Note: This page contains sample records for the topic postoperative wound complications from
While these samples are representative of the content of,
they are not comprehensive nor are they the most current set.
We encourage you to perform a real-time search of
to obtain the most current and comprehensive results.
Last update: November 12, 2013.

[Prophylaxis of postoperative wound complications].  


Etiological factors of postoperative wound complications were studied in experiment on the models of surgical wounds in 1185 white Wistar rats, 28 mongrel dogs, 48 corpses, as well as the role of sutures and suture materials in development of eventrations and postoperative hernias. Morphological and microbiological studies have shown that the key role in etiology of wound complication belongs to morphofunctional substratem of the wound comprises, besides the type of the wound, the degree of traumatization and ischemia of paravulnar tissues, presence of devitalized tissue in the wound, the features and quantity of suture material, pattern and intensity of microbial dissemination, characteristics of sutures, etc. Isolated presence of only one from the mentioned factors in majority of cases does not result in development of wound complication. Thus, wound infection even by critical doses of monocultures and their associations would not in alle cases cause the development of would infection. Thus, critical dose of microbes in fresh wounds could not be considered as an obligatory factor which results in suppuration. PMID:9791994

Volenko, A V



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

PubMed Central

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.

Borejsza-Wysocki, Maciej; Meissner, Wiktor; Malinger, Stanislaw; Szmeja, Jacek; Koscinski, Tomasz; Ratajczak, Andrzej; Drews, Michal



Postoperative Complications After Gynecologic Surgery  

PubMed Central

Objective To estimate the association of age, medical comorbidities, functional status, and unintentional weight loss (as a marker of frailty) with postoperative complications in women undergoing major gynecologic surgery. Methods We conducted a cross-sectional analysis of the American College of Surgeons National Surgical Quality Improvement Program 2005-2009 participant use data files were used to analyze gynecologic procedures. The primary outcome was composite 30-day major postoperative complications. Results A total of 22,214 women were included in our final analysis. The overall prevalence of composite 30 day major postoperative complications was 3.7% (n=817). Age 80 years or older (adjusted odds ratio (OR)=1.8(95% Confidence Interval (CI) 1.25,2.58)), dependent functional status (adjusted OR= 2.37(95% CI 1.53,3.68)), and unintentional weight loss (adjusted OR = 2.49(95% CI 1.48,4.17)) were significantly associated with postoperative morbidity after adjusting for diabetes mellitus (adjusted OR= 1.44(95% CI 1.15,1.79)), known bleeding disorder (adjusted OR= 2.29 (95% 1.49,3.52)), morbid obesity (adjusted OR= 1.77(95% CI 1.45,2.17)), ascites (adjusted OR= 3.27(95% CI 2.18,4.90)), preoperative systemic infection (adjusted OR= 3.02(95% CI 2.03,4.48)), procedures for gynecologic cancer (adjusted OR= 1.60(95% CI 1.27,2.0)), disseminated cancer (adjusted OR= 2.57(95% CI 1.64,4.03)), emergency procedures (adjusted OR = 1.82(95% CI 1.18,2.79)), operative time greater than 4 hours vs. less than 1 hour (adjusted OR = 2.91(95%CI 2.18,3.89)) and wound class 4 vs. 1(adjusted OR= 4.28(95%CI 1.82,10.1). Conclusion Age 80 years or older, medical comorbidities, dependent functional status, and unintentional weight loss are associated with increased major postoperative complications after gynecologic procedures.

Erekson, Elisabeth A.; Yip, Sallis O.; Ciarleglio, Maria M.; Fried, Terri R.



Wound complications and stitch length  

Microsoft Academic Search

The effect of suturing with a very short stitch on the development of wound complications in midline incisions was investigated. Three hundred sixty-eight patients were analysed. The suture length to wound length ratio and mean stitch length were calculated. Wound infection occurred in 4% (four of 103) of patients sutured with a mean stitch length of less than 4 cm, in

D. Millbourn; L. A. Israelsson



Laparoscopic surgery complications: Postoperative peritonitis  

PubMed Central

Introduction: Complications within laparoscopic surgery, similar to classic surgery are inevitable and require immediate actions both to diminish intraoperative risks and to choose the appropriate therapeutic attitude. Peritonitis and hemorrhagic incidents are both part of the complications aspect of laparoscopic surgery. Fortunately, the incidence is limited, thus excluding the rejection of celioscopic methods. Patient’s risks and benefits are to be analyzed carefully prior recommending laparoscopic surgery. Materials and methods: This study presents a statistical analysis of peritonitis consecutive to laparoscopic surgery, experience of „Sf. Ioan” Emergency Hospital, Bucharest, and Department of Surgery (2000-2010). Results:There were 180 (0,96%) complicated situations requiring reinterventions, from a total of 18676 laparoscopic procedures. 106 cases (0,56%) represented different grades of postoperative peritonitis. Most frequently, there were consecutive laparoscopic appendicectomia and colecistectomia. During the last decade, few severe cases of peritonitis followed laparoscopic bariatric surgical procedures. Conclusions: This study reflects the possibility of unfavorable evolution of postoperative peritonitis comparing with hemorrhagic incidents within laparoscopic surgery.

Draghici, L; Draghici, I; Ungureanu, A; Copaescu, C; Popescu, M; Dragomirescu, C



Wound Complications Following Resection of Adductor Compartment Tumours  

PubMed Central

Purpose Limb salvage surgery of soft tissue sarcomas is associated with both a risk of local recurrence and wound complications. Although the lower limb appears to be at greater risk of wound-related morbidity, few studies separate anatomical compartments. We believe that the adductor compartment of the thigh has a particularly high rate of complications and so performed a retrospective analysis of all soft tissue sarcomas arising in this region undergoing limb salvage. Patients Patients with intermediate and high grade adductor compartment tumours were identified from our database and the case notes were reviewed for patient, tumour, surgical and wound variables, identifying those with wound complications both before and after discharge. Results Of 49 patients who underwent limb salvage surgery, 22 (42.9%) developed complications. Twelve patients (24.5%) required further surgery prior to wound healing and 10 patients had delays in post-operative radiotherapy. There were significant differences in the rates of preceding surgery, open biopsy performed at other centres and previous radiotherapy to this region between the complicated and uncomplicated groups. Discussion The management of these difficult tumours carries a high rate of wound complications and requires careful planning prior to tissue biopsy. Open biopsies should be performed by the tumour surgeon to allow easy inclusion of this site in the definitive procedure. In previously irradiated or operated limbs, alternative strategies for wound management may need to be considered.

Grimer, Robert J.; Carter, Simon R.; Tillman, Roger M.



Prevalence of 90-days postoperative wound infections after cardiac surgery  

Microsoft Academic Search

Objective: Postoperative wound infections generally cause considerable extra morbidity, mortality and costs. As nowadays length of hospitalization shortens, post-discharge surveillance is important to get reliable information on the prevalence of postoperative wound infections. In this study, the prevalences of sternal wound (SWI) and donor site infections (DSI) during hospitalization as well as, 30 and 90 days after cardiac surgery were

Daisy Jonkers; Ted Elenbaas; Peter Terporten; Fred Nieman; Ellen Stobberingh



Application of wound dressing Molndal technique in clean and potentially contamined postoperative wounds--initial comparative study.  


Because of a possible delayed wound healing, critical colonization and infection of wounds present a problem for surgeons, particularly in patients with compromised immune system or in case where the wound is heavy contaminated or poorly perfused. Molndal technique of wound dressing has proven to be effective in prevention of infection. In our study we wanted to describe the benefits of the application of Molndal technique wound dressing compared to traditional wound dressing technique at potentially contaminated and clean postoperative wounds. We examined postoperative wound after radical excision of pilonidal sinus and after implantation of partial endoprosthesis in hip fracture. Molndal technique consisted of wound dressing with Aquacel Ag - Hydrofiber. Traditional technique was performed using gauze compresses and hypoallergic adhesives. We analyzed the results of 50 patients after radical excision of pilonidal sinus. 25 patients were treated by Molndal technique and 25 patients by the traditional technique of wound dressing. In the group treated by Molndal technique only 1 (4%) patient has revealed a wound infection, proven by positive microbiological examination and suppuration. In the traditional technique group 4 (16%) patients developed wound infection as inflammation and secretion as a sign of superficial infection. In the other group we analyzed the results of 50 patients after implantation of partial endoprosthesis after hip fracture. 20 patients were treated by Molndal technique and 30 patients by the traditional technique of wound dressing. In the group treated by Molndal technique no patient has revealed a wound infection (0%). In the traditional technique group 4 (13%) patients developed wound infection. All complication in both group were superficial incisional surgical infection (according to HPSC). There was no deep incisional surgical site infection or organ/space surgical site infection. Our results are clearly showing that Molndal technique is effective in preventing the postoperative wound infection. PMID:22220414

Marinovi?, Marin; Cicvari?, Tedi; Grzalja, Nikola; Baci?, Giordano; Radovi?, Endi



Improvement of Post-Operative Coronary Artery Bypass Graft Surgery Wound Infection Rates  

Microsoft Academic Search

ISSUE: A devastating complication of coronary artery bypass graft (CABG) surgery is post-operative surgical site wound infections. In 2001, Baptist Medical Center (BMC) experienced a post-operative CABG surgical wound infection rate that was above the Centers for Disease Control and Prevention (CDC) National Nosocomial Infection Surveillance System (NISS) rate.PROJECT: A multidisciplinary performance improvement team, consisting of the chiefs of Cardiovascular

J. Kilts; K. S. Meyer; R. J. Still; K. Walsh



Ward Design in Relation to Postoperative Wound Infection: Part I  

Microsoft Academic Search

The incidence of postoperative wound infection in a general surgical unit is reported both before and after transfer from a “Nightingale” type multibed ward to a new “race-track” type of surgical ward with controlled ventilation and with 40% of its beds in single rooms. Following transfer postoperative wound infection was reduced by about 55%.With the use of certain types of

A. I. G. Davidson; A. Macdonald; G. Smith



Early postoperative complications following neurosurgical procedures  

Microsoft Academic Search

Purpose  To assess the incidence and characteristics of early postoperative complications in patients following neurosurgical procedures.\\u000a \\u000a \\u000a \\u000a Methods  All patients undergoing neurosurgery during a four month period were followed postoperatively for up to four hours in the\\u000a post anesthetic care unit or intensive care unit. Patient information and all complications were documented by the investigators\\u000a on a standardized form. Complications were classified as

Pirjo H. Manninen; Sitaram K. Raman; Kevin Boyle; Hossam El-Beheiry




PubMed Central

SYNOPSIS Postoperative complications are directly related to poor surgical outcomes in the elderly. This review outlines evidence based quality initiatives focused on decreasing neurologic, cardiac, and pulmonary complications in the elderly surgical patient. Delirium is the most common neurologic complication in the elderly. Important anesthesia quality initiatives for prevention of delirium in elderly surgical patients include use of structured clinical protocols focused on delirium risk factor modification, avoiding meperidine when managing postoperative pain, and careful selection and titration of drugs when sedation is required. There are few age-specific quality measures aimed at prevention of cardiac and pulmonary complications. However, some recommendations for adults such as avoidance of long acting muscle relaxants and perioperative use of statins and beta blockers in high risk patients can be applied to the geriatric surgical population. In the future, process measures may provide a more global assessment of quality in the elderly surgical population.

Sieber, Frederick E.; Barnett, Sheila Ryan



Maternal Obesity and Risk of Postcesarean Wound Complications.  


Objective To estimate the effect of increasing severity of obesity on postcesarean wound complications and surgical characteristics.Study Design We performed a retrospective cohort study of consecutive cesarean deliveries at a tertiary care facility from 2004 to 2008. Four comparison groups were defined by body mass index (BMI; kg/cm2): < 30 (n = 728), 30 to 39.9 (n = 1,087), 40 to 49.9 (n = 428), or ?50 (n = 201). The primary outcome was wound complication, defined as wound disruption or infection within 6 weeks postoperatively. Surgical characteristics were compared between groups including administration of preoperative antibiotics, type of skin incision, estimated blood loss (EBL), operative time, and type of skin closure.Results Of the 2,444 women with complete follow-up data, 266 (10.9%) developed a wound complication. Compared with nonobese women (6.6%), increasing BMI was associated with an increased risk of wound complications: BMI 30.0 to 39.9, 9.2%, adjusted odds ratio (aOR) 1.4 (95% confidence interval [CI] 0.99 to 2.0); BMI 40.0 to 49.9, 16.8%, aOR 2.6 (95% CI 1.7 to 3.8); BMI ?50, 22.9%, aOR 3.0 (95% CI 1.9 to 4.9). Increasing BMI was also associated with increased rates of midline vertical incision, longer operative time, higher EBL, and lower rates of subcuticular skin closure.Conclusion A dose-response relationship exists between increasing BMI and risk of postcesarean wound complications. Increasing obesity also significantly influences operative outcomes. PMID:23765707

Conner, Shayna N; Verticchio, Juliana C; Tuuli, Methodius G; Odibo, Anthony O; Macones, George A; Cahill, Alison G



[The surgery of laparoceles. The postoperative complications].  


The use of prosthetic meshes in incisional hernias repairs is now very attractive, particularly for wide fascial defects; nevertheless the presence of a foreign body and placement technique may be responsible for complications sometimes leading to failure. To evaluate technical problems and complications in incisional hernia surgery the authors reviewed their 5 year experience in 70 patients; 39 mesh repairs and 31 direct sutures of the abdominal wall were performed. Local complications (fistulas, wound hematoma or infections) were more frequent in the former group; PTFE meshes showed a lower resistance to infections, particularly in diabetics, and in three patients partial or total removal was mandatory. Prosthetic meshes showed a marked reduction of recurrences in incisional hernia surgery, but their use leads to more local complications than direct repair; the authors believe that mesh placement must be evaluated for every single patient and not used as a routine procedure. PMID:9297143

Garavello, A; Tuccimei, U; Sadighi, A; Belardi, A; Remedi, M; Antonellis, D



Postoperative sequelae and complications of rhinoplasty.  


