importance. Our institution participates in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), a national outcomes database that collects wound classification for all qualifying operative procedures, and we noted discrepancies when comparing ACS NSQIP wound classification coding with perioperative coding in our electronic medical record. We tested the effectiveness of an intervention that included staff educational sessions, informational posters, and postoperative debriefings on improving the accuracy of documented intraoperative wound classification. The ?(2) test was used to compare proportions of wound classification miscodings before and after educational sessions and debriefings commenced. Baseline data revealed misclassification of wounds occurred 21 per cent (30 of 141) of the time in predominately colorectal procedures performed by two surgeons from April through August 2012. Errors decreased to 9 per cent (13 of 147) from August to December 2012, after our intervention of education sessions with operating room staff and the surgeons incorporating a statement confirming the wound classification at the end of the case debriefing. The ?(2) statistic was 8.7589. The P value was significant at 0.003. Ensuring concordance of classification between the surgeon and nurse during a postprocedure debriefing as well as education of perioperative nursing staff through posters and seminars significantly improved the accuracy of intraoperative wound classification coding. PMID:25642884

Turrentine, Florence E; Giballa, Sarah B; Shah, Puja M; Jones, David R; Hedrick, Traci L; Friel, Charles M

2015-02-01

325

A Randomized Clinical Trial on the Effect of Oral Metronidazole on Wound Healing and Pain after Anal Sphincterotomy and Fissurectomy  

Microsoft Academic Search

Chronic anal fissure is one of the most common causes of anal pain and surgical therapy is the treatment of choice. There is scarce information regarding the prophylactic effects of oral metronidazole on postoperative complications of anal fissure. The objective of this study was to determine the effects of metronidazole as a prophylactic measure for postoperative anal fissure complications. In

Seyed Vahid Hosseini; Babak Sabet; Mohamoud Nouri; Shahram Bolandparvaz

326

A comparative double-blind, randomised trial of a new second generation LMWH (bemiparin) and UFH in the prevention of post-operative venous thromboembolism. The Bemiparin Assessment group.  

PubMed

A randomised, prospective, double-blind trial was performed, to compare the safety and efficacy of a new low-molecular-weight heparin (LMWH) Bemiparin and standard unfractionated heparin (UFH), for the prophylaxis of postoperative venous thromboembolism. 300 patients scheduled to undergo elective hip arthroplasty were included. The principal outcome measures were the incidence of thromboembolic events and bleeding complications. 149 patients received 3,500 anti-Xa IU of bemiparin plus a placebo injection daily and 149 patients received 5,000 IU of UFH twice a day. The two groups were similar with respect to factors likely to affect the risk of developing post-operative venous thromboembolism (VTE) and risk of bleeding events. During the post-operative period, 34 patients developed VTE complications; 9 (7.2%) in the bemiparin group and 25 (18.7%) in the UFH group. VTE in the two groups was statistically significant (OR of 2.96; 95% CI 1.32-6.62 and p = 0.01). There were no significant differences in the frequency of bleeding complications: major bleeding requiring discontinuation of prophylaxis, (OR 1.21; 95% CI 0.36-4.05; p = 1.00), the measured median operative blood loss (p = 0.77) or the median postoperative drain loss (p = 0.97), and the number of patients who developed wound haematoma (OR 0.87; 95% CI 0.31-2.46; p = 1.00). A comparison of coagulation parameters on the preoperative day with post-operative day 2 +/- 1, day 6 +/- 1 and day of discharge showed a significantly higher AT concentration, anti-factor Xa activity and TFPI levels in the bemiparin group when compared with UFH. This study demonstrates that bemiparin, in a single daily subcutaneous dose of 3,500 anti-Xa IU in high risk patients undergoing hip arthroplasty is more effective than UFH administered twice daily at a dose of 5,000 IU in the prevention of postoperative VTE. Both agents are equally safe. PMID:10780310

Kakkar, V V; Howes, J; Sharma, V; Kadziola, Z

2000-04-01

327

Analysis of blood flow and local expression of angiogenesis?associated growth factors in infected wounds treated with negative pressure wound therapy.  

PubMed

Angiogenesis is involved in the wound healing process. Increased angiogenesis and blood flow constitute a major mechanism of negative pressure wound therapy (NPWT), which has been shown to facilitate the healing of infected wounds. However, the effect on the expression of angiogensis?related growth factor remains unknown. The goal of the current study was to investigate the angiogenic factor levels prior to and following NPWT in infected wounds. A total of 20 patients with infected wounds treated with NPWT were included in the study. Patients acted as their own control; the postoperative measurements of patients were considered as the experimental group, while preoperative measurements were considered as the controlled group. Blood flow was recorded prior to and during NPWT. A total of 10 angiogensis?related growth factors were detected using a protein biochip array to analyze the change in protein levels prior to NPWT, and on the third day during NPWT. All wounds were successfully reconstructed by skin grafting or using local flaps following NPWT. NPWT resulted in significantly increased blood flow in the wound. There was a significant increase in vascular endothelial growth factor (VEGF), EGF, platelet?derived growth factor and angiotesin?2 following NPWT, while basic fibroblast growth factor decreased significantly. NPWT affects the local expression of angiogenesis?associated growth factors, which represents another mechanism to explain how NPWT accelerates wound healing. PMID:24584462

Xia, Cheng-Yan; Yu, Ai-Xi; Qi, Baiwen; Zhou, Min; Li, Zong-Huan; Wang, Wei-Yang

2014-05-01

328

Urethral stricture vaporization with the KTP laser provides evidence for a favorable impact of laser surgery on wound healing  

NASA Astrophysics Data System (ADS)

The objective of this study was to evaluate and compare the safety and efficacy of the KTP 532 laser to direct vision internal urethrotomy (DVIU) in the management of urethral strictures. A total of 32 patients were randomized prospectively in this study, 14 DVIU and 18 KTP 532 laser. Patients were evaluated postoperatively with flowmetry and in the case of recurrence with cystourethrography at 3, 12, 24 weeks. With the KTP 532 laser complete symptomatic and uredynamic success was achieved in 15 (83%) patients at 12 and 24 weeks. Success rate was lower in the DVIU group with 9 (64%) patients at 12 weeks and 8 (57%) patients at 24 weeks. Mean preoperative peak-flow was improved from 6 cc/s to 20 cc/s at 3, 12 and 24 weeks with the KTP laser. With DVIU mean preoperative peak-flow was improved from 5.5 cc/s to 20 cc/s at 3 weeks followed by a steady decrease to 13 cc/s at 12 weeks and to 12 cc/s 24 weeks. No complication was observed in either group of patients. Our results confirm that stricture vaporization with the KTP 532 laser is a safe and efficient procedure. The better results after laser surgery make it also a valuable alternative in the endoscopic treatment of urethral strictures. These findings suggest a favorable influence of laser surgery on wound healing with less wound contraction and scarring. The lack of contraction of laser wounds might be related to the absence and the lack of organization of myofibroblasts in laser induced lesions.

Schmidlin, Franz R.; Venzi, Giordano; Jichlinski, Patrice; Oswald, Michael; Delacretaz, Guy P.; Gabbiani, Giulio; Leisinger, Hans-Juerg; Graber, Peter

1997-12-01

329

Use of gelatin powder added to rifamycin versus bone wax in sternal wound hemostasis after cardiac surgery.  

PubMed

Bone wax is the substance which has been used for hemostasis in different surgical fields for up to one hundred years and historically used in our center to prevent sternal bleeding and subsequent complications. Recently, reabsorbable gelatin powder has come into use. Up to now there are no clinical studies that compare these two substances. Between 1st January and 31st December 2004, 1249 subsequent patients have been operated on for different cardiac surgical procedures in our center, of them 557 were enrolled in a randomized perspective monocentric study. They have been divided into two similar subgroups: one treated with swine gelatin plus rifamycin (group one) and the other with bone wax (group two). The two hemostatic products have been applied just after the sternotomy and before the chest closing. Each patient was evaluated for bleeding, sternal infections and was followed-up for two months for bone and wound healing. Postoperative bleeding at the tenth hour was 315 ml+/-269 (mean+/-S.D.) in the first group and 395 ml+/-265 in the second (P<0.001). In the 10th-20th hour interval time bleeding was 120 ml+/-74 and 205 ml+/-132, respectively (P<0.001). Total bleeding was 415 ml+/-87 in group one and 580 ml+/-150 in group two (P<0.001). Chest reopening for bleeding not due to surgical problems was carried out in 14 patients (4.7%) (group one) and 19 (7.3%) (group two) (n.s.). Superficial sternal wound infection occurred in two patients (0.7%) in group one and three patients (1.1%) in group two (n.s.). There were no deep sternal wound infections. Bleeding was significantly higher in patients treated with bone wax compared to those with absorbable gelatin plus rifamycin. PMID:17669768

Ragusa, Renato; Faggian, Giuseppe; Rungatscher, Alessio; Cugola, Diego; Marcon, Alessandro; Mazzucco, Alessandro

2007-02-01

330

Continuous ropivacaine infusion vs transdermal fentanyl for providing postoperative analgesia following temporomandibular joint interpositional gap arthroplasty  

PubMed Central

Aim The purpose of this study was to evaluate the postoperative pain control and mouth opening in patients undergoing temporomandibular joint interpositional gap arthroplasty by either placing an epidural catheter in the incision wound and infusing ropivacaine 0.25% or by using a transdermal fentanyl patch. Materials and Methods: The study was prospective, randomized and double blind. Eighty patients belonging to American Society of Anesthesiologists grade I and II, 18–32 years of age, scheduled for temporomandibular joint interpositional gap arthroplasty were randomized into 2 groups; ropivacaine group (G rop): to receive 0.25% ropivacaine infusion and transdermal fentanyl group (G tf): to receive transdermal fentanyl patch. For postoperative pain (Visual Analog Score [VAS]) and analgesic requirements were assessed 2, 4 and 8 h after surgery and each morning, until and 4 days after surgery. Results: Time to first analgesic requirement was found to be significantly (P < 0.0001) higher in G rop (49 ± 6.7) as compared with G tf (32 ± 9.1) VAS were also significantly lower in G rop throughout the postoperative period. Postoperatively, mouth opening was better in G rop as compared with G tf, which was statistically significant. Conclusion: It was concluded that by placing an epidural catheter at the incision wound and continuously infusing with ropivacaine 0.25% effectively controls the postoperative pain in patients undergoing temporomandibular joint interpositional gap arthroplasty and provides better postoperative mouth opening. PMID:22442580

Dhasmana, Satish; Singh, Vibha; Pal, U.S.