This article has overviewed complications of rhinoplasty. Generally, these complications fall into two categories: aesthetic (that is, cosmetic sequelae that may require a revision rhinoplasty) and nonaesthetic. Of the nonaesthetic complications, infection has the widest span of severity. A localized Staphylococcus aureus abscess or Pseudomonas infection of the nose may occur postoperatively. Owing to the proximity of the nose to the cranium, a cavernous sinus thrombosis or basilar meningitis may result. Postoperative toxic-shock syndrome is a rare occurrence that surgeons should be aware of; most cases have occurred with the presence of nasal packing, but a case using only plastic nasal splints has been reported also. Bacteremia seems to be uncommon during rhinoplasty. Infection after rhinoplasty is generally much less frequent than one would expect from an operation in an unsterile field. Antibiotics are frequently utilized electively. Postoperative nasal-periorbital edema and ecchymosis are regarded as unavoidable but may be lessened significantly by postoperative head elevation and cold packs. The possibility of postoperative bleeding must be evaluated by the surgeon preoperatively. This sequela usually occurs either within 72 hours postoperatively or at around 10 days postoperatively. Many different causes exist for chronic postoperative nasal obstruction, from poorly supported nasal valves closing upon inspiration to an enhanced allergic rhinitis leading to chronic nasal mucosal edema. The latter may be treated by injection of steroid into the turbinates. Among aesthetic complications, supratip prominence, saddle deformity, and persistent hump are among the more commonly reported. Supratip prominence--"polly-beak"--can be caused by inadequate reduction of tip cartilaginous or soft-tissue elements, especially in relation to the reduction of the dorsum. An over-reduced dorsum will leave an otherwise normal nasal tip with a relative prominence. An accumulation of blood or a mucous cyst occurring under the skin of the tip will produce a prominence. Poor tip projection, tip ptosis, and alar collapse are the result of overreduction of tip elements. A dislocated alar cartilage can appear as an asymmetric nasal bossa. Saddle-nose deformity occurs after overaggressive bony and/or cartilaginous hump removal. Infractured nasal bones that subsequently drop into the piriform aperture can create a bony saddle. Persistent hump is due to inadequate reduction of a bony or cartilaginous hump. If the septal cartilage reduction is disproportionate to the bony septum reduction, the appearance of either a hump or a saddle is possible.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:3320872

Holt, G R; Garner, E T; McLarey, D



Postoperative wound infections and surgical face masks: A controlled study  

Microsoft Academic Search

It has never been shown that wearing surgical face masks decreases postoperative wound infections. On the contrary, a 50% decrease has been reported after omitting face masks. The present study was designed to reveal any 30% or greater difference in general surgery wound infection rates by using face masks or not.

Th. Göran Tunevall




Microsoft Academic Search

The following paper reports the topical use of Calendula officinalis in the treatment of 10 dogs that showed post-operative complications in emergency (mainly trauma), orthopedic and oncologic surgeries. These severe complications included suture dehiscence, infections and even tissular necrosis. All the patients reached complete healing between 21 and 28 days of treatment.



Improved results of the vacuum assisted closure and Nitinol clips sternal closure after postoperative deep sternal wound infection  

Microsoft Academic Search

Objective: Postoperative deep sternal wound infection is a severe complication of cardiac surgery, with a high mortality rate and a high morbidity rate. The objective of this prospective study is to report our experience with the vacuum assisted closure (VAC) system for the management of deep wound infection. We also devised an innovative closure technique post VAC therapy using thermo

Maria Pia Tocco; Alberto Costantino; Milva Ballardini; Claudio D’Andrea; Marcello Masala; Eusebio Merico; Luigi Mosillo; Paolo Sordini



Noninfectious Wound Complications in Clean Surgery: Epidemiology, Risk Factors, and Association with Antibiotic Use  

Microsoft Academic Search

Background  Noninfectious wound complications are frequent and often are confused with and treated as infection.\\u000a \\u000a \\u000a \\u000a Methods  We assessed the epidemiology, impact, risk factors, and associations with antibiotic use of noninfectious wound complications\\u000a in clean orthopedic and trauma surgery. We report a single-center, prospective, observational study in an orthopedic department.\\u000a \\u000a \\u000a \\u000a \\u000a Results  Among 1,073 adult patients, 630 (59%) revealed clinically relevant postoperative noninfectious wound complications,

Ilker UckayAmerico; Americo Agostinho; Wilson Belaieff; Laurence Toutous-Trellu; Saja Scherer-Pietramaggiori; Axel Andres; Louis Bernard; Hubert Vuagnat; Pierre Hoffmeyer; Blaise Wyssa



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


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. PMID:2742416

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



Incident of Pseudomonas aeruginosa in Post-Operative Wound Infection  

Microsoft Academic Search

The primary aim of this study was to determine the incidents of pseudomonas aeruginosa in post-operative wound infection and its sensitivity pattern to commonly used antibiotics. During a period of six months between February to December, 2005, 115 specimens were collected from King Abdullah University Hospital, Princess Basma Hospital, Princess Badea and Princess Rahma Hospitals. Samples were obtained from the

Hani A. Masaadeh; Adnan S. Jaran



[The use of fibrous wound dressing sheets made of carboxymethylcellulose natrium in the postoperative management of tracheostomy].  


Postoperative management of tracheostomy is very important to reduce several complications such as abnormal granulation and subcutaneous abscess. One of the causes is the use of gauzes and a disinfectant because they induce the secondary wound injury and prevention of wound healing. We used a fibrous wound dressing, carboxymethylcellulose natrium sheet (Aquacel) on the postoperative management of tracheostomy for 5 patients. The sheets were very useful to absorb exudates including blood and to make suitable moist and clean surroundings in all patients. PMID:16281857

Tsunezuka, Y; Suzuki, M; Nitta, K; Oda, M



MRI manifestations and differentiated diagnosis of postoperative spinal complications  

Microsoft Academic Search

Summary  To analyze MR manifestations of postoperative spinal complications and investigate the value of MRI in the diagnosis and differentiated\\u000a diagnosis, 114 cases of spinal postoperative complications were analyzed retrospectively and compared with the clinical data.\\u000a The results showed that the main postoperative spinal complications included spinal stenosis (n=33, consisting of 21 cases of epidural fibrosis and 12 cases of epidural

Haitao Yang; Renfa Wang; Tianyou Luo; Yu Ouyang; Fajin Lv; Liming Xia; Chengyuan Wang



Postoperative interstitial hernia as a cause of obscure incisional wound site pain  

PubMed Central

An interstitial hernia is one in which the hernia sac is located between the layers of the abdominal wall. The analysis of contemporary literature shows that interstitial hernias are most often seen in children as a type of inguinal hernia and often accompany undescended testis. The hernia sac is usually located between the external-oblique and internal-oblique muscles in a lateral-cephalic direction. The authors present 3 cases of interstitial hernia found during laparoscopic exploration of the front abdominal wall done due to incisional wound site pain. No previous diagnosis of hernia was considered in all the cases. Hernias were found as complications of appendectomy and wound healing after radiotherapy of uterine and cervical cancer. In conclusion, in obscure wound site pain, the presence of an interstitial postoperative hernia should be considered as a possible reason for the complaint. Laparoscopic examination of the anterior abdominal wall during adhesiolysis in patients with abdominal pain enables proper diagnosis and treatment.

Modrzejewski, Andrzej; Smietanski, Maciej



Postoperative pulmonary complications: reducing risks for noncardiac surgery.  


Postoperative pulmonary complications (PPCs) are a major contributor to the overall risk of noncardiac surgery that may lead to serious postoperative morbidity and long-term mortality. Nurse practitioners should be familiar with risk indices for PPCs, clinical guidelines, and risk reduction strategies to prevent PPCs and improve PPC outcomes. PMID:23728493

Thanavaro, Joanne L; Foner, Barbara J



A Systematic Review of Intraoperative Warming to Prevent Postoperative Complications  

Microsoft Academic Search

•THIS SYSTEMATIC REVIEW examines whether preventing hypothermia during surgery prevents postoperative complications and thereby improves outcomes for patients. Twenty-six randomized controlled trials were identified, and data extraction and assessment of study quality were carried out by two researchers independently. The results of studies with similar patients, surgical procedures, and outcomes were pooled.•OUTCOMES MEASURED included postoperative pain levels, thermal comfort, and

Eileen M. Scott; Richard Buckland



Multiple thoracoabdominal gunshot wounds with complicated trajectories  

Microsoft Academic Search

A 41-year-old man was shot three times with a custom-made handgun. There were six small round wounds on the surface from two\\u000a bullets that went into the body and one bullet found in a wall behind the victim at the scene. The gunshot wound in the left\\u000a supraclavicular region bled massively. He was transferred to our hospital and soon fell

Takashi Iwata; Kiyotoshi Inoue; Masaaki Hige; Keiichi Yamazaki; Yasuhiro Kawata; Shigefumi Suehiro



Distal wound complications following pedal bypass: analysis of risk factors.  


Wound complications of the pedal incision continue to compromise successful limb salvage following aggressive revascularization. Significant distal wound disruption occurred in 14 of 142 (9.8%) patients undergoing pedal bypass with autogenous vein for limb salvage between 1986 and 1993. One hundred forty-two pedal bypass procedures were performed for rest pain in 66 patients and tissue necrosis in 76. Among the 86 men and 56 women, 76% were diabetic and 73% were black. All but eight patients had a history of diabetes and/or tobacco use. Eight wounds were successfully managed with maintenance of patent grafts from 5 to 57 months. Exposure of a patent graft precipitated amputation in three patients, as did graft occlusion in an additional patient. One graft was salvaged by revision to the peroneal artery and one was covered by a local bipedicled flap. Multiple regression analysis identified three factors associated with wound complications at the pedal incision site: diabetes mellitus (p = 0.03), age > 70 years (p = 0.03), and rest pain (p = 0.05). Ancillary techniques ("pie-crusting") to reduce skin tension resulted in no distal wound problems among 15 patients considered to be at greatest risk for wound breakdown. Attention to technique of distal graft tunneling, a wound closure that reduces tension, and control of swelling by avoiding dependency on and use of gentle elastic compression assume crucial importance in minimizing pedal wound complications following pedal bypass. PMID:7703063

Robison, J G; Ross, J P; Brothers, T E; Elliott, B M



Postoperative gastrointestinal complications after lung volume reduction operations  

Microsoft Academic Search

Background. Lung volume reduction operations have been shown to improve the quality of life and functional status of some patients with end-stage emphysema.Methods. Because of a perceived increase in the occurrence of postoperative gastrointestinal (GI) complications, we reviewed our experience in 287 patients who had lung volume reduction operations to determine the frequency of GI complications and to identify risk

Ibrahim B Cetindag; Theresa M Boley; Mitchell J Magee; Stephen R Hazelrigg



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



Negative pressure wound therapy for inguinal lymphatic complications in critically ill patients  

PubMed Central

Purpose In this study, we investigated the therapeutic potential of regulated negative pressure vacuum-assisted wound therapy for inguinal lymphatic complications in critically ill, liver transplant recipients. Methods The great saphenous vein was harvested for hepatic vein reconstruction during liver transplantation in 599 living-donor liver transplant recipients. Fourteen of the recipients (2.3%) developed postoperative inguinal lymphatic complications and were treated with negative pressure wound therapy, and they were included in this study. Results The average total duration of negative pressure wound therapy was 23 days (range, 11 to 42 days). Complete resolution of the lymphatic complications and wound healing were achieved in all 14 patients, 5 of whom were treated in hospital and 9 as outpatients. There was no clinically detectable infection, bleeding or recurrence after an average follow-up of 27 months (range, 7 to 36 months). Conclusion Negative pressure wound therapy is an effective, readily-available treatment option that is less invasive than exploration and ligation of leaking lymphatics and provides good control of drainage and rapid wound closure in critically ill patients.

Cheong, Yong-Kyu; Jun, Heungman; Song, Gi-Won; Moon, Ki-Myung; Kwon, Tae-Won; Lee, Sung-Gyu



Postoperative complications after laparoscopic incisional hernia repair  

Microsoft Academic Search

  Background: The popularity of laparoscopic repair of incisional hernias is increasing due to the apparent advantages of laparoscopy.\\u000a Patients and methods: A group of 150 consecutive patients with incisional hernias were treated by laparoscopic IPOM technique\\u000a with a Goretex Dualmesh between September 1999 and September 2001 and subsequently followed up. Some minor and major complications\\u000a could clearly identify advantages as

D. Berger; M. Bientzle; A. Müller



Factors influencing wound complications: a clinical and experimental study.  

PubMed Central

Burst abdomen, incisional herniation, sinus formation and post-operative wound infection continue to bedevil the surgeon. A prospective study of 1129 laparotomy wounds defined the extent of the problem; 1.7% incidence of dehiscence, 7.4% herniation and 6.7% sinus formation, all significantly associated with wound infection. Mass closure reduced the dehiscence rate from 3.8% to 0.76%. Infection reduced wound strength in a rat laparotomy model due to a decrease in fibroblast concentration and activity. A monofilament non-absorbable suture was shown experimentally to be the most suitable suture for closing infected abdominal wounds. Electron microscopy demonstrated bacteria in the interstices of infected multifilament sutures. A randomised clinical trial comparing polyglycolic acid and monofilament nylon in the closure of abdominal wounds confirmed the experimental findings; polyglycolic acid resulted in a significantly higher wound failure rate with no decrease in sinus formation. A mass closure technique using monofilament nylon is recommended for laparatomy closure and efforts should continue to reduce wound sepsis. Images Fig. 1 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 9 Fig. 10 Fig. 11 Fig. 12

Bucknall, T. E.



Abnormal pigmentation within cutaneous scars: A complication of wound healing  

PubMed Central

Abnormally pigmented scars are an undesirable consequence of cutaneous wound healing and are a complication every single individual worldwide is at risk of. They present a challenge for clinicians, as there are currently no definitive treatment options available, and render scars much more noticeable making them highly distressing for patients. Despite extensive research into both wound healing and the pigment cell, there remains a scarcity of knowledge surrounding the repigmentation of cutaneous scars. Pigment production is complex and under the control of many extrinsic and intrinsic factors and patterns of scar repigmentation are unpredictable. This article gives an overview of human skin pigmentation, repigmentation following wounding and current treatment options.

Chadwick, Sarah; Heath, Rebecca; Shah, Mamta



Effects of immediate postoperative enteral nutrition on body composition, muscle function, and wound healing.  


Thirty-two patients undergoing bowel resection were randomized to receive either immediate postoperative nasojejunal feeding with full strength Osmolite solution for 56 hours (n = 16) or routine postoperative hypocaloric fluids and gradual reintroduction of diet (n = 16). Body composition changes were measured at 14 days after operation with in vivo neutron activation analysis, the wound healing response by subcutaneous implantation of Gortex tubes, and muscle function by grip strength, maximum ventilatory volume, and stimulation of the ulnar nerve at the wrist. Postoperative fatigue up to 3 months after operation was assessed using a 10-point analogue. Successful immediate enteral nutrition was established in 12 of the 16 patients. Enterally fed patients had a mean daily caloric intake of 1179 +/- 388 kcal/d (mean +/- SD) over the first 4 postoperative days compared with 382 +/- 71 kcal/d for the controls (p less than 0.0001). The amount of hydroxyproline accumulating in the Gortex tubes was also significantly greater (2.5 +/- 1.1 nmol/g tube vs 1.5 +/- 0.8 nmol/g tube; p less than 0.02). However, the amount and composition of the weight lost was not significantly different. Muscle function was not preserved, and postoperative fatigue occurred to an equal extent in both groups. Complications were similar in both groups, except for a preponderance of bowel obstructions in the controls. The time to passage of first flatus and first bowel motion, although shorter in the fed group, did not reach significance (p = 0.07). We conclude that immediate enteral nutrition is feasible and results in an improved wound healing response.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1910100

Schroeder, D; Gillanders, L; Mahr, K; Hill, G L


[The prevention of postoperative suppurative complications in stomach cancer].  