2010-01-01

331

[Postoperative pulmonary thromboembolism].  

PubMed

Since 1986, American College of Chest Physicians (ACCP) has been regularly releasing guidelines for antithrombotic therapy for prevention and treatment of thrombosis. The sixth ACCP consensus 2001 conference has recommended successful prevention strategies in surgical patients. A few Japanese prospective studies disclosed that the incidence of deep vein thrombosis(DVT) after general surgery in Japan is about half in western countries. On the other hand, it is reported that the incidence of DVT after total hip replacement and total knee replacement in Japan is almost as same as in western countries. Since there is still little data available for the incidence of postoperative DVT and pulmonary thromboembolism in Japan, it is necessary to organize some prospective multicenter surveys for them. PMID:14577293

Seo, Norimasa

2003-10-01

332

Postoperative nausea and vomiting  

PubMed Central

Postoperative nausea and vomiting (PONV) is a long-standing issue, not a new concept in anesthesiology. Despite many studies over the last several decades, PONV remains a significant problem due to its complex mechanism. This review presents a summary of the mechanism underlying the pathogenesis of PONV, focusing on preventive treatment, particularly the use of new drugs. In addition, we discuss the latest meta-analysis results regarding correct clinical use of classic drugs. I also summarize the latest trends of postdischarge nausea and vomiting and the pharmacogenetics, which is attracting a great deal of attention from other medical fields in PONV-related studies. Finally, we discuss the drawbacks of existing studies on PONV and suggest a focus for future investigations. PMID:25302092

2014-01-01

333

The TopClosure® 3S System, for skin stretching and a secure wound closure.  

PubMed

The principle of stretching wound margins for primary wound closure is commonly practiced and used for various skin defects, leading at times to excessive tension and complications during wound closure. Different surgical techniques, skin stretching devices and tissue expanders have been utilized to address this issue. Previously designed skin stretching devices resulted in considerable morbidity. They were invasive by nature and associated with relatively high localized tissue pressure, frequently leading to necrosis, damage and tearing of skin at the wound margins. To assess the clinical effectiveness and performance and, to determine the safety of TopClosure® for gradual, controlled, temporary, noninvasive and invasive applications for skin stretching and secure wound closing, the TopClosure® device was applied to 20 patients for preoperative skin lesion removal and to secure closure of a variety of wound sizes. TopClosure® was reinforced with adhesives, staples and/or surgical sutures, depending on the circumstances of the wound and the surgeon's judgment. TopClosure® was used prior to, during and/or after surgery to reduce tension across wound edges. No significant complications or adverse events were associated with its use. TopClosure® was effectively used for preoperative skin expansion in preparation for dermal resection (e.g., congenital nevi). It aided closure of large wounds involving significant loss of skin and soft tissue by mobilizing skin and subcutaneous tissue, thus avoiding the need for skin grafts or flaps. Following surgery, it was used to secure closure of wounds under tension, thus improving wound aesthetics. A sample case study will be presented. We designed TopClosure®, an innovative device, to modify the currently practiced concept of wound closure by applying minimal stress to the skin, away from damaged wound edges, with flexible force vectors and versatile methods of attachment to the skin, in a noninvasive or invasive manner. PMID:22719176

Topaz, Moris; Carmel, Narin-Nard; Silberman, Adi; Li, Ming Sen; Li, Yong Zhong

2012-07-01

334

[Introduction on postoperative nutritional support in neonatal cardiac surgery].  

PubMed

Malnutrition is common in newborn patients after cardiac surgery, because of the low metabolic reserves, increased energy expenditure caused by the injury, and reduced or delayed nutritional support they receive, as well as their inability to metabolize the nutrients administered. It is important to achieve appropriate nutrition; a better metabolic response after surgery has a significant impact on length of stay, wound healing, susceptibility to infections and surgical outcome. This guideline intended to establish the practical foundation for parenteral and enteral nutritional support in the newborn with cardiac surgery, considering water restriction, optimizing macro and micronutrients required in the postoperative time. PMID:25192526

Oeschger, Vanesa Verónica; Mazza, Carmen Silvia; Araujo, María Beatriz; Sauré, Carola

2014-10-01

335

Management strategies to reduce risk of postoperative infections  

PubMed Central

Postoperative infections, although rare, are still of great concern to the ophthalmologist. The incidence of post-cataract endophthalmitis is low, with a range of .28 per 1,000 to 2.99 per 1000. In addition to intraoperative considerations such as poor wound construction, vitreous loss, topical anesthesia, and prolonged surgical time, other risk factors include preoperative factors such as a diseased ocular surface and systemic immunosuppression. Potential methods of reducing risk of endophthalmitis after anterior segment surgery are discussed and available literature is summarized. PMID:24319649

Galor, Anat; Goldhardt, Raquel; Wellik, Sarah R.; Gregori, Ninel Z.; Flynn, Harry W.

2013-01-01

336

Survival after postoperative morbidity: a longitudinal observational cohort study†  

PubMed Central

Background Previous studies have suggested that there may be long-term harm associated with postoperative complications. Uncertainty exists however, because of the need for risk adjustment and inconsistent definitions of postoperative morbidity. Methods We did a longitudinal observational cohort study of patients undergoing major surgery. Case-mix adjustment was applied and morbidity was recorded using a validated outcome measure. Cox proportional hazards modelling using time-dependent covariates was used to measure the independent relationship between prolonged postoperative morbidity and longer term survival. Results Data were analysed for 1362 patients. The median length of stay was 9 days and the median follow-up time was 6.5 yr. Independent of perioperative risk, postoperative neurological morbidity (prevalence 2.9%) was associated with a relative hazard for long-term mortality of 2.00 [P=0.001; 95% confidence interval (CI) 1.32–3.04]. Prolonged postoperative morbidity (prevalence 15.6%) conferred a relative hazard for death in the first 12 months after surgery of 3.51 (P<0.001; 95% CI 2.28–5.42) and for the next 2 yr of 2.44 (P<0.001; 95% CI 1.62–3.65), returning to baseline thereafter. Conclusions Prolonged morbidity after surgery is associated with a risk of premature death for a longer duration than perhaps is commonly thought; however, this risk falls with time. We suggest that prolonged postoperative morbidity measured in this way may be a valid indicator of the quality of surgical healthcare. Our findings reinforce the importance of research and quality improvement initiatives aimed at reducing the duration and severity of postoperative complications. PMID:25012586

Moonesinghe, S. R.; Harris, S.; Mythen, M. G.; Rowan, K. M.; Haddad, F. S.; Emberton, M.; Grocott, M. P. W.

2014-01-01

337

[Atypical maxillofacial shot wound].  

PubMed

Maxillofacial shot wounds belong to the relatively less frequent injuries. The soft tissues might be affected in particular, however the most of injuries are combined with infliction of hard tissues. Shot wounds by the bow or crossbow are very rare. They might result as a consequence of either accident or suicide. In the literature some cases of a suicidal experiments had been published, all of these cases were due to arrow from the crossbow. There was no injury being documented due to arrow from the bow. The authors present a case of maxillofacial injury done by shoot of arrow from the bow in the course of a child's play. PMID:21416697

Malachovský, I; Straka, L; Novomeský, F; Statelová, D; Janícková, M; Stilla, J; Urbanová, E

2011-01-01

338

Postoperative atrial fibrillation: incidence, mechanisms, and clinical correlates.  

PubMed

Atrial fibrillation is the most commonly encountered arrhythmia after cardiac surgery. Although usually self-limiting, it represents an important predictor of increased patient morbidity, mortality, and health care costs. Numerous studies have attempted to determine the underlying mechanisms of postoperative atrial fibrillation (POAF) with varied success. A multifactorial pathophysiology is hypothesized, with inflammation and postoperative ?-adrenergic activation recognized as important contributing factors. The management of POAF is complicated by a paucity of data relating to the outcomes of different therapeutic interventions in this population. This article reviews the literature on epidemiology, mechanisms, and risk factors of POAF, with a subsequent focus on the therapeutic interventions and guidelines regarding management. PMID:25443241

Yadava, Mrinal; Hughey, Andrew B; Crawford, Thomas Christopher

2014-11-01

339

Postoperative delirium and plasma melatonin  

Microsoft Academic Search

The molecular mechanisms of postoperative delirium are not understood in detail yet. This condition is similar to cases of mental symptoms in interferon therapy or hemodialysis. We propose that postoperative delirium is caused by a deficiency of serotonin, an important neurotransmitter, and review the evidence supporting our hypothesis. The serotonin deficiency results from a decrease in tryptophan, the serotonin precursor,

K. Uchida; T. Aoki; B. Ishizuka

1999-01-01

340

Pregnancy Complications: Gonorrhea  

MedlinePLUS

... is running out: Home > Pregnancy > Pregnancy Complications > Gonorrhea Pregnancy complications Pregnancy complications may need special medical care. ... the United States. Can gonorrhea cause complications during pregnancy and for your baby? Yes. Gonorrhea can lead ...