Bacteriologic studies of gastric juice and purulent drainage fluids in the event of complications were carried out in 80 patients who had undergone gastric resections and had been on conventional parenteral antibiotic treatment (control group). Another (experimental) group of 37 patient, having undergone the same operations, received prophylaxis of the suppurative complications with 5-nitrox and Flagyl solutions through nasogastric probe once in 3 hours for 6 to 8 days. The suppurative complications in the experimental group were reduced from 47.5 to 8.1 per cent and of the postoperative lethality due to suppurative complications from 22.5 to 0 per cent. PMID:2796222

Chak?rov, S; Iosifova, L; Karanov, S; Tomov, I; Marinova, V



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

PubMed Central

Context: Pre- and postoperative distress in breast cancer patients can cause complications and delay recovery from surgery. Objective: The aim of our study was to evaluate the effects of yoga intervention on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery. Methods: Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited in a randomized controlled trial comparing the effects of a yoga program with supportive therapy and exercise rehabilitation on postoperative outcomes and wound healing following surgery. Subjects were assessed at the baseline prior to surgery and four weeks later. Sociodemographic, clinical and investigative notes were ascertained in the beginning of the study. Blood samples were collected for estimation of plasma cytokines—soluble Interleukin (IL)-2 receptor (IL-2R), tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma. Postoperative outcomes such as the duration of hospital stay and drain retention, time of suture removal and postoperative complications were ascertained. We used independent samples t test and nonparametric Mann Whitney U tests to compare groups for postoperative outcomes and plasma cytokines. Regression analysis was done to determine predictors for postoperative outcomes. Results: Sixty-nine patients contributed data to the current analysis (yoga: n = 33, control: n = 36). The results suggest a significant decrease in the duration of hospital stay (P = 0.003), days of drain retention (P = 0.001) and days for suture removal (P = 0.03) in the yoga group as compared to the controls. There was also a significant decrease in plasma TNF alpha levels following surgery in the yoga group (P < 0.001), as compared to the controls. Regression analysis on postoperative outcomes showed that the yoga intervention affected the duration of drain retention and hospital stay as well as TNF alpha levels. Conclusion: The results suggest possible benefits of yoga in reducing postoperative complications in breast cancer patients.

Rao, Raghavendra M; Nagendra, H R; Raghuram, Nagarathna; Vinay, C; Chandrashekara, S; Gopinath, K. S.; Srinath, B. S.



Postoperative respiratory complications in non-idiopathic scoliosis.  


The medical records of 303 patients undergoing fusions for scoliosis correction were retrospectively reviewed. The frequency and type of postoperative respiratory complications were compared in idiopathic versus non-idiopathic scoliosis patients in relation to age, type of spinal fusion procedure, pulmonary function test (PFT) results and preoperative diagnoses. The following factors were found to increase the incidence of problems in the postoperative period: a non-idiopathic type of scoliosis, mental retardation, anterior spinal fusion procedures, age of 20 or more years, a relative arterial hypoxemia and an obstructive component to the PFT's. Topics for further investigation are suggested. PMID:3976332

Anderson, P R; Puno, M R; Lovell, S L; Swayze, C R



Laparoscopic surgery for endometrial cancer: increasing body mass index does not impact postoperative complications  

PubMed Central

Objective To determine the effect of body mass index on postoperative complications and the performance of lymph node dissection in women undergoing laparoscopy or laparotomy for endometrial cancer. Methods Retrospective chart review of all patients undergoing surgery for endometrial cancer between 8/2004 and 12/2008. Complications graded and analyzed using Common Toxicity Criteria for Adverse Events ver. 4.03 classification. Results 168 women underwent surgery: laparoscopy n=65, laparotomy n=103. Overall median body mass index 36.2 (range, 18.1 to 72.7) with similar distributions for age, body mass index and performance of lymph node dissection between groups. Following laparoscopy vs. laparotomy the percent rate of overall complications 53.8:73.8 (p=0.01), grade ?3 complications 9.2:34.0 (p<0.01), ?3 wound complications 3.1:22.3 (p<0.01) and ?3 wound infection 3.1:20.4 (p=0.01) were significantly lower after laparoscopy. In a logistic model there was no effect of body mass index (?36 and<36) on complications after laparoscopy in contrast to laparotomy. Para-aortic lymph node dissection was performed by laparoscopy 19/65 (29%): by laparotomy 34/103 (33%) p=0.61 and pelvic lymph node dissection by laparoscopy 21/65 (32.3%): by laparotomy 46/103 (44.7%) p=0.11. Logistic regression analysis revealed that for patients undergoing laparoscopy for stage I disease there was an inverse relationship between the performance of both para-aortic lymph node dissection and pelvic lymph node dissection and increasing body mass index (p=0.03 and p<0.01 respectively) in contrast to the laparotomy group where there was a trend only (p=0.09 and 0.05). Conclusion For patients undergoing laparoscopy, increasing body mass index did not impact postoperative complications but did influence the decision to perform lymph node dissection.

Arumugam, Cibi; Gordinier, Mary E.; Metzinger, Daniel S.; Pan, Jianmin; Rai, Shesh N.



Treatment outcomes of postoperative mediastinitis in cardiac surgery; negative pressure wound therapy versus conventional treatment  

PubMed Central

Background The aim of the present study is to compare negative pressure wound therapy versus conventional treatment outcomes at postoperative mediastinitis after cardiac surgery. Methods Between January 2000 and December 2011, after 9972 sternotomies, postoperative mediastinitis was diagnosed in 90 patients. The treatment modalities divided the patients into two groups: group 1 patients (n?=?47) were initially treated with the negative pressure wound therapy and group 2 patients (n?=?43) were underwent conventional treatment protocols. The outcomes were investigated with Kaplan-Meier method, log-rank test, Student’s test and Fisher’s exact test. Results The 90-days mortality was found significantly lower in the negative pressure wound group than in the conventionally treated group. Overall survival was significantly better in the negative pressure wound group than in the conventionally treated group. Conclusion Negative pressure wound therapy is safe and reliable option in mediastinitis after cardiac surgery, with excellent survival and low failure rate when compared with conventional treatments.



Risk factors for postoperative infectious complications after hepatectomy  

Microsoft Academic Search

Background\\/purpose  This study aimed to clarify the incidence of surgical site infections (SSIs) after hepatectomy.\\u000a \\u000a \\u000a \\u000a Methods  The database records of three hundred and eight patients who underwent elective surgical treatment for hepatolithiasis, hepatocellular\\u000a carcinoma (HCC), and metastatic carcinoma were retrospectively analyzed to determine the occurrence of postoperative infectious\\u000a complications. The incidences of SSIs, classified as superficial or deep incisional SSIs and organ

Kazuhisa Uchiyama; Masaki Ueno; Satoru Ozawa; Shigehisa Kiriyama; Manabu Kawai; Seiko Hirono; Masaji Tani; Hiroki Yamaue



The Relationship between Preoperative Wound Classification and Postoperative Infection: A Multi-Institutional Analysis of 15,289 Patients  

PubMed Central

Background Despite advances in surgical techniques, sterile protocols, and perioperative antibiotic regimens, surgical site infections (SSIs) remain a significant problem. We investigated the relationship between wound classification (i.e., clean, clean/contaminated, contaminated, dirty) and SSI rates in plastic surgery. Methods We performed a retrospective review of a multi-institutional, surgical outcomes database for all patients undergoing plastic surgery procedures from 2006-2010. Patient demographics, wound classification, and 30-day outcomes were recorded and analyzed by multivariate logistic regression. Results A total of 15,289 plastic surgery cases were analyzed. The overall SSI rate was 3.00%, with superficial SSIs occurring at comparable rates across wound classes. There were similar rates of deep SSIs in the clean and clean/contaminated groups (0.64%), while rates reached over 2% in contaminated and dirty cases. Organ/space SSIs occurred in less than 1% of each wound classification. Contaminated and dirty cases were at an increased risk for deep SSIs (odds ratios, 2.81 and 2.74, respectively); however, wound classification did not appear to be a significant predictor of superficial or organ/space SSIs. Clean/contaminated, contaminated, and dirty cases were at increased risk for a postoperative complication, and contaminated and dirty cases also had higher odds of reoperation and 30-day mortality. Conclusions Analyzing a multi-center database, we found that wound classification was a significant predictor of overall complications, reoperation, and mortality, but not an adequate predictor of surgical site infections. When comparing infections for a given wound classification, plastic surgery had lower overall rates than the surgical population at large.

Mioton, Lauren M; Jordan, Sumanas W; Hanwright, Philip J; Bilimoria, Karl Y



[Prophylactics of postoperative complications in destructive appendicitis and typhlitis].  


The method of extraperitonization of the blind gut cupola based on the removable monofilament sutures and drainage of the area was designed, approved in experiments in dogs (n=18) and corpses (n=14) and successfully applied in the clinic (n=25). Unlike the traditional method, the using of this one results in less impaired trophicity, LPO intensification and phospholipase activity of the tissues of regenerating structures that was the grounds of sufficiently rapid reparation process under conditions of inflammation. The proposed complex of surgical measures in patients with destructive forms of acute appendicitis complicated by the inflammatory-necrotic phenomena in the blind gut wall was shown to prevent the development of dangerous postoperative complications, incompetence of the sutures included. PMID:15651697

Vlasov, A P; Saraev, V V; Okunev, N A; Stepanov, Iu P



Ineffectiveness of local wound anesthesia to reduce postoperative pain after median sternotomy.  


Postoperative pain control still represents a major challenge in every surgical field. Bupivacaine wound infiltration is frequently used to reduce the pain related to the surgical incision itself. In this randomized study, we investigated the efficacy of bupivacaine local anesthesia after median sternotomy to reduce postoperative pain. Forty-seven patients undergoing major cardiac surgery procedures were allocated randomly to group A (bupivacaine wound infiltration 0.5%; 10 mL, followed by continuous infusion: 10 mg/24 H) or to group C (controls). Extubation time, postoperative arterial blood gases, postoperative pain (assessed by means of a visual analog scale), and morphine consumption were the endpoints of the study. Patients of group C were extubated earlier; blood gases and VAS values were similar in both group. Bupivacaine local analgesia did not improve postoperative pain control after median sternotomy. PMID:15985128

Magnano, Diego; Montalbano, Roberto; Lamarra, Mauro; Ferri, Francesco; Lorini, Luca; Clarizia, Sergio; Rescigno, Giuseppe


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.

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



Wound complications from the tsunami disaster - a reminder of indications for delayed closure  

Microsoft Academic Search

Objectives: To illustrate the character, clinical course and late complications of wounds caused by high en- ergy with severe contamination during a natural disaster, as a basis for designing principles for primary treatment under these conditions. Patients and Methods: This paper presents case re- ports from complicated wounds treated at a special- ized unit for wound management in a hospital

Åsa Edsander-Nord



Abdominal wound perfusion for the relief of postoperative pain.  


In a double-blind trial, 50 patients with subcostal incisions performed for cholecystectomy or splenectomy, received 10 ml of either 0.5% bupivacaine plain or physiological saline twice daily by wound perfusion through an indwelling drainage tube for 3 days after operation. Analgesia, assessed by visual analogue score (VAS) and forced vital capacity (FVC), was significantly improved after perfusion with bupivacaine. Perfusion with physiological saline produced an analgesic effect comparable to that of bupivacaine as indicated by improvement in VAS. There was, however, no improvement in FVC, and opioid requirements were greater, in the patients whose wounds had been perfused with saline. PMID:3707799

Levack, I D; Holmes, J D; Robertson, G S



Risk factors associated with postoperative pulmonary complications following oncological surgery.  


The purpose of our study was to determine the incidence of different postoperative pulmonary complications (PPCs) and their associated risk factors in patients who have undergone various elective surgical procedures in an oncological surgery center. Ninety five adult patients were studied prospectively for one year period. For the study group, predictors of pulmonary complications of interest were determined as age, gender, body mass index, co morbid conditions (preexisting history of chronic obstructive pulmonary disease, asthma, bronchiectasis, restrictive lung disease), site and type of the operation, smoking history, The American Society of Anesthesiologists (ASA) physical status, physical examination and chest X- Ray findings, pulmonary function tests, type and duration of anesthesia, surgical incision site and length and presence of nasogastric tube suction. The PPC rate of our study group was 40% (38/95). Atelectasis and bronchospasm were the most frequently observed PPCs (13.7%) Among all the risk factors taken into consideration, only three were found to be significant independent predictors of pulmonary complications according to multivariate analysis as follows: incision location concerning abdomen (p= 0.008), duration of anesthesia per hour (p= 0.0001), values of FEV1 < 50% (p= 0.007). Our data revealed that the incidence of PPCs was high in our study group when compared to results of general population. Application of major resection surgeries for cancer patients can be an explanation for this result. Shortening the duration of surgery, avoiding general anaesthesia in selected group of patients may reduce the risk of PPCs. PMID:15351938

Ozdilekcan, Ci?dem; Songur, Necla; Berkta?, Bahadir M; Dinç, Meral; Uçgül, Emel; Ok, U?ur



Prevention of post-operative infections after surgical treatment of bite wounds  

PubMed Central

After reviewing the literature about the microbial spectrum, the risk factors of post-operative infections, and the results of surgical interventions, the following recommendation can be made for the management of bite wounds: fresh, open wounds: surgical debridement, if appropriate, then an antiseptic lavage with a fluid consisting of povidone iodine and ethanol (e.g., Betaseptic®), no antibiotics, primary wound closure nearly closed fresh wounds (e.g., cat bites): surgical debridement, if appropriate, dressing with an antiseptic-soaked compress for ~60 minutes with repeated soaking (e.g., Betaseptic®), no antibiotics older wounds after ~4 hours: surgical debridement, if appropriate, dressing with an antiseptic-soaked compress or bandage for ~60 minutes with repeated soaking (e.g., Betaseptic®), at the same time intravenous or dose-adapted oral antibiotics (Amoxicillin and/or clavulanic acid) older wounds after ~24 hours: surgical debridement, then antiseptic lavage (Betaseptic®), in case of clinically apparent infection or inflammation surgical revision with opening of wound and treatment with antibiotics according to resistogram (empirical start with Amoxicillin and/or clavulanic acid). For each kind of bite wound, the patient’s tetanus immunization status as well as the risk of exposure to rabies have to be assessed. Similarly, the possibility of other infections, such as lues (Syphilis), hepatitis B (HBV), hepatitis C (HBC), hepatitis D (HDV) and HIV, in the rare case of a human bite wound, has to be taken into account.