341

Transmediastinal and Transcardiac Gunshot Wound with Hemodynamic Stability  

PubMed Central

Cardiac injuries caused by knives and firearms are slightly increasing in our environment. We report the case of a 43-year-old male patient with a transmediastinal gunshot wound (TGSW) and a through-and-through cardiac wound who was hemodynamically stable upon his admission. He had an entrance wound below the left clavicle, with no exit wound, and decreased breath sounds in the right hemithorax. Chest X-ray showed the bullet in the right hemithorax and large right hemothorax. The ultrasound revealed pericardial effusion, and a chest tube produced 1500?cc. of blood, but he remained hemodynamically stable. Considering these findings, a median sternotomy was carried out, the through-and-through cardiac wounds were suture-repaired, lung laceration was sutured, and a pacemaker was placed in the right ventricle. The patient had uneventful recovery and was discharged home on the twelfth postoperative day. The management and prognosis of these patients are determined by the hemodynamic situation upon arrival to the Emergency Department (ED), as well as a prompt surgical repair if needed. Patients with a TGSW have been divided into three groups according to the SBP: group I, with SBP >100?mmHg; group II, with SBP 60–100?mmHg; and group III, with SBP <60?mmHg. The diagnostic workup and management should be tailored accordingly, and several series have confirmed high chances of success with conservative management when these patients are hemodynamically stable. PMID:25197606

Al-Lal, Yusef Mohamed; de Tomás Palacios, Jorge; Amunategui Prats, Iñaki; Turégano Fuentes, Fernando

2014-01-01

342

Topical lidocaine patch 5% for acute postoperative pain control.  

PubMed

A 39-year-old para 3 woman presented for elective caesarean section (lower segment caesarean section (LSCS)) for breech presentation. The patient had a strong history of atopy and anaphylaxis to paracetamol, codeine, penicillin and latex. The patient was asthmatic, triggered by aspirin. Epidural anaesthesia was unsuccessful and LSCS was carried out under spinal anaesthesia. Postoperatively the patient was unwilling to take analgesic medication due to fear of an allergic reaction. Three 5% lidocaine patches were applied to the wound for postoperative analgesia. This reduced the patient's visual analogue scale pain score from 10/10 to 5/10 at rest and 10/10 to 7/10 with movement. Transcutaneous electrical nerve stimulation was added and this improved associated back pain, reducing the pain further to 2/10. This is the first description of lignocaine patch 5% for postoperative LSCS pain. It is suggested that this method of delivery of local anaesthetic, which is easy to apply and has minimal side effects, should be considered not as a sole agent but as part of a multimodal technique to address postoperative LSCS pain. PMID:22715181

Gilhooly, D; McGarvey, B; O'Mahony, H; O'Connor, T C

2011-01-01

343

Cell therapy for wound healing.  

PubMed

In covering wounds, efforts should include utilization of the safest and least invasive methods with goals of achieving optimal functional and cosmetic outcome. The recent development of advanced wound healing technology has triggered the use of cells to improve wound healing conditions. The purpose of this review is to provide information on clinically available cell-based treatment options for healing of acute and chronic wounds. Compared with a variety of conventional methods, such as skin grafts and local flaps, the cell therapy technique is simple, less time-consuming, and reduces the surgical burden for patients in the repair of acute wounds. Cell therapy has also been developed for chronic wound healing. By transplanting cells with an excellent wound healing capacity profile to chronic wounds, in which wound healing cannot be achieved successfully, attempts are made to convert the wound bed into the environment where maximum wound healing can be achieved. Fibroblasts, keratinocytes, adipose-derived stromal vascular fraction cells, bone marrow stem cells, and platelets have been used for wound healing in clinical practice. Some formulations are commercially available. To establish the cell therapy as a standard treatment, however, further research is needed. PMID:24616577

You, Hi-Jin; Han, Seung-Kyu

2014-03-01

344

[Useful wound management at home].  

PubMed

In wound care, close observation of the quantity and nature of exudate from a wound, and selection of appropriate dressing and/or medication are crucial. Care should be taken to prevent wounds with excessive exudate from becoming too moist. Furthermore, wound care at home must be easy, which is achievable through the use of readily available materials and medications. 1 ) A wound with little to moderate exudate should be treated using wrap therapy with perforated polyethylene sheets. This therapy can be used to treat pressure ulcers, wounds, wounds with slough, and burns. 2 ) An 18-gauge needle can be used to perforate wounds with little exudate, such as mild pressure ulcers or wounds with slough, and polyurethane film can then be applied. 3 ) Polyurethane film should be applied to blisters, pressure ulcers, or similar skin injuries with little exudate. 4 ) A hydrocolloid dressing should be used on wounds with light exudate. 5 ) An ointment containing steroids should be applied to critically colonized wounds. 6 ) Melolin dressings, Moiskin Pads, or a disposable diaper should be used to manage wounds with heavy exudate. PMID:25595088

Mizuhara, Akihiro; Taguchi, Akemi; Sato, Mikako; Shindo, Kazuko

2014-12-01

345

Use of polytetrafluoroethylene patch for temporary wound closure after pediatric liver transplantation.  

PubMed

Despite numerous options for pediatric transplantation, closure of the abdominal wall after liver transplantation is occasionally difficult, resulting in increased abdominal pressure and possible vascular compromise. Since 1990, we have utilized a 2-mm thick sheet of polytetrafluoroethylene (PTFE) to overcome this situation in 21 transplants for 17 patients. The median age was 0.9 months. Ten of the 21 transplants utilized full-size grafts. The donor to recipient weight ratio was 1.7+/-1.2. Cadaveric left lateral segments were used in 8 of 21 transplants (weight ratio, 7.4+/-5.9), living donor left lateral segments were used in 3 of 21 transplants (weight ratio, 13.2+/-6.7). We were able to remove 14 of 21 patches with one additional operation, whereas 4/21 patches required two operations and 3/21 required three operations. Reoperations identified two cases of hepatic artery thrombosis not previously identified by duplex ultrasonography. There were no technical problems or adverse effects associated with the use of the PTFE patch. After patch removal, the fascia was closed with a nonabsorbable suture and the skin was allowed to close by secondary intention. There were no wound infections, portal vein thrombosis, or fluid and electrolyte abnormalities. PTFE is a safe, temporary alternative to primary wound closure in liver transplantation when the size of the graft or intestinal and graft edema does not allow conventional closure of the abdomen. Infectious, fluid/electrolyte, or ventilatory complications were not noted. The necessity of a second-look operation is useful in assessing the graft and vascular patency. The majority of patches can be removed within the first postoperative week. PMID:8878403

Seaman, D S; Newell, K A; Piper, J B; Bruce, D S; Woodle, E S; Cronin, D C; Alonso, E M; Whitington, P F; Thistlethwaite, J R; Millis, J M

1996-10-15

346

An innovative method to evaluate the suture compliance in sealing the surgical wound lips  

Microsoft Academic Search

Background and aim: The increasing number of surgical procedures performed with local anesthesia, followed by immediate patient discharge from the hospital, emphasizes the need for a tight waterproof suture that is ca- pable of maintaining its tensile strength in the postoperative phase when the wound tumescence, edema due to the anesthetic drug, and surgical trauma disappear. Moreover, the issue of

Farid Saleh; Beniamino Palmieri; Danielle Lodi; Khalid Al-Sebeih

347

Healing Invisible Wounds  

ERIC Educational Resources Information Center

As many as 9 in 10 justice-involved youth are affected by traumatic childhood experiences. According to "Healing Invisible Wounds: Why Investing in Trauma-Informed Care for Children Makes Sense," between 75 and 93 percent of youth currently incarcerated in the justice system have had at least one traumatic experience, including sexual abuse, war,…

Adams, Erica J.

2010-01-01

348

Spiral wound extraction cartridge  

DOEpatents

A cartridge device for removing an analyte from a fluid comprises a hollow core, a sheet composite comprising a particulate-loaded porous membrane and optionally at least one reinforcing spacer sheet, the particulate being capable of binding the analyte, the sheet composite being formed into a spiral configuration about the core, wherein the sheet composite is wound around itself and wherein the windings of sheet composite are of sufficient tightness so that adjacent layers are essentially free of spaces therebetween, two end caps which are disposed over the core and the lateral ends of the spirally wound sheet composite, and means for securing the end caps to the core, the end caps also being secured to the lateral ends of the spirally wound sheet composite. A method for removing an analyte from a fluid comprises the steps of providing a spirally wound element of the invention and passing the fluid containing the analyte through the element essentially normal to a surface of the sheet composite so as to bind the analyte to the particulate of the particulate-loaded porous membrane, the method optionally including the step of eluting the bound analyte from the sheet composite. 4 figs.

Wisted, E.E.; Lundquist, S.H.

1999-04-27

349

Stress and Wound Healing  

Microsoft Academic Search

Over the past decade it has become clear that stress can significantly slow wound healing: stressors ranging in magnitude and duration impair healing in humans and animals. For example, in humans, the chronic stress of caregiving as well as the relatively brief stress of academic examinations impedes healing. Similarly, restraint stress slows healing in mice. The interactive effects of glucocorticoids

Lisa M. Christian; Jennifer E. Graham; David A. Padgett; Ronald Glaser; Janice K. Kiecolt-Glaser

2006-01-01

350

Hepatic wound repair  

Microsoft Academic Search

BACKGROUND: Human chronic liver diseases (CLDs) with different aetiologies rely on chronic activation of wound healing that represents the driving force for fibrogenesis progression (throughout defined patterns of fibrosis) to the end stage of cirrhosis and liver failure. ISSUES: Fibrogenesis progression has a major worldwide clinical impact due to the high number of patients affected by CLDs, increasing mortality rate,

Maurizio Parola; Massimo Pinzani

2009-01-01

351

[Tracheotomy complications in resuscitation patients].  

PubMed

Many statistics on what concerned the tracheotomy complications are old, dating from 1960-1970, and discouraging to practise this kind of gesture. Moreover, it is unfeasible to objectively evaluate this technique from these huge sets where it is often difficult to separate the dramatic complications (massive haemorrhage, suffocating pneumothorax,...) and those more benign. The authors analyze through a retrospective study of 32 tracheotomised patients, the index of these complications in distinguishing those of the early stage and the late stage can occur even after decannulation. In the acute phase, haemorrhages 9.3 p 100) per inadequate haematosis, the pneumothorax (3.1 p 100) and the infection of the stoma (12.5 p 100) are the most frequent. The opening tracheotomy infection can support pulmonary infections (28.1 p 100) which cause serious problems at tracheotomised. After decannulation, the principal complication is the tracheobronchial stenosis (3.1 p 100). Its diagnosis is difficult and should be done by systematic endoscopic control of the trachea and radiological explorations at the time of the decannulation. The authors insist on the use of proper equipments, protocols of rigorous care and strict post-operative monitoring. PMID:19666382

Qamouss, Y; Filali, K; Seddiki, M; Boughalem, M; Chafik, A; Touati, A; Ammar, H; Benariba, F

2009-01-01

352

[Modern wound dressings for the therapy of chronic wounds].  

PubMed

The incidence of chronic wounds is increasing in developed Western countries. There are many causes for chronic or non-healing wounds. A multidisciplinary diagnostic approach and attention to underlying disorders are essential. A modern, moist, and phase adapted wound therapy is also essential. Modern wound dressings include activated charcoal, alginates, hyaluronic acid, hydrofibers, hydrogels, hydrocolloids, impregnated gauze, collagen, moist methods, proteolytic enzymes, foams, semipermeable membranes and silver dressings. Because of the lack of comparative investigations the phase-adapted use of wound dressings is still empiric. Application of modern wound dressings may help to create an optimized wound milieu and accelerate healing. Treatment of the underlying causes is an absolute requirement for long-term complete healing. PMID:16317552

Dissemond, J

2006-10-01

353

Value of Prophylactic Postoperative Antibiotic Therapy after Bimaxillary Orthognathic Surgery: A Clinical Trial  

PubMed Central

Introduction: Antibiotic therapy before or after orthognathic surgery is commonly recommended by surgeons to minimize the risk of wound infection. This article evaluates the value of Prophylactic antibiotic therapy in order to diminish the incidence of postoperative wound infection after orthognathic surgery. Materials and Methods: Fifty candidates for bimaxillary orthognathic surgery were divided into cases and controls. Cefazolin (1g) was administered intravenously to all participants 30 mins prior to surgery followed by a similar dose 4 hours later. Case-group patients ingested amoxicillin (500 mg) orally for 7 days after surgery. Postoperative wound infection was assessed using clinical features, and the P-value significance was set at P<0.05. Results: Both groups were similar according to gender, age, and operating time. During the follow-up period no infection was observed in either the case or control group. Conclusion: The results of this study suggest that long-term postoperative antibiotic therapy is not essential for the prevention of postoperative infection, and that application of aseptic surgical technique and hygiene instruction after surgery are sufficient. PMID:25320697

Eshghpour, Majid; Khajavi, Amin; Bagheri, Mahmoud; Banihashemi, Elham

2014-01-01

354

Postoperative thrombotic thrombocytopenic purpura.  

PubMed

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening disease characterized by acute episodes of thrombocytopenia and microangiopathic hemolytic anemia occurring due to platelet and von Willebrand factor deposition and hyaline thrombi formation in arterioles and capillaries throughout the body, which results in organ ischemia. TTP can be idiopathic or secondary, and there are several causes of secondary TTP. There is a clinical syndrome resembling TTP that occurs after surgical procedures, so-called "postoperative TTP" (pTTP). In this review, the differential diagnosis, pathogenesis and clinical and laboratory features of pTTP, together with the treatment modalities and outcomes of the patients, are discussed. The pTTP is a diagnosis of exclusion, and disseminated intravascular coagulation, heparin-induced thrombocytopenia and medication-induced effects should be ruled out. As in classical TTP, patients with pTTP should be diagnosed and treated with therapeutic plasma exchange (TPE) as early as possible to reduce their morbidity and mortality. Although rarely seen, surgeons and physicians of all specialties should be alert to the possibility of pTTP, and since pTTP is a life-threatening event that usually can be treated successfully with TPE, especially when diagnosed early in its course, it is critical to recognize and treat pTTP promptly. PMID:24374368

Eskazan, Ahmet Emre; Buyuktas, Deram; Soysal, Teoman

2015-01-01

355

Sexual function and perineal wound healing after intersphincteric excision of the rectum for inflammatory bowel disease.  

PubMed

The technique of intersphincteric excision of the rectum in patients with inflammatory bowel disease was introduced with the aim of avoiding postoperative sexual dysfunction and, combined with primary perineal suture, should decrease morbidity from delayed perineal wound healing. In a series of 98 patients so treated at St. Mark's Hospital, permanent sexual dysfunction from sympathetic nerve damage occurred in one male patient among 23 aged 60 years or less assessed postoperatively. No patient exhibited evidence of permanent parasympathetic nerve damage. Primary healing of the perineal wound was successful in 50 per cent of the cases and in 69 per cent the wound healed within three months of operation. It is suggested that this combination of operative techniques significantly decreases morbidity from rectal excision compared with more extensive procedures and should be more widely adopted. PMID:6370632

Leicester, R J; Ritchie, J K; Wadsworth, J; Thomson, J P; Hawley, P R

1984-04-01

356

Nutritional support for wound healing.  

PubMed

Healing of wounds, whether from accidental injury or surgical intervention, involves the activity of an intricate network of blood cells, tissue types, cytokines, and growth factors. This results in increased cellular activity, which causes an intensified metabolic demand for nutrients. Nutritional deficiencies can impede wound healing, and several nutritional factors required for wound repair may improve healing time and wound outcome. Vitamin A is required for epithelial and bone formation, cellular differentiation, and immune function. Vitamin C is necessary for collagen formation, proper immune function, and as a tissue antioxidant. Vitamin E is the major lipid-soluble antioxidant in the skin; however, the effect of vitamin E on surgical wounds is inconclusive. Bromelain reduces edema, bruising, pain, and healing time following trauma and surgical procedures. Glucosamine appears to be the rate-limiting substrate for hyaluronic acid production in the wound. Adequate dietary protein is absolutely essential for proper wound healing, and tissue levels of the amino acids arginine and glutamine may influence wound repair and immune function. The botanical medicines Centella asiatica and Aloe vera have been used for decades, both topically and internally, to enhance wound repair, and scientific studies are now beginning to validate efficacy and explore mechanisms of action for these botanicals. To promote wound healing in the shortest time possible, with minimal pain, discomfort, and scarring to the patient, it is important to explore nutritional and botanical influences on wound outcome. PMID:14653765

MacKay, Douglas; Miller, Alan L

2003-11-01

357

Common questions about wound care.  

PubMed

Lacerations, abrasions, burns, and puncture wounds are common in the outpatient setting. Because wounds can quickly become infected, the most important aspect of treating a minor wound is irrigation and cleaning. There is no evidence that antiseptic irrigation is superior to sterile saline or tap water. Occlusion of the wound is key to preventing contamination. Suturing, if required, can be completed up to 24 hours after the trauma occurs, depending on the wound site. Tissue adhesives are equally effective for low-tension wounds with linear edges that can be evenly approximated. Although patients are often instructed to keep their wounds covered and dry after suturing, they can get wet within the first 24 to 48 hours without increasing the risk of infection. There is no evidence that prophylactic antibiotics improve outcomes for most simple wounds. Tetanus toxoid should be administered as soon as possible to patients who have not received a booster in the past 10 years. Superficial mild wound infections can be treated with topical agents, whereas deeper mild and moderate infections should be treated with oral antibiotics. Most severe infections, and moderate infections in high-risk patients, require initial parenteral antibiotics. Severe burns and wounds that cover large areas of the body or involve the face, joints, bone, tendons, or nerves should generally be referred to wound care specialists. PMID:25591209

Worster, Brooke; Zawora, Michelle Q; Hsieh, Christine

2015-01-15

358

[Negative pressure wound therapy - review].  

PubMed

Negative pressure wound therapy (NPWT) is a new therapeutic option in wound healing and was first described in its present form in 1997. A vacuum source is used to create sub-atmospheric pressure in the local wound environment to promote healing. This is achieved by connecting a vacuum pump to a tube that is threaded into a wound gauze or foam filler dressing covered with a drape. This concept in wound treatment has been shown to be useful in treating different wound infections, including diabetic wounds as well as complex infections of the abdomen and thorax. NPWT has been used in Iceland for over a decade and its use is steadily increasing. This review describes the indications and outcome of NPWT and is aimed at a broad group of doctors and nurses where recent Icelandic studies on the subject are covered. PMID:24713539

Gudmundsdottir, Ingibjorg; Steingrimsson, Steinn; Valsdottir, Elsa; Gudbjartsson, Tomas

2014-04-01

359

Wound Microbiology and Associated Approaches to Wound Management  

PubMed Central

The majority of dermal wounds are colonized with aerobic and anaerobic microorganisms that originate predominantly from mucosal surfaces such as those of the oral cavity and gut. The role and significance of microorganisms in wound healing has been debated for many years. While some experts consider the microbial density to be critical in predicting wound healing and infection, others consider the types of microorganisms to be of greater importance. However, these and other factors such as microbial synergy, the host immune response, and the quality of tissue must be considered collectively in assessing the probability of infection. Debate also exists regarding the value of wound sampling, the types of wounds that should be sampled, and the sampling technique required to generate the most meaningful data. In the laboratory, consideration must be given to the relevance of culturing polymicrobial specimens, the value in identifying one or more microorganisms, and the microorganisms that should be assayed for antibiotic susceptibility. Although appropriate systemic antibiotics are essential for the treatment of deteriorating, clinically infected wounds, debate exists regarding the relevance and use of antibiotics (systemic or topical) and antiseptics (topical) in the treatment of nonhealing wounds that have no clinical signs of infection. In providing a detailed analysis of wound microbiology, together with current opinion and controversies regarding wound assessment and treatment, this review has attempted to capture and address microbiological aspects that are critical to the successful management of microorganisms in wounds. PMID:11292638

Bowler, P. G.; Duerden, B. I.; Armstrong, D. G.