Kramer, Axel; Assadian, Ojan; Frank, Matthias; Bender, Claudia; Hinz, Peter



A retrospective review of leg wound complications after coronary artery bypass surgery.  


Little research or attention has been paid to finding out whether wound closure with sutures or staples attains the best outcomes after saphenous vein harvest for coronary artery bypass grafting. We undertook a quality improvement project to compare the prevalence of leg wound complications (eg, infection, seroma, hematoma, dehiscence) between two types of skin closure (ie, staples, subcuticular sutures) after conventional open surgery with bridging between incisions and vein harvesting during coronary revascularization to determine the need for practice changes. We found no significant differences between patients with wound complications and those without. However, in this project, the risk for infections was greater for patients with diabetes whose wounds were closed by using subcuticular sutures. These findings have led to practice changes for reducing leg wound complications within our institution: clinicians now assess patients for increased risk of leg wound complications preoperatively and opt to close wounds with staples for patients who have diabetes. PMID:24075335

East, Susan A; Lorenz, Rebecca A; Armbrecht, Eric S



The significance of nasal carriage of Staphylococcus aureus and the incidence of postoperative wound infection  

Microsoft Academic Search

Staphylococcus aureus infections are associated with considerable morbidity and, in certain situations, mortality. The association between the nasal carriage of S. aureus and subsequent infection has been comprehensively established in a variety of clinical settings, in particular, patients undergoing haemodialysis and continuous ambulatory peritoneal dialysis (CAPD), and in patients undergoing surgery. Postoperative wound infections are associated with a high degree

R. P. Wenzel; T. M. Perl



Pilot study of perioperative accidental durotomy: does the period of postoperative bed rest reduce the incidence of complication?  


Introduction. An accidental durotomy is a recognised and not infrequent complication of lumbar spine surgery, and may lead to postoperative low-pressure headaches, pseudomeningocele and CSF leak. Conventional postoperative management involves a period of flat bed rest. There is no agreement as to the need for and duration of postoperative bed rest. This study aims to determine whether the duration of flat bed rest alters the rate of these complications. Materials and methods. This is a retrospective study. All patients who underwent surgery for degenerative spinal disease between May 2010 and May 2011 were reviewed. All patients who incurred an accidental durotomy and who were repaired using fibrin glue were included in this study. Their notes were reviewed for evidence of complications for a minimum of 12 months after surgery. The following complications were identified: postural headache, pseudomeningocele, CSF leak wound infection, subdural haematoma. Results. Eight hundred and eighty-nine patients underwent lumbar spine surgery. Sixty-one (6.8%) patients suffered an accidental durotomy and were repaired with fibrin glue. Twenty-six patients were mobilised on the first postoperative day, 9 patients on the second, and a further 26 patients were mobilised on the third postoperative day or later. The overall incidence of complications related to the durotomy was 18%. There was no statistical significance between the day of mobilisation and the rate of complication (p = 0.433). Conclusion. A longer period of mandatory bed rest does not decrease the rate of complications. Patients should be mobilised as soon as they can. This could potentially reduce the length of hospital stay and the cost of aftercare. PMID:23724795

Low, Jacob Chen Ming; von Niederhäusern, Belinda; Rutherford, Scott A; King, Andrew T



Immediate Breast Reconstruction After Mastectomy Increases Wound Complications However, Initiation of Adjuvant Chemotherapy Is Not Delayed  

Microsoft Academic Search

Background: Immediate breast reconstruction is be- ing increasingly used after mastectomy, although it may increase the incidence of wound complications. The in- dications for chemotherapy in breast cancer are expand- ingandwoundcomplicationsfollowingmastectomymay delay the initiation of adjuvant chemotherapy. Hypothesis:Immediatebreastreconstructionaftermas- tectomy for breast cancer does not lead to an increased incidence of wound complications nor delay the initia- tion of systemic chemotherapy.

Melinda M. Mortenson; Philip D. Schneider; Vijay P. Khatri; Thomas R. Stevenson; Thomas P. Whetzel; Eiler J. Sommerhaug; James E. Goodnight; Richard J. Bold


Superficial and deep sternal wound complications: incidence, risk factors and mortality  

Microsoft Academic Search

Objectives: Sternal wound complications often have a late onset and are detected after patients are discharged from the hospital. In an effort to catch all sternal wound complications, different postdischarge surveillance methods have to be used. Together with this long-term follow-up an analysis of risk factors may help to identify patients at risk and can lead to more effective preventive

Lisa Ridderstolpe; Hans Gill; Hans Granfeldt; Hans Åhlfeldt; Hans Rutberg



Early postoperative complications of pediatric liver transplantation: experience at one center  

Microsoft Academic Search

To evaluate the postoperative complications within the first month among 20 pediatric liver transplant recipients between April 1990 and March 2003 we retrospectively studied their medical charts to gather demographic data; primary diagnosis; operative duration; perioperative transfusions; time to extubation; length of intensive care unit (ICU) stay; mortality; perioperative laboratory values; and postoperative complications including respiratory, infections, renal, neurological, cardiovascular,

C Araz; A Pirat; A Torgay; P Zeyneloglu; G Arslan



The effect of wound irrigation with bupivacaine on postoperative analgesia of the feline onychectomy patient.  


Eighteen cats that each underwent an elective onychectomy were evaluated using a double-blind study design to determine if wound irrigation with bupivacaine prior to wound closure would decrease postoperative pain. The cats were divided alternately into an experimental group (n = 9) and a control group (n = 9). The experimental patients received bupivacaine in each incision prior to closure. The control patients received saline in each incision prior to closure. The patients were evaluated for postoperative pain using a pain-score system. The bupivacaine-treated patients had a significantly higher mean pain score at two hours following recovery from anesthesia than the saline-treated patients. At three hours following recovery from anesthesia, pain scores were not significantly different. PMID:9204473

Winkler, K P; Greenfield, C L; Benson, G J


[Comparative evaluation of postoperative complication in the reconstructive surgery of the esophagus].  


The paper presents 78 patients with stenosis of the middle thoracic segment of the esophagus. The substitute, being pedunculated intestinal graft, was brought to the neck through the retrosternal space. Early post-operative complications occurred in 8.9% of patients. Post-operative mortality rate was 7.6%. The most dangerous complication after esophageal plastic surgery is blood supply insufficiency. It was observed in 2 cases. Other complications included anastomotic leaks and respiratory distress syndrome. The authors emphasize that frequency of post-operative complications and mortality are related with the patient general condition and extent of the surgery. PMID:10540583

Struty?ska-Karpi?ska, M; Lewandowski, A; Knast, W; Markocka-Maczka, K; Czapla, L; B?aszczuk, J



Can Administrative Data Be Used to Ascertain Clinically Significant Postoperative Complications?  

Microsoft Academic Search

The purpose of this study is to assess whether postoperative complications can be ascertained using administrative data. We randomly sampled 991 adults who underwent elective open diskectomies at 30 nonfederal acute care hospitals in California. Postoperative complications were specified by reviewing medical literature and by consulting clinical experts. We compared hospital-reported ICD-9-CM data and independently recoded ICD-9-CM data with complications

Patrick S. Romano; Michael E. Schembri; Julie A. Rainwater



Open-label clinical trial comparing the clinical and economic effectiveness of using a polyurethane film surgical dressing with gauze surgical dressings in the care of postoperative surgical wounds.  


Surgical site infection (SSI) is a common postoperative complication and can cause avoidable morbidity and excessive costs for the health service. Novel dressings, designed specifically for postoperative wounds, can help to reduce the risk of SSI and other complications like blistering. This study compared the use of a new polyurethane film surgical dressing (Opsite Post-Op Visible, Smith & Nephew, Hull, UK) with gauze and tape in the management of postoperative wounds. The results show that the polyurethane film dressing results in a significant reduction in SSI (1·4% versus 6·6%, P?=?0·006) as well as a reduction in other postoperative wound complications (e.g. blistering and erythema). Economic analysis conducted alongside the study suggests that these improved outcomes can be achieved at a lower total treatment cost than gauze and tape dressings. The modest incremental cost of the polyurethane film surgical dressing is easily offset by the reduction in the costs associated with treating SSI and other wound complications associated with gauze and tape dressings. PMID:23742125

Abejón Arroyo, Ana; López Casanova, Pabló; Verdú Soriano, José; Torra I Bou, Joan-Enric



Critical evaluation of eighty laryngectomies for the possible causes of postoperative complications: A prospective study  

Microsoft Academic Search

Eighty laryngectomised patients have been evaluated for the possible causes of postoperative morbidity. It was found that\\u000a pre or postoperative haemoglobin levels and age of the patient have no significant effect. But definite correlation has been\\u000a found between the preoperative radiation and formation of pharyngocutaneous fistula. The dose of irradiation seems to affect\\u000a the severity of fistula. Wound sepsis was

M. M. L. Arora; R. D. Yande; S. Golhar; S. C. Pandhi; S. B. S. Mann



Circulating interleukin 6 as a useful marker for predicting postoperative complications.  


We examined postoperative serial changes in the levels of serum interleukin 6 (IL-6), serum acute phase reactants (APRs) and plasma neutrophil elastase (NE) in patients with various cancers and reviewed these changes in patients who did, and did not, show postoperative complications. Serum IL-6 level was elevated after surgery, peaking on the first postoperative day. Elevation of serum APRs and plasma NE levels also followed. There was a significant correlation between the serum peak level of IL-6 and those of APRs and NE (P less than 0.01). Moreover, there was a significant difference in the serum IL-6 level in patients with and without complications. The relationship between the serum IL-6 greater than 400 pg/ml and the incidence of postoperative complications was also marked. These results suggest that circulating IL-6 is a clinically useful marker for the earliest detection and prediction of postoperative complications. PMID:1515554

Oka, Y; Murata, A; Nishijima, J; Yasuda, T; Hiraoka, N; Ohmachi, Y; Kitagawa, K; Yasuda, T; Toda, H; Tanaka, N



Wound complications in the multimodality treatment of extremity and superficial truncal sarcomas.  


The incidence and severity of wound complications were examined in 105 patients with extremity and superficial truncal sarcomas who were eligible for wide local excision with or without adjuvant perioperative brachytherapy (BRT) and/or chemotherapy. Fifty-four cases from the eligible group were entered into a randomized prospective trial of the efficacy of BRT in decreasing local recurrence. In the eligible patients, major wound complications occurred in nine of 41 (22%) of the BRT cases, compared with two of 64 (3%) of the non-BRT patients, which was a significant increase (P = .002). The combined frequency of major and moderate wound complications was also significantly increased in the BRT (18 of 41, 44%) compared with the non-BRT (nine of 64, 14%) patients (P = .0006). The median duration to complete resolution of these complications was 189 days (14 to 597) in the BRT, compared with 49 (11 to 170) days in the non-BRT group (P = .0005); however, no amputations were required, and only 14% of the BRT-associated wound complications were of prolonged duration, ie, greater than 200 days. In the randomized study, both the total number of complications, and the combination of major and moderate complications were increased significantly in the BRT v the non-BRT patients. Adjuvant Adriamycin (Adria Laboratories, Columbus, OH) administered in 60 mg/m2 increments to a cumulative dose of 540 mg/m2 did not appear to impair wound healing even when administered within 15 days of operation. Significant wound complications occur in major resections of extremity and superficial truncal sarcomas. If the addition of adjuvant BRT produces a decrease in local recurrence, then either patient selection will have to be more rigidly applied, especially in wounds where skin flap blood supply is tenuous, or the technique will need to be modified to balance the short-term aim of reducing wound complications with the long-term goal of local tumor control. PMID:3819810

Arbeit, J M; Hilaris, B S; Brennan, M F



Severe wound traction-blisters after inadequate dressing application following laparoscopic cholecystectomy: case report of a preventable complication  

PubMed Central

Background The inadequate application of postoperative dressings can lead to significant complications, including skin injuries, compartment syndromes, and potential limb loss. To our knowledge, the occurrence of post laparoscopic cholecystectomy related skin complications have not yet been reported in the peer-reviewed literature. Case Presentation Following laparoscopic cholecystectomy for symptomatic gallstone disease, a seventy eight year old healthy white male broke out in painful erythema on either side of his epigastric port site. Vesicles akin to a partial thickness burns were revealed upon removal of dressings. An unusual indentation created by the dressing, and skin traction by the dressing's adhesive edges were implicated, raising questions about technique of its application. Conclusion Incorrect application of wound dressings can disrupt skin architecture, causing painful blistering. This complication should not occur to patients, as it is theoretically 100% preventable. Avoidance of stretching adhesive dressings, and careful adherence to relevant manufacturers' instructions are recommended.



Inverted epiglottis: A postoperative complication of supracricoid laryngectomy with cricohyoidoepiglottopexy  

Microsoft Academic Search

ObjectivesAmong the 50 laryngeal cancer patients who received SCL-CHEP between 1997 and 2008, we experienced three patients with complete epiglottis prolapse, which obstructed the neoglottis. By defining this complication as “Inverted epiglottis” and presenting the clinical features, we intend to elucidate the mechanism, risk factors, and management of this complication.

Meijin Nakayama; Makito Okamoto; Yutomo Seino; Shunsuke Miyamoto; Seiichi Hayashi; Takashi Masaki; Satoru Yokobori; Masahiko Takeda



[Prognosis of postoperative complications from the chronomedicine viewpoint].  