2001-01-01

360

Low immediate postoperative platelet count is associated with hepatic insufficiency after hepatectomy  

PubMed Central

AIM: To investigate the relationship between low immediate postoperative platelet count and perioperative outcome after liver resection in patients with hepatocellular carcinoma (HCC). METHODS: In a cohort of 565 consecutive hepatitis B-related HCC patients who underwent major liver resection, the characteristics and clinical outcomes after liver resection were compared between patients with immediate postoperative platelet count < 100 × 109/L and patients with platelet count ? 100 × 109/L. Risk factors for postoperative hepatic insufficiency were evaluated by multivariate analysis. RESULTS: Patients with a low immediate postoperative platelet count (< 100 × 109/L) had more grade III-V complications (20.5% vs 12.4%, P = 0.016), and higher rates of postoperative liver failure (6.8% vs 2.6%, P = 0.02), hepatic insufficiency (31.5% vs 21.2%, P < 0.001) and mortality (6.8% vs 0.5%, P < 0.001), compared to patients with a platelet count ? 100 × 109/L. The alanine aminotransferase levels on postoperative days 3 and 5, and bilirubin on postoperative days 1, 3 and 5 were higher in patients with immediate postoperative low platelet count. Multivariate analysis revealed that immediate postoperative low platelet count, rather than preoperative low platelet count, was a significant independent risk factor for hepatic insufficiency. CONCLUSION: A low immediate postoperative platelet count is an independent risk factor for hepatic insufficiency. Platelets can mediate liver regeneration in the cirrhotic liver. PMID:25206294

Wang, Hai-Qing; Yang, Jian; Yang, Jia-Yin; Wang, Wen-Tao; Yan, Lu-Nan

2014-01-01

361

Dermatological complications of obesity.  

PubMed

Obesity is a health problem of considerable magnitude in the Western world. Dermatological changes have been reported in patients with obesity, including: acanthosis nigricans and skin tags (due to insulin resistance); hyperandrogenism; striae due to over extension; stasis pigmentation due to peripheral vascular disease; lymphedema; pathologies associated with augmented folds; morphologic changes in the foot anatomy due to excess load; and complications that may arise from hospitalization. Acanthosis nigricans plaques can be managed by improved control of hyperinsulinemia; the vitamin D3 analog calcipitriol has also been shown to be effective. Skin tags can be removed by snipping with curved scissors, by cryotherapy or by electrodesiccation. Hyperandrogenism, a result of increased production of endogenous androgens due to increased volumes of adipose tissue (which synthesizes testosterone) and hyperinsulinemia (which increases the production of ovarian androgens) needs to be carefully assessed to ensure disorders such as virilizing tumors and congenital adrenal hyperplasia are treated appropriately. Treatment of hyperandrogenism should be centred on controlling insulin levels; weight loss, oral contraceptive and antiandrogenic therapies are also possible treatment options. The etiology of striae distensae, also known as stretch marks, is yet to be defined and treatment options are unsatisfactory at present; striae rubra and alba have been treated with a pulsed dye laser with marginal success. The relationship between obesity and varicose veins is controversial; symptoms are best prevented by the use of elastic stockings. Itching and inflammation associated with stasis pigmentation, the result of red blood cells escaping into the tissues, can be treated with corticosteroids. Lymphedema is associated with dilatation of tissue channels, reduced tissue oxygenation and provides a culture medium for bacterial growth. Lymphedema treatment is directed towards reducing the limb girth and weight, and the prevention of infection. Intertrigo is caused by friction between skin surfaces, combined with moisture and warmth, resulting in infection. This infection, most commonly candidiasis, is best treated with topical antifungal agents; systemic antifungal therapy may be required in some patients. Excess load on the feet can result in morphological changes that require careful diagnosis; insoles may offer some symptom relief while control of obesity is achieved. Obesity-related dermatoses associated with hospitalization, such as pressure ulcers, diminished wound healing, dermatoses secondary to respiratory conditions, and incontinence, must all be carefully managed with an emphasis on prevention where possible. Recognition and control of the dermatological complications of obesity play an important role in diminishing the morbidity of obesity. PMID:12180897

García Hidalgo, Linda

2002-01-01

362

Complications of thyroidectomy and parathyroidectomy in the rural community hospital setting.  

PubMed

The objective of this study was to examine the complications encountered in a series of 150 consecutive thyroid and parathyroid procedures performed by a single surgeon in a rural community hospital setting. The goal was to demonstrate that these procedures may be performed safely and with outcomes equivalent to those of academic hospitals in major metropolitan areas despite the lack of availability of specific technologies that are being increasingly used for these procedures in tertiary care settings. Specifically, these include intraoperative parathyroid hormone measurements, intraoperative recurrent laryngeal nerve monitoring, and the use of the gamma probe for detection of parathyroid adenoma. A retrospective chart review was conducted on a series of 150 patients undergoing any thyroid or parathyroid operation by a single surgeon in a rural setting over a 4-year period. Data was reported regarding success at achieving the goal of the operation and any perioperative complications such as recurrent laryngeal nerve injury, permanent hypoparathyroidism, wound hematoma, infection, or pneumonia. One hundred thirty-one thyroid procedures were performed (71 lobectomies, 60 total or near total procedures) for a diverse range of patholological conditions: multinodular goiter, 76 (50.7%) patients, follicular adenoma, 9 (6.0%) patients, Hashimoto's thyroiditis, 13 (8.7%) patients, papillary carcinoma, 14 (9.3%) patients, follicular carcinoma, 5 (3.3%) patients, follicular variant of papillary carcinoma, 13 (8.7%) patients, and medullary carcinoma, 1 (0.7%) patient. Nineteen successful parathyroid explorations were performed for primary hyperparathyroidism. The overall incidence of recurrent nerve injury was 1.33 per cent overall (0.99% for each nerve encountered). The incidence of transient postoperative hypocalcemia was 13 per cent, with one patient suffering permanent hypoparathyroidism (0.8%). Two patients developed wound hematomas requiring evacuation. The overall complication rate with respect to recurrent laryngeal nerve injury and permanent hypoparathyroidism was consistent with or below that that in recent large series, despite the absence of specialized equipment for nerve monitoring. The success of identifying parathyroid adenoma was 100 per cent, despite the absence of intraoperative parathormone assays, and the decision not to perform radio-guided parathyroidectomy. We conclude that outcomes and complications in thyroid and parathyroid surgical procedures are largely dependent on surgeon skill and experience, and can be performed safely in the community setting by an experienced general surgeon despite the absence of advanced technology in this setting. We encourage all surgeons to continually examine their operative results with all technically demanding procedures when deciding the composition of their individual practices. PMID:17439023

Richmond, Bryan K; Eads, K; Flaherty, Sarah; Belcher, Michael; Runyon, David

2007-04-01

363

Negative pressure wound dressing of the radial forearm donor site  

Microsoft Academic Search

Donor site complications of the radial forearm are a significant cause of post-operative morbidity. 15 patients had radial forearm free tissue donor sites treated with split skin grafts and a negative pressure dressing. All grafts showed 100% take at 5 days. The advantages of this technique include rapid healing at an unfavourable graft recipient site, increased graft take and decreased

C. Avery; J. Pereira; A. Moody; M. Gargiulo; I. Whitworth

2000-01-01

364

[Treatment and diagnostic policy in gunshot wounds of the pancreas].  

PubMed

Results of treatment of 71 patients with gun-shot wounds of the pancreas were analyzed. Features and structure of gun-shot abdominal penetrating wounds with injury of the pancreas, potential of up-to-date diagnostic methods were studied. Surgical policy in combined injuries of hollow organs and pancreas was developed. Variants and sequence of surgeries were determined depending on location and types of pancreatic injuries. Proposed treatment and diagnostic policy permitted to reduce rate of purulent and septic complications by 11.1% and lethality by 5.3%. PMID:14983156

Vo?novski?, E A; Abakumov, M M; Vasil'ev, A Iu; Vo?novski?, A E

2004-01-01

365

Use of collagenase ointment in conjunction with negative pressure wound therapy in the care of diabetic wounds: a case series of six patients  

PubMed Central

Background Diabetic wounds with additional comorbidities are costly, time intensive, and difficult to heal. Often, multiple modalities may be necessary to achieve wound resolution, relying on the synergistic advantage of each therapy to affect wound healing. The selectivity of Clostridium collagenase is physiologically effective at degrading non-viable collagen fibers while preserving living collagen tissue. Additionally, negative pressure wound therapy (NPWT) has long been used to aid wound healing while concurrently depreciating biological wound burden time. Methods Six patients were selected from those appearing to our university based limb salvage service. Inclusion criteria included patients with a recurrent mixed fibrotic and granular wound base, in which NPWT was indicated, without exclusion criteria. Patients enrolled were administered clostridial collagenase ointment at each regularly scheduled NPWT dressing change. Patients were followed until healing, with visual representations of wound progression and time to full healing recorded. Results Tandem application of these therapies appeared to expedite wound healing by clearing degenerative fibrous tissue and expediting wound granulation without additional complication. Unfortunately, not all patients were able to reach full healing; with two patients experiencing ulcer recurrence, likely a result of their significant comorbid nature. Conclusion In our experience, we have noticed a specific subgroup of patients who benefit greatly when collagenase enzymatic debridement therapy is combined with NPWT. It is our belief that this combination therapy combines the molecular clearing of non-viable collagen with the wound granulation necessary to advance complex wounds to the next step in healing despite the current paucity in literature discussing this specific pairing. PMID:25630362

Miller, John D.; Carter, Elizabeth; Hatch, David C.; Zhubrak, Michelle; Giovinco, Nicholas A.; Armstrong, David G.

2015-01-01

366

Negative pressure wound therapy with instillation: the current state of the art.  

PubMed

Traditional negative pressure wound therapy (NPWT) has revolutionized the treatment of complex wounds for nearly 20 years. A decade ago, a modification of the original system added intermittent automated instillation of topical wound irrigation solutions to traditional negative pressure wound therapy. This combined therapy, termed negative pressure wound therapy with instillation (NPWTi), has been shown to be effective in the treatment of a variety of complex wounds. Negative pressure wound therapy with instillation has been shown to reduce bioburden and biofilms present in wounds helping heal clinically infected wounds. It has also been used with success to jump-start stalled wounds, in relieving wound pain and treating infected foreign bodies including infected orthopedic hardware and some types of exposed abdominal wall mesh. The system includes a foam dressing placed in the wound covered by a semi-occlusive drape. A tubing placed over a hole cut in the drape connects the foam dressing to a pump run by a computerized microprocessor that delivers negative pressure to the dressing and wound. A preset volume of instillation fluid is automatically delivered via the instillation tubing to the wound. The fluid is held in the foam to bathe the wound for a predetermined time period. Negative pressure is then re-started draining the irrigation fluid and any wound exudate into a collection canister. The entire sequence is automated and consists of three phases: (1) fluid instillation; (2) holding for a period of time in the wound, which is fully expanded since the negative pressure is off during this phase; and then (3) a cycle of continuous negative pressure. The entire sequence repeats itself automatically. Typically the dressing is changed three times a week. The variables involved in treating patients with negative pressure wound therapy with instillation included: the indicated wound types; the system settings; the choice of the irrigation solution and the duration of therapy. This article will serve as a reference to help the negative through treating patients with NPWTi from patient selection, system setting to the complication of therapy. PMID:24574014

Wolvos, Tom A

2014-03-01

367

Complications of medium depth and deep chemical peels.  

PubMed

Superficial and medium depth peels are dynamic tools when used as part of office procedures for treatment of acne, pigmentation disorders, and photo-aging. Results and complications are generally related to the depth of wounding, with deeper peels providing more marked results and higher incidence of complications. Complications are also more likely with darker skin types, certain peeling agents, and sun exposure. They can range from minor irritations, uneven pigmentation to permanent scarring. In very rare cases, complications can be life-threatening. PMID:23378707

Nikalji, Nanma; Godse, Kiran; Sakhiya, Jagdish; Patil, Sharmila; Nadkarni, Nitin

2012-10-01

368

Pulmonary Complications following Percutaneous Nephrolithotomy: A Prospective Study  

PubMed Central

Introduction Pulmonary complications may occur in the post-operative period and are a significant cause of morbidity and mortality in patients undergoing anesthesia and surgery. Complication rates vary according to different procedures and different types of anesthesia and may be affected by the patient condition. The purpose of this study was to examine pulmonary complications following percutaneous nephrolithotomy (PCNL) and to search for associations between the pre- and intra-operative factors and the risk of post-operative pulmonary complications (PPC). Patients and Methods This was a prospective observational study of 100 consecutive adult patients who underwent PCNL surgery. We collected data of the patient, surgery and anesthesia and analyzed it to find correlations with PPC. Results Eight (8%) patients had PPC following PCNL, 7 patients had pneumothorax and 1 had atelectasis and pleural effusion. The latter patient died at post-operative day 24 due to respiratory failure. It was found that patients who had PCNL on the right kidney were at lower risk for PPC. In addition it was found that younger patients had a higher incidence of PPC. Conclusions Based on this study the most common type of post-operative complication following PCNL is pulmonary, with pneumothorax being the main complication. PPC may result in patient mortality. The side of the operation and the patient's age might affect the risk of PPC. PMID:24917770

Palnizky, Gili; Halachmi, Sarel; Barak, Michal

2014-01-01

369

The effect of local anaesthetic wound infiltration on chronic pain after lower limb joint replacement: A protocol for a double-blind randomised controlled trial  

PubMed Central

Background For the majority of patients with osteoarthritis (OA), joint replacement is a successful intervention for relieving chronic joint pain. However, between 10-30% of patients continue to experience chronic pain after joint replacement. Evidence suggests that a risk factor for chronic pain after joint replacement is the severity of acute post-operative pain. The aim of this randomised controlled trial (RCT) is to determine if intra-operative local anaesthethic wound infiltration additional to a standard anaethesia regimen can reduce the severity of joint pain at 12-months after total knee replacement (TKR) and total hip replacement (THR) for OA. Methods 300 TKR patients and 300 THR patients are being recruited into this single-centre double-blind RCT. Participants are recruited before surgery and randomised to either the standard care group or the intervention group. Participants and outcome assessors are blind to treatment allocation throughout the study. The intervention consists of an intra-operative local anaesthetic wound infiltration, consisting of 60 mls of 0.25% bupivacaine with 1 in 200,000 adrenaline. Participants are assessed on the first 5 days post-operative, and then at 3-months, 6-months and 12-months. The primary outcome is the WOMAC Pain Scale, a validated measure of joint pain at 12-months. Secondary outcomes include pain severity during the in-patient stay, post-operative nausea and vomiting, satisfaction with pain relief, length of hospital stay, joint pain and disability, pain sensitivity, complications and cost-effectiveness. A nested qualitative study within the RCT will examine the acceptability and feasibility of the intervention for both patients and healthcare professionals. Discussion Large-scale RCTs assessing the effectiveness of a surgical intervention are uncommon, particulary in orthopaedics. The results from this trial will inform evidence-based recommendations for both short-term and long-term pain management after lower limb joint replacement. If a local anaesthetic wound infiltration is found to be an effective and cost-effective intervention, implementation into clinical practice could improve long-term pain outcomes for patients undergoing lower limb joint replacement. Trial registration Current Controlled Trials ISRCTN96095682 PMID:21352559

2011-01-01

370

Proteases and Delayed Wound Healing  

PubMed Central

Significance Proteases and their inhibitors contribute to the balance between extracellular matrix (ECM) degradation and deposition, creating an equilibrium that is essential for the timely and coordinated healing of cutaneous wounds. However, when this balance is disrupted, wounds are led into a state of chronicity characterized by abundant levels of proteases and decreased levels of protease inhibitors. Recent Advances Researchers have sought to investigate the roles of proteases within both acute and chronic wounds and how the manipulation of protease activity may aid healing. Indeed, numerous wound dressings have been developed that target such proteases in an attempt to promote wound healing. Critical Issues The normal tissue response to injury involves a complex interaction between cells and cellular mediators. In particular, the inflammatory response is augmented in chronic wounds which are characterized by elevated levels of proinflammatory cytokines and proteases. While controlling levels of inflammation and protease expression is a critical part of normal wound healing, elevated and prolonged expression of proteases produced during the inflammatory phase of healing can lead to excessive ECM degradation associated with impaired healing. Future Directions It seems plausible that future research should aim to investigate the ways in which proteases may be targeted as an alternative therapeutic approach to wound management and to assess the benefits and draw-backs of utilizing wound fluids to assess wound progression in terms of proteolytic activity. PMID:24688830

McCarty, Sara M.; Percival, Steven L.

2013-01-01

371

Clinician perceptions of wound biofilm.  

PubMed

In wound care today, biofilm is a subject area of great interest and debate. There is an increasing awareness that biofilm exists in the majority of non-healing wounds, and that it is implicated in both recalcitrance and infection. Together with the presence of devitalised host tissue, biofilm is recognised as a component of the wound environment that requires removal to enable wound progression. However, uncertainty exists among wound care practitioners regarding confirmation of the presence of biofilm, and how best to remove biofilm from a non-healing wound. While recent efforts have been taken to assist practitioners in signs and symptoms of wound biofilm, continuing research is required to characterise and confirm wound biofilm. This research was conducted as part of a market research process to better understand the knowledge levels, experiences, clinical awareness and impact of biofilm in wound care, which was undertaken across the USA and Europe. While knowledge levels and experiences vary from country to country, certain wound characteristics were consistently associated with the presence of biofilm. PMID:25196188

Metcalf, Daniel G; Bowler, Philip G

2014-09-01

372

Acute Postoperative Endophthalmitis Caused by Staphylococcus lugdunensis?  

PubMed Central

Acute postoperative endophthalmitis caused by Staphylococcus lugdunensis is infrequently reported in clinical studies. Five cases of acute postcataract surgery endophthalmitis caused by S. lugdunensis were taken from a multicenter prospective study conducted in four university-affiliated hospitals in France (2004 to 2005). These cases were characterized by severe ocular inflammation occurring with a mean delay of 7.6 days after cataract surgery, severe visual loss (hand motions or less in three cases), and dense infiltration of the vitreous. Each of these patients was initially treated by using a standard protocol with intravitreal (vancomycin and ceftazidime), systemic, and topical antibiotics. Given the severity of the endophthalmitis, even though bacteria were sensitive to intravitreal antibiotics, pars plana vitrectomy was needed in four cases. The final visual prognosis was complicated by severe retinal detachment in three cases. The microbiological diagnosis was reached by using conventional cultures with specific biochemical tests and eubacterial PCR amplification followed by direct sequencing. PMID:17392442

Chiquet, C.; Pechinot, A.; Creuzot-Garcher, C.; Benito, Y.; Croize, J.; Boisset, S.; Romanet, J. P.; Lina, G.; Vandenesch, F.

2007-01-01

373

[Traumatic wound botulism].  

PubMed

Botulism is a rare illness caused by a potent neurotoxin produced by the bacterium of the Clostridium family. Clostridium botulinum is the most frequent one, but Clostridium baratti and Clostridium butyricum are also neurotoxins producers. There are seven neurotoxins types, A to G; A, B, E, F and G cause human botulism. Every neurotoxin type blocks cholinergic transmission at the myoneural junction. The least frequent syndrome results from Clostridium botulinum colonization of a wound and it is clinically similar to the other botulism syndromes, but with fever due to an infected wound. Disease should be suspected in lucid patient with a symmetric descending, flaccid paralysis. This syndrome appears within the first twenty days, but it could be present for weeks or months before the disease is diagnosed. This disease is poorly known, so to be diagnosed it requires a high index of suspicion. The treatment is a supportive one; administration of the specific antitoxin must be early in order to neutralize the toxin before the debridement and cleaning of the infected wound. PMID:24584800

Moreno, Emilia; Pannocchia, Cecilia; Carricondo, Concepción

2014-04-01

374

Wounding, wound healing and staining of mature pear fruit  

Microsoft Academic Search

Incidence of wounding in commercially-harvested `d'Anjou' and `Bosc' pear fruit, healing of wounds to decrease decay caused by Botrytis cinerea, Mucor piriformis, Penicillium expansum, and Penicillium solitum at ?1°C, 20°C, and 28°C, and formation of compounds potentially involved in resistance were determined. Use of a blue food coloring to make wounds on fruit more visible on packinghouse lines was evaluated.