In 57 convalescence courses after surgery, temperature, pulse rate and complications recorded daily for 24 days were investigated. Complications were synchronized approximately with temperature. The time structure of the temperature proved to be periodical (reactive periods). The approximately 7-day periods (medium waves) predominated, frequently superimposed by short waves (< or = 4-day periods) and long waves (> or = 14-day periods). There was an intermediate band of approximately 10-day periods. The phases were synchronized with the day of operation, mostly with maxima, otherwise with minima. Periods and phases could jump, the periods preferably in integer ratios, the phases approximately 180 degrees. The long waves yielded a steep drop initially and a reascent of the temperature in the approximately 3rd week. As the number of complications was coincident with the temperature, it also dropped quickly after operation but rose again during the 3rd week. Apart from long waves, temperature and complications descended slowly, synchronizing with the medium waves. The reascent time structure is generally associated with a trophotropic type of patient (late reactive), the gradual descent with an ergotropic type (early reactive). As both of them can be recognized preoperatively, the time structure of the late complications expected can be predicted. Besides the long waves the time structure of the complications is related to the medium waves. Therefore a peak of the complications often occurs at the end of the 1st week. PMID:9498197

Weckenmann, M; Klemm, H W; Möllenbruck, G



Multivariate Analysis of Factors Associated With Postoperative Pulmonary Complications Following General Elective Surgery  

Microsoft Academic Search

Results: Postoperative pulmonary complications devel- oped in 16 (11%) of 148 patients. The risk factors found to be higher among those with PPCs compared with those without PPCs were postoperative nasogastric intubation (81% vs 16%, P,.001), preoperative sputum production (56% vs 21%, P=.005), and longer anesthesia duration (480 vs 309 minutes, P,.001). Upper abdominal surgery was performed in 11 (69%)

Charlene K. Mitchell; Steven H. Smoger; Mark P. Pfeifer; Robert L. Vogel; Manjula K. Pandit; Patricia J. Donnelly; Richard N. Garrison; Marylee A. Rothschild



Perfluorocarbon liquids as postoperative short-term vitreous substitutes in complicated retinal detachment  

Microsoft Academic Search

To avoid postoperative “compartmentalization” of the vitreous cavity, which can potentially accelerate the recurrence of proliferative vitreoretinopathy (PVR), 32 eyes of 32 selected patients with complicated retinal detachment were managed with lensectomy, vitrectomy, 5-day internal tamponade with perfluorocarbon liquids (PFCL) and postoperative supine positioning until PFCL removal. Intraoperatively, 19 eyes had grade C3 or greater PVR; 10 eyes exhibited ocular

Ferdinando Bottoni; Maurizio Sborgia; Paolo Arpa; Nino De Casa; Emanuela Bertazzi; Marzio Monticelli; Vito De Molfetta



Risk factors for postoperative respiratory complications in adult liver transplant recipients  

Microsoft Academic Search

To determine the types and the incidence of as well as risk factors for early postoperative (<30 days) respiratory complications in adult liver transplant (LT) recipients, we reviewed The data of 44 consecutive adult LT recipients who received their grafts from January 1995 through December 2002. The data included demographic features; primary diagnosis; number of intraoperative transfusions; preoperative and postoperative

A Pirat; S Özgur; A Torgay; S Candan; P Zeynelo?lu; G Arslan



[Prevention of postoperative pancreatic complications following duodenopancreatectomy using somatostatin].  


Somatostatin was prophylactically administered to 10 patients who had surgery for pancreatic diseases. The postoperative course uncomplicated with no increase in serum amylase levels. Bile induced acute pancreatitis in six beagles was prophylactically treated with somatostatin. The results demonstrate that SRIF not only inhibits basal but also pancreatic-induced blood amylase and enzyme activities in the dog. SRIF-treated animals were in good general condition compared with untreated controls, macroscopic and histologic aspects of the pancreas were significantly improved. PMID:477469

Klempa, I; Schwedes, U; Usadel, K H



Chemotherapy, Liver Injury, and Postoperative Complications in Colorectal Liver Metastases  

Microsoft Academic Search

Background  Systemic chemotherapy (CTx) is increasingly used before surgery for colorectal liver metastases (CRC-LM). However, CTx may\\u000a cause liver injury like steatosis, steatohepatitis, and sinusoidal injury which may be associated with postoperative morbidity.\\u000a Some recent data have even shown an increased mortality in patients with CTx-associated steatohepatitis. We, therefore, analyzed\\u000a our recent experience with potential hepatic injury and its association with

Frank Makowiec; Simone Möhrle; Hannes Neeff; Oliver Drognitz; Gerald Illerhaus; Oliver G. Opitz; Ulrich T. Hopt; Axel zur Hausen



Reverse Total Shoulder Replacement: Intraoperative and Early Postoperative Complications  

Microsoft Academic Search

Reverse total shoulder arthroplasty is a treatment option for patients with symptomatic glenohumeral arthritis and a deficient\\u000a rotator cuff. The reported complication rates vary from 0% to 68%. Given this variation, our purposes were to (1) determine\\u000a the learning curve for the procedure, (2) identify complications and surgical pitfalls, and (3) compare our results with those\\u000a of similar published series.

Carl Wierks; Richard L. Skolasky; Jong Hun Ji; Edward G. McFarland



Postoperative Laparoscopic Bariatric Surgery Patients do Not Remember Potential Complications  

Microsoft Academic Search

\\u000a Background  Despite comprehensive preoperative education, patients may forget important information such as potential complications.\\u000a \\u000a \\u000a \\u000a Methods  Patients who had undergone laparoscopic bariatric surgery were surveyed. All patients were asked to write down as many as\\u000a possible of the potential complications. Preoperatively, patients had been given an educational book, two preoperative educational\\u000a appointments, a test, and an informed consent discussion and form with clear

Atul K. Madan; David S. Tichansky; Raymond J. Taddeucci



The efficacy of multimodal high-volume wound infiltration in primary total knee replacement in facilitating immediate post-operative pain relief and attainment of early rehabilitation milestones.  


Inadequate pain relief after lower limb joint replacement surgery has been a well-recognised limiting factor affecting post-operative mobilisation and length of hospital stay. Multimodal local wound infiltration with local anaesthetics, adrenaline and non-steroidal anti-inflammatory agents can lower the opiate intake, reduce the length of stay and enhance early mobilisation in knee replacement patients. A retrospective review of 64 patients undergoing primary total knee replacement was undertaken. Thirty-two patients (cases) had their wounds infiltrated with ropivacaine, adrenaline and ketorolac by the operating surgeon, intraoperatively. Subsequently, a 19G wound catheter placed into the knee joint. They received two further top-up doses of the same combination at 10 and 20 h post-operatively. This group was compared with a control group of 32 patients who did not receive any local infiltration. Both groups were comparable in terms of BMI and age. Post-operative opiate drug consumption in first 48 h after surgery, length of hospital stays and time taken to mobilise after surgery were recorded. There was significant reduction in opiate consumption in the treatment group with an average consumption of 49.35 mg of morphine compared to 71.48 mg in the control group (p = 0.004). The median length of hospital stay was significantly reduced from 5 days in the control group to 4 days in the treatment group (p = 0.03). The patients in the treatment group mobilised around 19 h earlier (p = 0.001). No major post-operative complications were encountered in either group. Wound infiltration is an effective and safe technique that promotes early rehabilitation and discharge of patients following primary total knee replacement. PMID:23689908

Banerjee, Purnajyoti



Cerebral vasculitis complicating postoperative meningitis: the role of steroids revisited.  


Meningitis due to Streptococcus pneumoniae is a rare complication of trans-sphenoidal surgery. We present the case of a patient who developed pneumococcal meningitis with associated bacteraemia after elective endoscopic trans-sphenoidal resection of a pituitary macro-adenoma. After initial treatment with ceftriaxone and dexamethasone, the patient made a good recovery and dexamethasone was discontinued. Two days later the patient's condition deteriorated rapidly, presenting focal and diffuse neurological deficits. Cerebral MRI revealed widespread punctate ischaemic-type lesions affecting both anterior and posterior vascular territories bilaterally and involving features consistent with cerebral vasculitis. Antibiotic treatment was broadened to include meropenem and dexamethasone was restarted, but the patient remained in a comatose state and died 14 days later. Steroid treatment may play a dual role in this poorly characterised infectious complication of trans-sphenoidal pituitary surgery. This possibility is discussed and the options for prophylaxis are reviewed. PMID:23135730

Darling, Katharine E A; Niederhauser, Julien; Bervini, David; Giulieri, Stefano; Daniel, Roy T; Bille, Jacques; Erard, Veronique



Postoperative complications: factors of significance to anaesthetic practice  

Microsoft Academic Search

In an attempt to define what factors are important to the development of postanaesthetic complications, the data from a nine-year\\u000a prospective study of anaesthetic practice in a large tertiary care institution were evaluated. A model of anaesthetic morbidity\\u000a dependent upon factors of (1) patient illness, (2) surgical practice, (3) anaesthetic technique and physician experience,\\u000a and (4) duration of anaesthesia was

Peter G. Duncan; Marsha M. Cohen



Postoperative Chylous Ascites: A Rare Complication of Laparoscopic Nissen Fundoplication  

PubMed Central

The accumulation of chylous fluid in the abdominal cavity is an infrequent, yet alarming, complication in abdominal surgery. Laparoscopic fundoplication has assumed a central role in the surgical treatment of gastroesophageal reflux disease and is significantly altering the balance of therapy toward more common and earlier surgical intervention. We report the case of a 67-year-old woman with gastroesophageal reflux disease and intense esophagitis who underwent a laparoscopic Nissen fundoplication in February 2000. The procedure was performed without apparent complications. Twenty days later, the patient complained of abdominal pain and distension. Ultrasonography showed ascites, whereas endoscopic and radiological exploration of the fundoplication demonstrated no abnormalities. A paracentesis was performed, which showed a milky fluid with high concentrations of triglycerides (1024 ng/dL) and cholesterol (241 ng/dL). The patient was treated successfully with total parenteral nutrition for 3 weeks, followed by a low-fat diet. To our knowledge, this is the third reported case of chylous ascites after a Nissen fundoplication and the second case after laparoscopic fundoplication. The development of chylous ascites seems to be related to the injury of lymphatic vessels, including the thoracic duct, during the retroesophageal window dissection. The careful dissection and judicious use of diathermy is proposed to prevent this rare complication.

Bacelar, Tercio Souto; de Arruda, Pedro Carlos Loureiro; Ferraz, Alvaro Antonio Bandeira; Ferraz, Edmundo Machado



Fatal pulmonary embolism complicating a postoperative chylothorax despite adequate thromboprophylaxis.  


Chylothorax is a recognized complication of intrathoracic surgery, but its occurrence after coronary artery bypass grafting (CABG) is very rare. We report a case of a fatal pulmonary embolism as a complication of chylothorax following CABG. The patient was an 82-year-old woman who presented with increasing chest pain 2 weeks after discharge after an uncomplicated CABG. A computerized tomography (CT) scan with contrast angiogram showed a left-sided pleural effusion and no concurrent pulmonary embolus. Analysis of the pleural effusion revealed a chylothorax, which was treated with chest tube drainage and total parenteral nutrition followed by an oral medium-chain fatty acid diet. The patient improved steadily but, on day 6, she developed acute hypoxemic respiratory failure and shock. A CT angiogram revealed a massive pulmonary embolus and, despite thrombolysis, the patient died. Autopsy confirmed an acute saddle embolus in the pulmonary trunk. The patient had received appropriate venous thromboembolism prophylaxis with subcutaneous unfractionated heparin during her hospital course. This is the first reported case of a fatal pulmonary embolism that occurred in the setting of a post-CABG chylothorax in adults. The occurrence of this complication despite unfractionated heparin thromboprophylaxis may suggest a role for other, more effective medications, such as low molecular weight heparin or fondaparinux in patients with chylothorax. PMID:23751608

Hoskote, Sumedh S; Devarapally, Santhosh R; Dasgupta, Rajkumar; Pang, Yinghua; Shapiro, Janet M



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.

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



Sternotomy or bilateral thoracoscopy: pain and postoperative complications after lung-volume reduction surgery  

PubMed Central

OBJECTIVES Video-assisted thoracoscopic surgery (VATS) and median sternotomy (MS) are two approaches in lung-volume reduction surgery (LVRS). This study focused on the two surgical approaches with regard to postoperative pain. METHODS In this prospective, non-randomized study, pain was measured preoperatively and postoperatively using the visual analog scale (VAS) and the brief pain inventory (BPI). Incentive spirometry (IS) assessed restriction of the thoracic cage due to pain. Factors associated with treatment complications, medication usage, hospital stay, operating times, and chest-tube duration differences were examined between groups. RESULTS Of 85 patients undergoing LVRS, 23 patients underwent reduction via MS and 62 patients via bilateral VATS. VAS scores revealed no difference in postoperative pain except for VAS scores on days 6 (PM) and 7 (PM). BPI scores yielded higher scores in the VATS group on postoperative day (POD) 1 in the reactive dimension, but no other overall differences. MS patients receiving tramadol consumed a higher mean amount than VATS patients on POD 5 and POD 6. IS change from baseline to postoperative were similar between groups, and increased pain correlated with decreased IS scores on POD 1. Chest-tube duration, complications, and pain medication were similar between groups. CONCLUSIONS Bilateral VATS and MS offer similar outcomes with regard to postoperative pain and complications. These results suggest that the choice of LVRS operative approach should be dependent on disease presentation, surgeon expertise, and patient preference, not based upon differences in perceived postoperative pain between MS and bilateral VATS.

Boley, Theresa M.; Reid, Adam J.; Manning, Blaine T.; Markwell, Stephen J.; Vassileva, Christina M.; Hazelrigg, Stephen R.



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



The risk of postoperative pulmonary or pleural complications after aortic valve replacement is low in elderly patients: an observational study  

Microsoft Academic Search

Question: What factors predict postoperative pulmonary and pleural complications following aortic valve replacement? Design: Retrospective study. Participants: One thousand consecutive patients who underwent aortic valve replacement with a pericardial valve between 1986 and 2006. Of these, 610 underwent also coronary artery surgery. Outcome measures: Thirty putative predictors were investigated. Postoperative pulmonary complications (defined as respiratory failure, pneumonia, atelectasis) and postoperative

Wilhelm Mistiaen; Dirk Vissers



The temporary use of allograft for complicated wounds in plastic surgery  

Microsoft Academic Search

A retrospective analysis was performed on the use of glycerol-preserved allografts (GPA) in the preparation of complicated wounds for secondary wound closure. All files from the plastic surgery department in the period 1992–1998 were screened. Thirty-three patients within a total 85GPA treatments were selected and screened for indication of use of GPA, frequency of GPA changes, duration of treatment and

E Moerman; E Middelkoop; D Mackie; F Groenevelt



C-reactive protein as early predictor for infectious postoperative complications in rectal surgery  

Microsoft Academic Search

Background  This study evaluated the role of the acute phase C-reactive protein (CRP) in the postoperative course of a large series of\\u000a rectal resections on the basis of a prospective database. Main focus of this study was the early identification of complications.\\u000a \\u000a \\u000a \\u000a Materials and methods  Three hundred eighty-three rectal resections with primary anastomosis for rectal cancer were screened for infectious postoperative\\u000a complications.