Robert A Spotts; Peter G Sanderson; Cheryl L Lennox; David Sugar; Louis A Cervantes

1998-01-01

375

Right liver necrosis: complication of laparoscopic cholecystectomy.  

PubMed

Although bile duct injuries are common among the complications of laparoscopic cholecystectomy, hepatic vascular injuries are not well described. Between January 1990 to December 1999, 83 patients with bile duct injuries have been referred to our clinic. Two of them had liver necrosis due to hepatic arterial occlusion. These two women had laparoscopic cholecystectomy for symptomatic cholelithiasis in district hospitals 4 and 15 days prior to their referral to our clinic. Serum aspartate aminotransferase and alanine aminotransferase levels were found to be 30 to 40-fold higher than normal levels. Ultrasonography, computed tomography and Doppler sonography showed necrosis in the right liver lobe and no flow in the right hepatic artery. Patients were also complicated with liver abscess and biliary peritonitis, respectively. Emergency right hepatectomy was performed in both cases and one of them needed Roux-Y-hepaticojejunostomy (to the left hepatic duct). One patient died of peritonitis in the postoperative period. The other one has no problem in her third postoperative year. The earliest and the simplest method for diagnosis or ruling out hepatic arterial occlusion is detecting the blood biochemistry and Doppler ultrasonography. In some cases emergency hepatectomy can be necessary. Postoperative complications should be expected higher than elective cases. PMID:11813609

Kayaalp, C; Nessar, G; Kaman, S; Akoglu, M

2001-01-01

376

Advanced glycation end products delay corneal epithelial wound healing through reactive oxygen species generation.  

PubMed

Delayed healing of corneal epithelial wounds is a serious complication in diabetes. Advanced glycation end products (AGEs) are intimately associated with the diabetic complications and are deleterious to the wound healing process. However, the effect of AGEs on corneal epithelial wound healing has not yet been evaluated. In the present study, we investigated the effect of AGE-modified bovine serum albumin (BSA) on corneal epithelial wound healing and its underlying mechanisms. Our data showed that AGE-BSA significantly increased the generation of intracellular ROS in telomerase-immortalized human corneal epithelial cells. However, the generation of intracellular ROS was completely inhibited by antioxidant N-acetylcysteine (NAC), anti-receptor of AGEs (RAGE) antibodies, or the inhibitor of NADPH oxidase. Moreover, AGE-BSA increased NADPH oxidase activity and protein expression of NADPH oxidase subunits, p22phox and Nox4, but anti-RAGE antibodies eliminated these effects. Furthermore, prevention of intracellular ROS generation using NAC or anti-RAGE antibodies rescued AGE-BSA-delayed epithelial wound healing in porcine corneal organ culture. In conclusion, our results demonstrated that AGE-BSA impaired corneal epithelial wound healing ex vivo. AGE-BSA increased intracellular ROS generation through NADPH oxidase activation, which accounted for the delayed corneal epithelial wound healing. These results may provide better insights for understanding the mechanism of delayed healing of corneal epithelial wounds in diabetes. PMID:23955437

Shi, Long; Chen, Hongmei; Yu, Xiaoming; Wu, Xinyi

2013-11-01

377

A new methodology for costing wound care.  

PubMed

Increasing pressure on health care budgets highlights the need for clinicians to understand the true costs of wound care, in order to be able to defend services against indiscriminate cost cutting. Our aim was to develop and test a straightforward method of measuring treatment costs, which is feasible in routine practice. The method was tested in a prospective study of leg ulcer patients attending three specialist clinics in the UK. A set of ulcer-related health state descriptors were defined on the basis that they represented distinct and clinically relevant descriptions of wound condition ['healed', 'progressing'; 'static''deteriorating; 'severe' (ulcer with serious complications)]. A standardised data-collection instrument was used to record information for all patients attending during the study period on (i) the health state of the ulcer; (ii) treatment received during the clinic visit and (iii) treatment planned between clinic visits. Information on resource use was used to estimate weekly treatment costs by ulcer state. Information was collected at 827 independent weekly observations from the three study centres. Treatment costs increased markedly with ulcer severity: an ulcer which was 'deteriorating' or 'severe' cost between twice and six times as much per week as an ulcer which was progressing normally towards healing. Higher costs were driven primarily by more frequent clinic visits and by the costs of hospitalisation for ulcers with severe complications. This exercise has demonstrated that the proposed methodology is easy to apply, and produces information which is of value in monitoring healing and potentially reducing treatment costs. PMID:23241303

Harding, Keith; Posnett, John; Vowden, Katherine

2012-12-13

378

Use of incisional negative pressure wound therapy on closed median sternal incisions after cardiothoracic surgery: clinical evidence and consensus recommendations.  

PubMed

Negative pressure wound therapy is a concept introduced initially to assist in the treatment of chronic open wounds. Recently, there has been growing interest in using the technique on closed incisions after surgery to prevent potentially severe surgical site infections and other wound complications in high-risk patients. Negative pressure wound therapy uses a negative pressure unit and specific dressings that help to hold the incision edges together, redistribute lateral tension, reduce edema, stimulate perfusion, and protect the surgical site from external infectious sources. Randomized, controlled studies of negative pressure wound therapy for closed incisions in orthopedic settings (which also is a clean surgical procedure in absence of an open fracture) have shown the technology can reduce the risk of wound infection, wound dehiscence, and seroma, and there is accumulating evidence that it also improves wound outcomes after cardiothoracic surgery. Identifying at-risk individuals for whom prophylactic use of negative pressure wound therapy would be most cost-effective remains a challenge; however, several risk-stratification systems have been proposed and should be evaluated more fully. The recent availability of a single-use, closed incision management system offers surgeons a convenient and practical means of delivering negative pressure wound therapy to their high-risk patients, with excellent wound outcomes reported to date. Although larger, randomized, controlled studies will help to clarify the precise role and benefits of such a system in cardiothoracic surgery, limited initial evidence from clinical studies and from the authors' own experiences appears promising. In light of the growing interest in this technology among cardiothoracic surgeons, a consensus meeting, which was attended by a group of international experts, was held to review existing evidence for negative pressure wound therapy in the prevention of wound complications after surgery and to provide recommendations on the optimal use of negative pressure wound therapy on closed median sternal incisions after cardiothoracic surgery. PMID:25280449

Dohmen, Pascal M; Markou, Thanasie; Ingemansson, Richard; Rotering, Heinrich; Hartman, Jean M; van Valen, Richard; Brunott, Maaike; Segers, Patrique

2014-01-01

379

Pregnancy Complications: Chlamydia  

MedlinePLUS

... is running out: Home > Pregnancy > Pregnancy Complications > Chlamydia Pregnancy complications Pregnancy complications may need special medical care. ... younger than 25. Can chlamydia cause problems during pregnancy? Yes. If you get it before or during ...

380

Electric Current Wound Healing David Cukjati  

E-print Network

one or more phases of wound healing. When conservative methods of wound care cannot facilitate wound31 Electric Current Wound Healing David Cukjati Laboratory of Biocybernetics, Faculty of Electrical, Slovenia The authors review the existing physical modalities for treatment of chronic wounds and show

Ljubljana, University of

381

Amniotic membrane transplantation for wound dehiscence after deep lamellar keratoplasty: a case report  

PubMed Central

Purpose To report amniotic membrane (AM) transplantation in a patient with wound dehiscence 5 months after deep lamellar keratoplasty (DLKP) Methods The patient was an 84-year-old Japanese man who had undergone right DLKP 5 months earlier for central corneal scarring due to recurrent stromal herpetic keratitis. He developed wound dehiscence with corneal stromal melting due to recurrence of stromal herpes in both the donor and recipient sites. "AM roll-in filling technique" and AM patching were performed. Results Following AM transplantation, stromal inflammation subsided and complete epithelization occurred within 10 days of surgery. At 8 months postoperatively, biomicroscopy revealed stable wound apposition or stromal gain. Following AM transplantation, stromal inflammation subsided and complete epithelialization was achieved within 10 days after surgery. Conclusion AM transplantation may offer an effective treatment modality for herpetic corneal wound dehiscence after DLKP. PMID:17567899

Kawakita, Tetsuya; Sumi, Tamaki; Dogru, Murat; Tsubota, Kazuo; Shimazaki, Jun

2007-01-01

382

Perioperative management in order to minimise postoperative delirium and postoperative cognitive dysfunction: Results from a Swedish web-based survey  

PubMed Central

Cognitive side-effects such as emergence agitation (EA), postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are not infrequently complicating the postoperative care especially in elderly and fragile patients. The aim of the present survey was to gain insight regarding concern and interest in prevention and treatment strategies for postoperative delirium and dysfunction, and the use of EEG-based depth-of-anaesthesia monitoring possibly reducing the risk for cognitive side effects among anaesthesia personnel. Methods A web-based validated questionnaire was sent to all Swedish anaesthesiologists and nurse anaesthetists during summer 2013. The questionnaire consisted of 3 sections, subjective preferences, routines and practices related to the perioperative handling of EA, POD, POCD. Results The response rate was 52%. Cardiovascular/pulmonary risks where assessed as importance by 98, 97% of responders while 69% considered the risk of neurocognitive side-effects important. When asked explicitly around cognitive side-effects 89%, 37% and 44% assessed awareness, POC and POD respectively of importance. EEG-based depth-of-anaesthesia monitors were used in 50% of hospitals. The responders were not convinced about the benefits of such monitors even in at-risk patients. Structured protocols for the management of postoperative cognitive side-effects were available only in few hospitals. Conclusion Swedish anaesthesia personnel are concerned about the risk of postoperative cognitive side-effects but are more concerned about cardiovascular/pulmonary risks, pain, PONV and the rare event of awareness. Most respondents were not convinced about the use of depth-of-anaesthesia monitors. There is a need to improve knowledge around risk factors, prevention and management of postoperative cognitive side effects. PMID:25568795

Jildenstål, Pether K.; Rawal, Narinder; Hallén, Jan L.; Berggren, Lars; Jakobsson, Jan G.

2014-01-01

383

A rare complication of septoplasty: tension pneumocephalus without rhinorrhea.  

PubMed

This paper describes a tension pneumocephalus without cerebrospinal fluid leak, a rare complication of septoplasty. We present a case of tension pneumocephalus without cerebrospinal fluid leak 1 month after a septoplasty operation. Although endoscopic sinus surgery can be utilized for repair of the defect, intracranially displaced ethmoid bone fragment makes an open approach more feasible. His postoperative course was uneventful and postoperative CT scan revealed no signs of pneumocephalus. Absence of cerebrospinal fluid leak made this case unique in presentation and caused a delay in diagnosis. Severe headache after septoplasty should alert the surgeon to investigate possible intracranial complications. PMID:25006947

Güvenç, Gönül; Eren, Erdem; Arslano?lu, Seçil; Yüceer, Nurullah

2014-07-01

384

A model for the study of wounds in normal elderly adults and patients with peripheral vascular disease or diabetes mellitus.  

PubMed

The purpose of the study was to test the hypothesis that significant delays in cutaneous wound healing could be demonstrated using standard wounds and high quality histological methods in patients with severe peripheral vascular disease (PVD) and/or diabetes mellitus (DM) compared to healthy elderly controls. Additionally, we proposed that standard wounds on the arms of elderly controls would heal more rapidly than comparable wounds on the legs. In order to test these hypotheses we developed and characterized a partial thickness wound model which could be used safely in human subjects. The study population consisted of 25 elderly normal volunteers, 17 patients with PVD, and 24 patients with DM. Standard wounds were created using a Simplate II bleeding-time device. A total of 309 wounds ranging in age from 1 to 25 days were determined to be suitable for analysis. A global index of wound maturity was developed based on selected epidermal and dermal events of repair which could be scored histologically. The superficial component (within 0.1 mm of the epidermis) and deep components of dermal wounds were analyzed separately. Simultaneously created arm and leg wounds were studied in 15 of the elderly controls. Transcutaneous partial pressure of oxygen (TcPO2) measurements were used to estimate the severity of cutaneous ischemia. Data analysis revealed that the most striking differences observed were in dermal events of repair. Control wounds were more mature than dermal wounds from patients with PVD (P < 0.05). A significant reduction in the number of neutrophils and macrophages (P < 0.05) was demonstrated in 7-day-old wounds of patients with PVD compared to controls. Patients with DM showed a similar trend of reduced wound maturity but it did not reach statistical significance. Wounds created in skin with TcPO2 > 20 were more mature than wounds with TcPO2 < or = 20 (P < 0.05) and arm wounds were more mature than leg wounds (P < 0.01). The most significant difference noted in this wound model was that the superficial compartment of dermal wounds was significantly more mature than the deep compartment (P < 0.001). Good agreement was observed between two independent scorers of wound histology and no complications were noted in either patients or controls when using this human wound model. We conclude that the model described allows evaluation of both epidermal and dermal events of repair with relative safety even in patients with PVD and DM.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:7643593

Olerud, J E; Odland, G F; Burgess, E M; Wyss, C R; Fisher, L D; Matsen, F A

1995-09-01

385

Risk and complications in endoscopic carpal tunnel release  

Microsoft Academic Search

Single portal endoscopic carpal tunnel release was carried out in 107 hands of 88 patients. There were 11 complications. These included incomplete release (2), post operative scarring around the median and ulnar nerves (2), laceration of the superficial palmar arterial arch (1), reflex sympathetic dystrophy (2), palmar fasciitis (1), and wound inflammation (3).In two cases there was no relief of

K. Shinya; M. Lanzetta; W. B. Conolly

1995-01-01

386

Vasectomy complications at a family practice center.  

PubMed

Vasectomy is a safe, effective, economical, and convenient form of permanent sterilization since it can be performed in an outpatient setting. Seventy-three vasectomies were performed during a nine-year period at the Kanawha Valley Family Practice Center. The procedures were performed by family practice residents under the active instruction and supervision of the attending staff. The complication type and frequency are as follows: epididymitis, 5.5 per cent; sperm granuloma, 2.7 per cent; wound infection, 1.4 per cent, and hematoma, 12 per cent. No failures occurred in this study group. All of the complications were minor and responded to conservative medical management. The results of this study reveal that vasectomy complications at this teaching family practice center are comparable to those reported in the medical literature. This study therefore supports the opinion that vasectomies can be performed safely and taught by trained family practitioners in the outpatient setting. PMID:2781781

Beavers, C H

1989-09-01

387

Topical application of Cleome viscosa increases the expression of basic fibroblast growth factor and type III collagen in rat cutaneous wound.  

PubMed

Cleome viscosa L. (Cleomaceae) is an important traditional medicine of the Indian-Ayurvedic and Chinese-medicine system documented for rheumatic arthritis, hypertension, malaria, neurasthenia, and wound healing. The plant is also known as Asian spider flower and is distributed throughout the greater part of India. The present study explored the wound healing property of C. viscosa methanol extract (CvME) and its related mechanism using Wistar rat cutaneous excision wound model. Wound contraction rate, hydroxyproline quantification, and histopathological examination of wound granulation tissue were performed. The healing potential was comparatively assessed with a reference gentamicin sulfate hydrogel (0.01% w/w). Western blot for COL3A1, bFGF, and Smad-2, Smad-3, Smad-4, and Smad-7 was performed with 7-day postoperative granulation tissue. Results revealed that the topical application of CvME (2.5% w/w) significantly accelerated the wound contraction rate (95.14%, 24 postoperative days), increased the hydroxyproline content (3.947 mg/100 mg tissue), and improved histopathology of wound tissue as compared to control groups. Western blot analysis revealed that CvME significantly upregulated the expression of COL3A1 and bFGF and increased the Smad-mediated collagen production in granulation tissue. These findings suggest that C. viscosa promoted the wound repair process by attenuating the Smad-mediated collagen production in wound granulation tissue. PMID:24864253

Upadhyay, Aadesh; Chattopadhyay, Pronobesh; Goyary, Danswrang; Mazumder, Papiya M; Veer, Vijay

2014-01-01

388

Antimicrobial effect of continuous lidocaine infusion in a Staphylococcus aureus-induced wound infection in a mouse model.  

PubMed

Continuous infusion of local anesthetics in surgical wounds has been shown to be an effective technique for postoperative analgesia. To investigate the potential antimicrobial effect of continuous local anesthetic infusion, we adapted a mouse model of surgical wound infection to examine effects on antibacterial response. Forty male BALB/c mice were randomized into 2 groups. An incision wound was made over the dorsal flank and instilled with Staphylococcus aureus. An osmotic pump was then implanted to deliver either 0.9% NaCl or 2% lidocaine continuously. Each wound was cultured postoperatively at 2 days, and the colony count of S. aureus was determined. Results showed that the number of colony-forming units of S. aureus measured in wounds treated with lidocaine displayed a nearly 10-fold reduction compared to the wounds in the saline group (P=0.009). The demonstrated antibacterial activity indicates that local anesthetic infusion may play a role in prophylaxis for surgical wound infections. PMID:25310128

Lu, Cheng-Wei; Lin, Tzu-Yu; Shieh, Jiann-Shing; Wang, Ming-Jiuh; Chiu, Kuan-Ming

2014-11-01

389

Wounded Nucleons, Wounded Quarks, and Relativistic Ion Collisions  

E-print Network

A concept of wounded nucleons and/or wounded quarks plays an important role in parametrizing and to some extent explaining many a feature of the relativistic ion collisions. This will be illustrated in a historical perspective, up to and including the latest developpments.

Helena Bialkowska

2006-09-06

390

Wound tube heat exchanger  

DOEpatents

What is disclosed is a wound tube heat exchanger in which a plurality of tubes having flattened areas are held contiguous adjacent flattened areas of tubes by a plurality of windings to give a double walled heat exchanger. The plurality of windings serve as a plurality of effective force vectors holding the conduits contiguous heat conducting walls of another conduit and result in highly efficient heat transfer. The resulting heat exchange bundle is economical and can be coiled into the desired shape. Also disclosed are specific embodiments such as the one in which the tubes are expanded against their windings after being coiled to insure highly efficient heat transfer.

Ecker, Amir L. (Duncanville, TX)

1983-01-01

391

Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival  

Microsoft Academic Search

OBJECTIVE--To assess the differences among surgeons in postoperative complications, postoperative mortality, and survival in patients undergoing surgery for colorectal cancer. DESIGN--Prospective study of patients with colorectal cancer managed by one of 13 consultant surgeons, none of whom had a special interest in colorectal surgery. SETTING--Royal Infirmary, Glasgow. PATIENTS--645 sequential patients with colorectal cancer presenting over the six years from 1974

C S McArdle; D Hole

1991-01-01

392

Assessment of pain during rest and during activities in the postoperative period of cardiac surgery  

PubMed Central

Objective to assess the intensity and site of pain after Cardiac Surgery through sternotomy during rest and while performing five activities. Method descriptive study with a prospective cohort design. A total of 48 individuals participated in the study. A Multidimensional Scale for Pain Assessment was used. Results postoperative pain from cardiac surgery was moderate during rest and decreased over time. Pain was also moderate during activities perform