T. Welsch; S. A. Müller; A. Ulrich; A. Kischlat; U. Hinz; P. Kienle; M. W. Büchler; J. Schmidt; B. M. Schmied



sTREM-1 as a Prognostic Marker of Postoperative Complications in Cardiac Surgery  

PubMed Central

Cell-activating receptor TREM-1 (triggering receptor expressed on myeloid cells 1) regulates congenital immune response and contributes to systemic inflammatory response syndrome (SIRS) development. It is able to multiply cytokine production while stimulated together with the main receptors of the congenital immune system. The purpose of the paper is to study the potential use of soluble TREM-1 (sTREM-1) as a marker of intensive SIRS and a criterion for postoperative complications prediction following on-pump coronary artery bypass surgery (CABG). Results show that early postoperative sTREM-1 concentrations demonstrate their potential prognostic value regarding SIRS-associated complications.

Golovkin, A. S.; Matveeva, V. G.; Grigoriev, E. V.; Shukevich, D. L.; Bayrakova, Y. V.; Barbarash, L. S.



Determinants of Long-Term Survival After Major Surgery and the Adverse Effect of Postoperative Complications  

PubMed Central

Objective: The objective of this study was to identify the determinants of 30-day postoperative mortality and long-term survival after major surgery as exemplified by 8 common operations. Summary Background Data: The National Surgical Quality Improvement Program (NSQIP) database contains pre-, intra-, and 30-day postoperative data, prospectively collected in a standardized fashion by a dedicated nurse reviewer, on major surgery in the Veterans Administration (VA). The Beneficiary Identification and Records Locator Subsystem (BIRLS) is a VA file that depicts the vital status of U.S. veterans with 87% to 95% accuracy. Methods: NSQIP data were merged with BIRLS to determine the vital status of 105,951 patients who underwent 8 types of operations performed between 1991 and 1999, providing an average follow up of 8 years. Logistic and Cox regression analyses were performed to identify the predictors of 30-day mortality and long-term survival, respectively. Results: The most important determinant of decreased postoperative survival was the occurrence, within 30 days postoperatively, of any one of 22 types of complications collected in the NSQIP. Independent of preoperative patient risk, the occurrence of a 30-day complication in the total patient group reduced median patient survival by 69%. The adverse effect of a complication on patient survival was also influenced by the operation type and was sustained even when patients who did not survive for 30 days were excluded from the analyses. Conclusions: The occurrence of a 30-day postoperative complication is more important than preoperative patient risk and intraoperative factors in determining the survival after major surgery in the VA. Quality and process improvement in surgery should be directed toward the prevention of postoperative complications.

Khuri, Shukri F.; Henderson, William G.; DePalma, Ralph G.; Mosca, Cecilia; Healey, Nancy A.; Kumbhani, Dharam J.



Risk Indicators of Postoperative Complications following Surgical Extraction of Lower Third Molars  

Microsoft Academic Search

Objective: The aim of this prospective clinical trial was to evaluate the incidence of postoperative complications following surgical extraction of lower third molars (L8) and the risk factors and clinical variables associated with these complications. Subjects and Methods: Three-hundred and twenty-seven consecutive patients (128 men and 199 women, mean age = 23.1 ± 3.9 years, range: 18–40) were recruited to

Ziad Malkawi; Mahmoud K. Al-Omiri; Ameen Khraisat



[Spiral computed tomography in the diagnosis of the abdomen gunshot wounds and their complications].  


The results of studies by spiral computed tomography (SCT) in 62 patients with abdominal wounds were analyzed at the Main Military Clinical Hospital of Internal Forces, Ministry of Internal Affairs of Russia. The main contingent of the wounded included active servicemen who had been wounded in the areas of local conflicts, military men. The studies were conducted on days 2 to 15 of their receiving a wound. The potentialities of the technique in evaluating damages to abdominal organs, retroabdominal space, bony structures, in assessing the topography of foreign bodies are described. SCT was compared with classical X-ray and ultrasound studies, laparocentesis which are traditionally used in the diagnosis of gunshot injury. In the authors' opinion, SCT has become the method of choice in the diagnosis of gunshot injury to the abdomen and its complications today. PMID:12216483

Obel'chak, I S; Gromova, M V


Association of preoperative obstructive jaundice with postoperative infectious complications following pancreaticoduodenectomy.  


:Background/Aims: The aim of this study was to evaluate the effects of obstructive jaundice on Infectious Complications of the patients who underwent pancreaticoduodenectomy. Methodology: One-hundred and sixteen consecutive patients without preoperative biliary drainage underwent pancreaticoduodenectomy from January 2006 to April 2010 and their data of post-operative complication were analyzed. Different level of bilirubin and different times of jaundice on infectious complications of the patients underwent pancreaticoduodenectomy were analysis. Results: Patients with severe jaundice (Total bilirubin ?5 mg/dL; n = 55), had a higher incidence in subsequent infectious complications than the patients with total bilirubin level of less than 5 mg/dL (n = 61) (36.06% vs. 56.36%, p <0.05). The patients with preoperative TB level of 5 or more sub classified according to the duration of jaundice. However, two groups without statistical significance in terms of post-operative complications. There were no significant differences in post-operative mortality rate among the different groups. Conclusions: The elevated serum bilirubin increases the rate of infectious complications of the patients underwent pancreaticoduodeneotomy. PMID:23933917

Wang, Sizhen; Wang, Xinbo; Li, Liang; Dai, Hongshan; Han, Jianming



Effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation  

Microsoft Academic Search

Background: The aim of this study was to examine the effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation itself. Methods: Relevant databases were searched for randomized controlled trials (RCTs) of preoperative smoking cessation interventions. Trial inclusion, risk of bias assessment and data extraction were performed by two authors. Risk ratios for the above outcomes were calculated

T. Thomsen; H. Tønnesen; A. M. Møller



Oxygen uptake kinetics during cardiopulmonary exercise testing and postoperative complications in patients with lung cancer  

Microsoft Academic Search

It is accepted that cardiopulmonary exercise testing is one of the most valuable parameters, especially peak oxygen uptake (VO2), for the evaluation of risk assessment in lung cancer surgery. It therefore represents an attractive way of identifying a patient at high risk for postoperative complications. However, many patients do not achieve the maximal or predictive level during an incremental exercise

Erdem Kasikcioglu; Alper Toker; Serhan Tanju; Piyer Arzuman; Abidin Kayserilioglu; Sukru Dilege; Goksel Kalayci



Does routine stress-thallium cardiac scanning reduce postoperative cardiac complications?  

PubMed Central

OBJECTIVE: Prophylactic cardiac revascularization in patients with ischemic myocardium could reduce postoperative cardiac complications after aortic reconstruction. However, the effectiveness of this approach has not been documented. SUMMARY BACKGROUND DATA: Stress-thallium scanning can identify patients with ischemic myocardium. Morbidity and mortality after aortic reconstruction appears to be largely caused by co-existent coronary artery disease, and patients who have had recent cardiac revascularization have few postoperative cardiac complications. METHODS: Preoperative stress-thallium scanning was evaluated prospectively in 146 patients undergoing aortic reconstruction. Patients with positive studies underwent coronary arteriography and cardiac revascularization, when appropriate. Postoperative cardiac complications and long-term survival in these patients were compared with results from 172 similar patients undergoing aortic reconstruction without stress-thallium scanning. Results also were analyzed to determine predictors of postoperative cardiac events. RESULTS: Forty-one per cent of patients undergoing stress-thallium testing underwent coronary arteriography, and 11.6% had cardiac revascularization. In contrast, 14.7% of patients treated without stress-thallium testing had coronary arteriography, and 4.1% had revascularization (p < 0.01). Despite this, cardiac mortality, serious cardiac complications, and long-term cardiac mortality were similar in both groups. Only advanced age and intraoperative complications (but not a positive stress-thallium test) predicted postoperative cardiac events. CONCLUSIONS: Preoperative stress-thallium testing confirmed a high incidence of significant coronary artery disease in patients undergoing aortic reconstruction, but prophylactic cardiac intervention does not reduce operative or long-term mortality. Thus, the risk and expense of routine stress-thallium testing and subsequent cardiac revascularization cannot be justified.

Seeger, J M; Rosenthal, G R; Self, S B; Flynn, T C; Limacher, M C; Harward, T R



Risk factors influencing the outcome after surgical treatment of complicated deep sternal wound complications  

Microsoft Academic Search

Background: Median sternotomy is the most frequently used incision for cardiac procedures but carries a substantial risk for deep sternal wound infections and\\/or sternal dehiscence. In contrast to previous studies that examined risk factors for sternal infections this study evaluates factors that lead to poor outcome after surgical revision of the non healing sternum.Methods: Between 1985 and 1999, 193 adults

A. A. Peivandi; W. Kasper-König; E. Quinkenstein; A. H. Loos; M. Dahm



Sternal Wound Infection After Heart Transplantation: Incidence and Results With Aggressive Surgical Treatment  

Microsoft Academic Search

Background. Sternal wound infection remains a signif- icant complication. We reviewed the incidence and the treatment of sternal wound infection after heart transplantation. Methods. Of 226 patients who had a heart transplanta- tion, 20 (8.8%) underwent postoperative wound debride- ment for superficial or deep sternal wound infection. The incidence and the survival of patients with sternal wound infection were analyzed.

Michel Carrier; Louis P. Perrault; Michel Pellerin; Richard Marchand; Pierre Auger; Guy B. Pelletier; Michel White; Normand Racine; Denis Bouchard



Risk factors for wound complications in midline abdominal incisions related to the size of stitches  

Microsoft Academic Search

Background  Midline abdominal incisions should be closed continuously with a suture length (SL) to wound length (WL) ratio above 4 using\\u000a small stitches. The effect on the rate of wound complications of a very high ratio and other potential risk factors when closure\\u000a is performed with small stitches is unknown.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Patients operated on through a midline incision were randomised to closure

D. Millbourn; Y. Cengiz; L. A. Israelsson



Post-operative wound infection in salvage laryngectomy: does antibiotic prophylaxis have an impact?  


Salvage laryngectomy carries a high risk of post-operative infection with reported rates of 40-61%. The purpose of this study was to analyse infections in our own patients and review the potential impact of our current antibiotic prophylaxis (AP). A retrospective analysis of infection in 26 consecutive patients between 2000 and 2010 undergoing salvage total laryngectomy (SL) following recurrent laryngeal cancer after failed radiotherapy or chemo-radiation was undertaken. The antibiotic prophylaxis was intravenous teicoplanin, cefuroxime and metronidazole at induction and for the following 24 h. Infection was defined by Tabet and Johnson's grade 5, categorized as pharyngocutaneous fistula. Fifteen patients (58%) developed a post-operative wound infection, which occurred on average at 12 days after surgery. Univariate analysis demonstrated three risk variables that had a significant correlation with infection: alcohol consumption (p = 0.01), cN stage of tumour (p < 0.01), and pre-operative albumin levels <3.2 g/L (p = 0.012). There was a trend, though not significant, for increased infection in patients with high or low BMIs. The most common organisms isolated from clinical samples from infected patients were methicillin-resistant Staphylococcus aureus MRSA (43%), Pseudomonas aeruginosa (36%), Serratia marcescens, Proteus mirabilis and Enterococcus faecalis (7% each). All these organisms are typical hospital-acquired pathogens. Pseudomonas and Serratia were not covered by the prophylactic regime we used. The current antibiotic regime following SL is inadequate as the rate of infection is high. It would therefore seem logical to trial a separate antibiotic protocol of AP for patients undergoing SL that would include an extended course of antibiotics after the standard prophylaxis. In addition, infection rates may also be reduced by improving the metabolic state of patients pre-operatively by multi-disciplinary action. Steps should also be taken to reduce cross-infection with nosocomial pathogens in these patients. Other aspects of surgical management should be also taken in consideration. PMID:22274693

Scotton, William; Cobb, Richard; Pang, Leo; Nixon, Iain; Joshi, Anil; Jeannon, Jeanne-Pierre; Oakley, Richard; French, Gary; Hemsley, Carolyn; Simo, Ricard



Postoperative complications following TECA-LBO in the dog and cat.  


The medical records for 133 total ear canal ablations combined with lateral bulla osteotomies (TECA-LBOs) performed on 82 dogs (121 ears) and 11 cats (12 ears) between 2004 and 2010 were reviewed to determine if the duration of preoperative clinical signs was associated with the incidence of postoperative facial nerve injury and Horner's syndrome. Other perioperative complications, such as a head tilt, nystagmus, incisional drainage, draining tracts, hearing loss, as well as bacterial culture results, were noted. Postoperative facial nerve paresis occurred in 36 of 133 ears (27.1%), and paralysis occurred in 29 of 133 ears (21.8%), with no significant difference between species. Thus, postoperative facial nerve deficits occurred in 48.9% of ears. The median duration of clinically evident temporary facial nerve deficits was 2 wk for dogs and 4 wk for cats. Dogs had a significantly longer duration of preoperative clinical signs and were less likely than cats to have a mass in the ear canal. Dogs were less likely to have residual (> 1 yr) postoperative facial nerve deficits. The incidence of postoperative Horner's syndrome was significantly higher in cats than dogs. The duration of preoperative clinical signs of ear disease was not associated with postoperative facial nerve deficits. PMID:23535749

Spivack, Rebecca E; Elkins, A Derrell; Moore, George E; Lantz, Gary C



Preoperative Steroid Use and Risk of Postoperative Complications in Patients With Inflammatory Bowel Disease Undergoing Abdominal Surgery  

Microsoft Academic Search

CONTEXT: Corticosteroids are the mainstay of medical therapies to induce remission in acute episodes of inflammatory bowel disease (IBD). However, evidence suggests that this may increase the risk of postoperative complications among patients with IBD who go on to have abdominal surgery.OBJECTIVE:To estimate the risk of postoperative complications following abdominal surgery in patients with IBD on steroids at the time

Venkataraman Subramanian; Sonia Saxena; Jin-Yong Kang; Richard C. G. Pollok



Simple Frailty Score Predicts Post-Operative Complications Across Surgical Specialties  

PubMed Central

Introduction Our purpose was to determine the relationship between pre-operative frailty and the occurrence of postoperative complications following colorectal and cardiac operations. Study Design Patients ?65 years undergoing elective colorectal or cardiac surgery were enrolled. Seven baseline frailty traits were measured pre-operatively: Katz Score ?5, Timed Up-and-Go ?15 seconds, Charlson Index ?3, anemia<35%, Mini-Cog score ?3, albumin<3.4gm/dL and ?1 fall within six-months. Patients were categorized by the number of positive traits: non-frail: 0–1 trait, pre-frail: 2–3 traits and frail: ?4 traits. Results 201 subjects (age 74±6 years) were studied. Preoperative frailty was associated with increased postoperative complications following colorectal (non-frail 21%, pre-frail 40% and frail 58%; p=0.016) and cardiac operations (non-frail 17%, pre-frail 28% and frail 56%; p<0.001). This finding in both groups was independent of advancing age. Frail individuals in both groups had longer hospital stays and higher 30-day readmission rates. Receiver operating characteristic curves examining frailty’s ability to forecast complications were: colorectal (0.702; p=0.004) and cardiac (0.711; p<0.001). Conclusion A simple pre-operative frailty score defines older adults at higher risk for postoperative complications across surgical specialties.

Robinson, Thomas N; Wu, Daniel S; Pointer, Lauren; Dunn, Christina L; Cleveland, Joseph C; Moss, Marc



Wound conditioning by vacuum assisted closure (V.A.C.) in postoperative infections after dorsal spine surgery  

PubMed Central

The use of vacuum assisted closure (V.A.C.) therapy in postoperative infections after dorsal spinal surgery was studied retrospectively. Successful treatment was defined as a stable healed wound that showed no signs of acute or chronic infection. The treatment of the infected back wounds consisted of repeated debridement, irrigation and open wound treatment with temporary closure by V.A.C. The instrumentation was exchanged or removed if necessary. Fifteen patients with deep subfascial infections after posterior spinal surgery were treated. The implants were exchanged in seven cases, removed completely in five cases and left without changing in one case. In two cases spinal surgery consisted of laminectomy without instrumentation. In two cases only the wound defects were closed by muscle flap, the remaining ones were closed by delayed suturing. Antibiotic treatment was necessary in all cases. Follow up was possible in 14 patients. One patient showed a new infection after treatment. The study illustrates the usefulness of V.A.C. therapy as a new alternative management for wound conditioning of complex back wounds after deep subfascial infection.

Keel, Marius; Trentz, Otmar; Heinzelmann, Michael



Postoperative hemorrhagic complications after elective laparoscopic cholecystectomy in patients receiving long-term anticoagulant therapy  

Microsoft Academic Search

Background and aims  Among patients on long-term anticoagulant therapy who undergo laparoscopic cholecystectomy (LC), bleeding complications have\\u000a not been extensively investigated. The objective of this study was therefore to investigate postoperative bleeding complications\\u000a prospectively in patients on chronic oral anticoagulation.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  In the period of January 2002 to December 2007, 44 patients on long-term anticoagulation with warfarin, an oral anticoagulant

Metin Ercan; Erdal B. Bostanci; Ilter Ozer; Murat Ulas; Yusuf B. Ozogul; Zafer Teke; Musa Akoglu



Comparison of the major intraoperative and postoperative complications between unilateral and sequential bilateral total knee arthroplasty in a high-volume community hospital  

PubMed Central

Background Total knee arthroplasty (TKA) is a common surgical treatment for arthritis. In the event of bilateral knee symptoms, a patient may elect for bilateral TKA (BTKA) under 1 anesthetic or 2 separate unilateral TKAs (UTKA). Controversy exists in the literature regarding the safety of BTKA versus UTKA. We compared the rate of major intraoperative and postoperative complications for BTKA versus UTKA at a high-volume community hospital. Methods We compared 373 patients who underwent BTKA with 966 who underwent UTKA between May 2008 and May 2011. Health records were used to determine patient characteristics and major intraoperative and postoperative complications. The BTKA and UTKA cohorts were matched for demographic characteristics and comorbidities with the exception of previous transient ischemic attack and previous knee surgery (UTKA > BTKA). Results Rates of intraoperative and postoperative complications, including cardiovascular, thromboembolic and neurologic complications; deep wound infections; and mortality, did not differ significantly between groups. Bilateral TKA was associated with a greater proportion of patients requiring blood transfusion than UTKA (29.8% v. 8.9%, p < 0.001). Among those transfused, there was no significant difference between the groups in the mean number of units required (1.72 ± 0.77 v. 1.53 ± 0.85 units, p = 0.68). Conclusion Bilateral TKA was not associated with statistically greater rates of intra-operative and postoperative complications than UTKA, barring the proportion of patients requiring transfusion. Our results support the use of BTKA to treat bilateral knee arthritis in a high-volume community hospital setting.

Spicer, Erin; Thomas, Garry Robert; Rumble, Edward John



Progressive Wound Necrosis Associated With Postoperative Thrombocytosis in Mastectomy and Immediate Breast Reconstruction Surgery: Report of a Case  

PubMed Central

A 37-year-old who underwent splenectomy for motor vehicle accident-related injuries was diagnosed with stage IIA carcinoma of left breast 12 years later. She underwent bilateral mastectomy and bilateral immediate unipedicle TRAM flap reconstruction. Her preoperative platelet counts ranged from 332 to 424 K/cmm. Intraoperative fluorescein confirmed mastectomy flap viability. On postoperative day 1, platelet count was 374 K/cmm and all suture lines appeared benign. The patient was discharged 3 days later with healthy appearing tram flaps and slight epidermolysis in the abdominal region. Over the next 2 weeks, both the mastectomy flaps and the abdominal region underwent progressive necrosis as the platelet count increased to 1390 K/cmm. Aspirin therapy was instituted at this time. The TRAM flaps remained completely viable. Eighteen days later, the patient required wound debridement with secondary closure of the breast wounds. Platelet count peaked at 1689 K/cmm 2 days later (postoperative day 38). The wounds deteriorated again and were managed conservatively. Two months after mastectomy, the first area of spontaneous healing was documented (platelet count 758 K/cmm). Ultimately, wounds healed as platelet count reached its preoperative baseline. We hypothesize that an abnormal secondary thrombocytosis at subdermal plexus level caused problematic healing in this patient's mastectomy and abdominal flaps.

Murphy, Robert X.; Holko, Ginger A.; Khoury, Afifi A.; Bleznak, Aaron D.



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


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



The Effect of Modified TURP (M-TURP) in Intra and Postoperative Complications  

PubMed Central

Background Transurethral resection of the prostate (TURP) is the most common surgical treatment for benign prostatic hyperplasia. Objectives The aim of the present study was to compare the conventional bipolar transurethral resection of prostate (TURP) with a modified transurethral resection of the prostate (M-TURP) in men with mild to moderate symptoms of benign prostatic hyperplasia. Patients and Methods To compare and evaluate the clinical outcomes of M-TURP, a new electrosurgical suggested method, with the standard treatment, transurethral resection of prostate (TURP), 200 patients with benign prostatic enlargement causing moderate to severe clinical lower urinary symptoms were selected and divided into two equal groups of A and B. Patients of group A underwent M-TURP (incomplete bladder neck resection), resecting only from 1 to 11 O'clock position and group B underwent conventional TURP. These patients were evaluated between Jun 2008 and April 2011, after excluding 24 patients, finally 176 men were studied, 98 in the conventional monopolar transurethral resection of prostate (TURP) group and 78 in the (M-TURP) group. Postoperative follow up to assess the results of the surgeries and the complication rates, began from the operation and continued with postoperative visits of the patient at 24 hour after the catheter remove, two weeks, three months and finally six months. Results The age range of both groups were the same (65-82 years old), preoperative IPSS score in study and control groups were 18 ± 3.3, 17 ± 4.6 (nonsignificant P value = ns) respectively. The size of prostate gland was 58 ± 3.5 g in study and 78 ± 1.2 g in control (ns) preoperatively. Intra and postoperative complications including hematuria (need for transfusion), urine retention (need for catheterization), fever after operation in study and control groups were 2.04%, 6.41%, 1.02% and 0.0%, 3.06%, 6.41% respectively. ISI score (stress incontinence score index) were 7 ± 2.5 and 19 ± 3.6 and UR (urge ratio) were %26 and %70 for study and control groups respectively; P < 0.05. IIEF (international index of erectile function) in study group was better than control (23 ± 3.2 vs. 11 ± 1.7), P < 0.05. Conclusions The results of this study showed that the support of anterior fibro muscular zone (anterior lobe) of prostate after TUR-P has a significant role in postoperative complications, especially in postoperative stress incontinence. So, we strongly recommend to preserve this segment of prostate for prevention of incontinence and other intra and postoperative complications.

Ketabchi, Ali Asghar; Ketabchi, Mahsa; Barkam, Mohsen



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.




Effectiveness of continuous wound infusion of 0.5% ropivacaine by On-Q pain relief system for postoperative pain management after open nephrectomy  

Microsoft Academic Search

Background. Block of parietal nociceptive afferent nerves using continuous wound infiltration with local anaesthetics may be beneficial in multimodal postoperative pain management. The effectiveness of continuous wound infusion of ropivacaine for postoperative pain relief after open nephrectomy was analysed in a prospective, randomized, double-blinded, placebo- controlled trial. Methods. One hundred and sixty-eight patients were randomized to either 0.5% ropivacaine (ON-Q

E. Forastiere; M. Sofra; D. Giannarelli; L. Fabrizi; G. Simone



Preoperative Thyroid Dysfunction Predicts 30-Day Postoperative Complications in Elderly Patients With Hip Fracture  

PubMed Central

Objectives: To investigate the relationship between thyroid function and short-term outcomes in elderly patients undergoing surgery for hip fracture. Methods: Patients aged >60 years admitted from July 2009 to June 2010 who underwent surgical fixation of low-energy hip fracture, excluding those with pathological or periprosthetic fracture, were enrolled in a retrospective observational cohort study. Patients were classified as having biochemically overt or subclinical hyperthyroidism or hypothyroidism, normal thyroid function, or nonclassifiable state based on preoperative thyroid-stimulating hormone and free thyroxine values. Outcome data were collected from hospital records. Biochemical thyroid dysfunction was not systematically treated. Outcomes measured were length of stay (LOS), 30-day postoperative complications, readmissions, and mortality. Results: A total of 254 patients were analyzed; 64 (25.2%) were male and mean age was 77.8 years. There were 128 (50.4%) patients with euthyroid, 68 (26.8%) nonclassifiable, 13 (5.1%) overtly hyperthyroid, 20 (7.9%) subclinically hyperthyroid, 4 (1.6%) overtly hypothyroid, and 21 (8.3%) subclinically hypothyroid. The 30-day postoperative complication rate was 38% (96 patients). The most common complication was urinary tract infection (12.6%), followed by cardiac events (8.3%) and delirium (5.5%). Patients with overt hyperthyroidism had an increased risk of complications in multivariate analysis (odds ratio 3.75, 95% confidence interval 1.10-12.84). Complications in this group were similar to those in the overall cohort. Thyroid function did not predict LOS, readmissions, or mortality. Conclusion: Older patients frequently develop complications following surgery for hip fractures. This risk appears to be increased by preoperative biochemically overt hyperthyroidism. Further study is warranted to confirm this finding and to determine whether preoperative treatment improves outcomes.

Ling, Xi Wern; Howe, Tet Sen; Koh, Joyce Suang Bee; Wong, Merng Koon; Ng, Alvin Choong Meng



Antibiotic sensitivity profile of bacterial pathogens in postoperative wound infections at a tertiary care hospital in Gujarat, India  

PubMed Central

Objective: To find out the most common bacterial pathogens responsible for post-operative wound infection and their antibiotic sensitivity profile. Materials and Methods: This prospective, observational study was carried out in patients of postoperative wound infection. Samples from wound discharge were collected using a sterile swab and studied for identification of isolates by Gram stains and culture growth followed by in vitro antibiotic susceptibility testing performed by disc diffusion method on Mueller Hinton agar. Results: Out of 183 organisms, 126 (68.85%) isolated organisms were gram negative. Staphylococcus aureus, 48 (26.23%), was the predominant organism. S. aureus was sensitive to rifampicin (89.58%), levofloxacin (60.42%), and vancomycin (54.17%). Pseudomonas aeruginosa was sensitive to ciprofloxacin (83.78%), gatifloxacin (51.35%), and meropenem (51.35%). Escherichia coli was sensitive to levofloxacin (72.41%) and ciprofloxacin (62.07%). Klebsiella pneumoniae was sensitive to ciprofloxacin (63.16%), levofloxacin (63.16%), gatifloxacin (63.16%), and linezolid (56.52%). Proteus mirabilis was sensitive to ciprofloxacin (75%) and linezolid (62.50). Proteus vulgaris was sensitive to ampicillin+sulbactam (57.14%) followed by levofloxacin (50%). Conclusions: There is an alarming increase of infections caused by antibiotic-resistant bacteria, particularly in the emergence of VRSA/VISA, meropenem, and third generation cephalosporin resistant Pseudomonas aeruginosa. Linezolid showing sensitivity against Gram negative bacteria.

Goswami, Nutanbala N.; Trivedi, Hiren R.; Goswami, Alpesh Puri P.; Patel, Tejas K.; Tripathi, C. B.



Postoperative Complications following Nodal Dissection and Their Association with Melanoma Recurrence  

PubMed Central

Background. Although postoperative complications are common after lymph node dissection, its association with disease recurrence has not yet been fully investigated. Methods. A retrospective review of a prospectively maintained database was conducted, looking at all malignant melanoma patients with sentinel nodes positive disease requiring axillary or inguinal dissection between 2002 and 2011. Results. A total of 124 patients required nodal clearance from 317 patients with stage I/II malignant melanoma who had undergone sentinel lymph node biopsy. Of these, 104 patients met the inclusion criteria and were divided into inguinal lymph node dissections (ILND; n = 63) or axillary lymph node dissections (ALND; n = 41). Immunohistochemical deposits had higher detection rate in ALND (P = 0.01). The ILND patients had a higher recurrence rate (84.1% versus 63.4%; P = 0.02) and mortality (68.3% versus 48.8%; P = 0.05) without a significant difference in complications. In patients whom complications developed, 75% of the ILND group and 71.4% of the ALND group had disease recurrence, but without reaching a statistical value as an independent predictor of melanoma recurrence. Conclusion. Complications are common following ILND and ALND; however there is no significant difference in complications rates between the groups with some associations with recurrence without reaching a significant difference.

Ahmed, Abubakr; Sadadcharam, Gaitri; Fogarty, Katrina; Mushtaque, Muhammad; Shafiq, Azher; Redmond, Paul



Complete small bowel obstruction in the early postoperative period complicating surgical sling procedure.  


The surgical insertion of an absorbable sling mesh has become the most promising technique for excluding the small bowel from the pelvis prior to radiotherapy. Both human and animal studies suggest that this procedure is very safe. The author reports what appears to be the first significant mesh-related complication. A 69-year-old man suffered early postoperative complete mechanical small bowel obstruction after insertion of a polyglactin 910 (Vicryl) surgical sling mesh at the time of low anterior resection for a stromal sarcoma of the rectum. Urgent laparotomy was required and revealed that the Vicryl mesh was associated with an intense inflammatory reaction. Radiation therapy is a critical component of contemporary multimodal treatment of patients with rectal cancer. This case suggests that inserting biodegradeable mesh to protect the small bowel from radiation effects is not without complications. PMID:8129251

Sloan, D A



CEUS: A new imaging approach for postoperative vascular complications after right-lobe LDLT  

PubMed Central

AIM: To investigate contrast-enhanced ultrasound (CEUS) for early diagnosis of postoperative vascular complications after right-lobe living donor liver transplantation (RLDLT). METHODS: The ultrasonography results of 172 patients who underwent RLDLT in West China Hospital, Sichuan University from January 2005 to June 2008 were analyzed retrospectively. Among these 172 patients, 16 patients’ hepatic artery flow and two patients’ portal vein flow was not observed by Doppler ultrasound, and 10 patients’ bridging vein flow was not shown by Doppler ultrasound and there was a regional inhomogeneous echo in the liver parenchyma upon 2D ultrasound. Thus, CEUS examination was performed in these 28 patients. RESULTS: Among the 16 patients without hepatic artery flow at Doppler ultrasound, CEUS showed nine cases of slender hepatic artery, six of hepatic arterial thrombosis that was confirmed by digital subtraction angiography and/or surgery, and one of hepatic arterial occlusion with formation of lateral branches. Among the two patients without portal vein flow at Doppler ultrasound, CEUS showed one case of hematoma compression and one of portal vein thrombosis, and both were confirmed by surgery. Among the 10 patients without bridging vein flow and with liver parenchyma inhomogeneous echo, CEUS showed regionally poor perfusion in the inhomogeneous area, two of which were confirmed by enhanced computed tomography (CT), but no more additional information about bridging vein flow was provided by enhanced CT. CONCLUSION: CEUS may be a new approach for early diagnosis of postoperative vascular complications after RLDLT, and it can be performed at the bedside.

Luo, Yan; Fan, Yu-Ting; Lu, Qiang; Li, Bo; Wen, Tian-Fu; Zhang, Zhong-Wei



Assessment of peri- and postoperative complications and Karnofsky-performance status in head and neck cancer patients after radiation or chemoradiation that underwent surgery with regional or free-flap reconstruction for salvage, palliation, or to improve function  

PubMed Central

Background Surgery after (chemo)radiation (RCTX/RTX) is felt to be plagued with a high incidence of wound healing complications reported to be as high as 70%. The additional use of vascularized flaps may help to decrease this high rate of complications. Therefore, we examined within a retrospective single-institutional study the peri--and postoperative complications in patients who underwent surgery for salvage, palliation or functional rehabilitation after (chemo)radiation with regional and free flaps. As a second study end point the Karnofsky performance status (KPS) was determined preoperatively and 3 months postoperatively to assess the impact of such extensive procedures on the overall performance status of this heavily pretreated patient population. Findings 21 patients were treated between 2005 and 2010 in a single institution (17 male, 4 female) for salvage (10/21), palliation (4/21), or functional rehabilitation (7/21). Overall 23 flaps were performed of which 8 were free flaps. Major recipient site complications were observed in only 4 pts. (19%) (1 postoperative haemorrhage, 1 partial flap loss, 2 fistulas) and major donor site complications in 1 pt (wound dehiscence). Also 2 minor donor site complications were observed. The overall complication rate was 33%. There was no free flap loss. Assessment of pre- and postoperative KPS revealed improvement in 13 out of 21 patients (62%). A decline of KPS was noted in only one patient. Conclusions We conclude that within this (chemo)radiated patient population surgical interventions for salvage, palliation or improve function can be safely performed once vascularised grafts are used.



Evaluation of postoperative complications following elective surgeries of dogs and cats at private practices using computer records.  


This study was designed to determine the frequency of postoperative complications following elective surgeries (castration, ovariohysterectomy, onychectomy) of dogs and cats from private practices and to evaluate the use of electronic medical records for this type of research. All elective surgeries performed during the study period at 5 private practices were included. The surgical techniques and materials used for each procedure were similar across practices, but the interpretation of "complication," the amount of detail recorded on the primary medical record, and the intensity of follow-up varied. The frequencies and types of complications varied by species and procedure. The postoperative complication frequencies ranged from 1% to 24% for all complications and 1% to 4% for severe complications. The results of this study describe populations of elective-surgery patients at private practices, provide data for educating clients about the risks associated with these procedures, and demonstrate how computerized records can be used to collect practice-specific medical information. PMID:8939333

Pollari, F L; Bonnett, B N



An unusual case of pleural-based tumor with life-threatening post-operative complication  

PubMed Central

A 57-year-old male presented with hemoptysis of 4 years duration and a gradually increasing pleural mass on chest X-ray. The mass was causing pressure effects on the liver and the lungs. To rule out malignancy, thoracotomy was performed, which revealed large, thick-walled hematoma. Complete excision of mass was performed. Post-operative course was complicated by massive pleural bleeding requiring massive blood transfusions and re-exploratory thoracotomy. Subsequent tests revealed factor IX deficiency and, hence, he was managed with recombinant factor IX concentrate. This case stresses upon the fact that hereditary bleeding disorders may be diagnosed even in late adulthood with atypical presentations such as pseudotumor in pleural space. Moreover, hemophilia B may present with normal APTT levels making the diagnosis even more difficult.

Goel, Manoj K.; Juneja, Deven; Jain, Satinder K.; Chaudhuri, Sai Kiran; Kumar, Ajay



Perfluorocarbon liquids as postoperative short-term vitreous substitutes in complicated retinal detachment.  


To avoid postoperative "compartmentalization" of the vitreous cavity, which can potentially accelerate the recurrence of proliferative vitreoretinopathy (PVR), 32 eyes of 32 selected patients with complicated retinal detachment were managed with lensectomy, vitrectomy, 5-day internal tamponade with perfluorocarbon liquids (PFCL) and postoperative supine positioning until PFCL removal. Intraoperatively, 19 eyes had grade C3 or greater PVR; 10 eyes exhibited ocular trauma and 6 displayed giant tears. All but 5 patients (PFCL/fluid exchange) underwent PFCL/silicone oil exchange 5 days after surgery. Anatomic attachment of the retina was achieved with one operation in 25 (78%) of the 32 eyes with a median follow-up of 8 months (mean 8.4 months). Of the 20 eyes that underwent silicone oil removal, none redetached. Nineteen eyes (61%) showed no or only mild reproliferation; a macular pucker developed in 50% of the 20 eyes successfully reattached after PFCL/silicone oil exchange and in none of the 5 eyes successfully reattached after PFCL/fluid exchange. Intraocular tolerance of PFCL for up to 5 days of internal tamponade appeared to be good as judged by static threshold perimetry in the two patients tested and by our functional outcomes, with 88% of the reattached eyes showing a final visual acuity of 5/200 or better. PMID:8258395

Bottoni, F; Sborgia, M; Arpa, P; De Casa, N; Bertazzi, E; Monticelli, M; De Molfetta, V



Complicated head trauma from machete wounds: the experience from a tertiary referral hospital in Jamaica.  


There have been limited reports on machete wounds to the cranium. This study was carried out to document the injury profile in a series of patients who have sustained cranial injuries from machete wounds in this setting. Between 1 January 1998 and 1 January 2008, demographic and clinical data were retrospectively collected from all patients treated with complicated head injuries from machete wounds with at least one of the following clinical or radiological features: a recorded Glasgow Coma Score < 8 at any point during admission; compound skull fractures; protruding brain matter; cerebrospinal fluid (CSF) leaks; intra-cranial bleeding; parenchymal contusions; lacerations and/or oedema. The data were analysed using the SPSS version 12.0. Of the 40 patients with complex injuries to the cranium, there was a 6:1 male preponderance with a mean age of 32.5 ± 13.7 years (Mean ± SD). The injuries included open skull fractures in all the 40 (100%) patients, depressed skull fractures in 20 (50%) patients, CSF leaks in 4 (10%) patients, protruding brain matter in 4 (10%) patients, cerebral contusions in 3 (7.5%) patients and extra cranial injuries in 16 (40%) patients. Tetanus prophylaxis and intravenous antibiotics were administered to all patients, and phenytoin was required in 16 (40%) cases. There were 37 (92%) patients requiring operative intervention at a mean of 10.4 h after presentation (SD ± 18.1; Median 6). The operative procedures included elevation of depressed fractures in 20 (54.1%) patients, dural repair in 10 (27.0%) patients and intra-cranial debridement in 7 (18.9%) patients. There were three deaths (7.5%), and seizures were recorded in 5 (12.5%) cases with no reports of infectious morbidity. Eighty percent of patients had a normal Glasgow outcome score on discharge. Complicated machete head trauma is uncommon at this health care facility in Jamaica. We achieved a satisfactory outcome with aggressive management consisting of prompt assessment of the extent of injury, appropriate antibiotics, anticonvulsants for those with seizures or cortical injury and early operation to decrease the risk of complications. PMID:21547816

Crandon, I W; Harding, H E; Cawich, S O; Webster, D



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


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



Postoperative blunt trauma to 7.5 mm scleral pocket wounds.  


Two patients received blunt trauma to the operated eye after phacoemulsification cataract surgery. Both patients had a three-step 7.5 mm chord width, 3.0 mm long, curving incision, extending from sclera into clear cornea. One patient had rupture of the scleral tunnel and horizontal suture 20 days after surgery. The intraocular lens was dislocated into and along the scleral tunnel. The second patient had direct trauma four days after surgery, resulting in cheese-wiring of the horizontal nylon 10-0 suture and wound leakage but no other sequelae. Blunt trauma after scleral pocket phacoemulsification cataract surgery may result in clinical wound dehiscence if sufficient force is sustained. PMID:8064613

Stevens, J D; Claoué, C M; Steele, A D



Syringe Pressure Irrigation of Subdermic Tissue after Appendectomy to Decrease the Incidence of Postoperative Wound Infection  

Microsoft Academic Search

.   To evaluate syringe pressure irrigation of the surgical wound to decrease its infection after appendectomy, we designed a\\u000a randomized control trial at the Emergency Department of Mexico City General Hospital, including 350 patients with acute abdomen\\u000a suggestive of appendicitis, without any other infection clinically evident. The trial was randomized into 2 groups. Group\\u000a I patients received prophylactic systemic antibiotics

Carlos R. Cervantes-Sánchez; Rafael Gutiérrez-Vega; Jorge A. Vázquez-Carpizo; Cesar Athié-Gutiérrez



Comparison of C-reactive protein and procalcitonin as predictors of postoperative infectious complications after elective colorectal surgery  

PubMed Central

Aim To assess diagnostic value of perioperative procalcitonin (PCT) levels compared to C-reactive protein (CRP) levels in early detection of infectious complications following colorectal surgery. Methods This prospective observational study included 79 patients undergoing elective colorectal surgery. White blood cell count, CRP, and PCT were measured preoperatively and on postoperative days (POD) 1, 2, 3, 5, and patients were followed for postoperative complications. Diagnostic accuracy of CRP and PCT values on each day was analyzed by the receiver operating characteristics (ROC) curve, with infectious complications as an outcome measure. ROC curves with the largest area under the curve for each inflammatory marker were compared in order to define the marker with higher diagnostic accuracy. Results Twenty nine patients (36.7%) developed infectious complications. CRP and PCT concentrations increased in the early postoperative period, with a significant difference between patients with and without complications at all measured postoperative times. ROC curve analysis showed that CRP concentrations on POD 3 and PCT concentrations on POD 2 had similar predictive values for the development of infectious complications (area under the curve, 0.746 and 0.750, respectively) with the best cut-off values of 99.0 mg/L for CRP and 1.34 µg/L for PCT. Diagnostic accuracy of CRP and PCT was highest on POD 5, however the cut-off values were not considered clinically useful. Conclusion Serial postoperative PCT measurements do not offer an advantage over CRP measurements for prediction of infectious complications following colorectal surgery.

Oberhofer, Dagmar; Juras, Josip; Pavicic, Ana Marija; Rancic Zuric, Iva; Rumenjak, Vlatko



Shave therapy for chronic venous ulcers: a guideline for surgical management and postoperative wound care.  


This article presents a practice-oriented concept in the treatment of chronic venous ulcers with accompanying lipodermatosclerosis by shave therapy. Besides the indication for shave therapy, we focus on the operative technique and important therapy during postoperative convalescence time. PMID:16543855

Bechara, Falk Georges; Sand, Michael; Sand, Daniel; Stücker, Markus; Altmeyer, Peter; Hoffmann, Klaus


Postoperative Complications in Patients With Obstructive Sleep Apnea Syndrome Undergoing Hip or Knee Replacement: A Case-Control Study  

Microsoft Academic Search

• Objective: To identify and assess the impact of postop- erative complications in patients with unrecognized or known obstructive sleep apnea syndrome (OSAS) under- going hip replacement or knee replacement compared with control patients undergoing similar operations. Al- though OSAS is a risk factor for perioperative morbidity, data quantifying the magnitude of the problem in patients undergoing non-upper airway operations



Relationship between Postoperative Infectious Complications and Glycemic Control for Diabetic Patients in an Orthopedic Hospital in Kuwait  

Microsoft Academic Search

Objective: To study the relationship between postoperative infectious complications and glycemic control for diabetic patients in an orthopedic hospital in Kuwait. Subjects and Methods: Patients who underwent surgical orthopedic procedures between 2006 and 2007 were identified to provide demographic and clinical informations including age, gender, type of surgery, length of operation, HbA1c values, nature of specimens and species of the

S. M. Lamloum; L. A. Mobasher; A. H. Karar; L. Basiony; T. H. Abdallah; A. I. Al-Saleh; N. A. Al-Shamali



High-dose preoperative chemoradiotherapy in esophageal cancer patients does not increase postoperative pulmonary complications: Correlation with dose–volume histogram parameters  

Microsoft Academic Search

PurposeTo investigate the association of high-dose preoperative chemoradiotherapy (CRT) and dose–volume histogram (DVH) parameters of lungs with incidence of postoperative pulmonary complications and to identify predictive clinical factors of pulmonary complications.

Meysan Hurmuzlu; Kjell Øvrebø; Tore Wentzel-Larsen; Ludvig Paul Muren; Asgaut Viste; Rune Smaaland



Sternal wound infection after heart transplantation: incidence and results with aggressive surgical treatment  

Microsoft Academic Search

Background. Sternal wound infection remains a significant complication. We reviewed the incidence and the treatment of sternal wound infection after heart transplantation.Methods. Of 226 patients who had a heart transplantation, 20 (8.8%) underwent postoperative wound debridement for superficial or deep sternal wound infection. The incidence and the survival of patients with sternal wound infection were analyzed.Results. The incidence of sternal

Michel Carrier; Louis P Perrault; Michel Pellerin; Richard Marchand; Pierre Auger; Guy B Pelletier; Michel White; Normand Racine; Denis Bouchard



Surgical treatment of sigmoid diverticulitis—analysis of predictive risk factors for postoperative infections, surgical complications, and mortality  

Microsoft Academic Search

Background and aims  Sigmoid diverticular disease has great clinical importance due to its increasing incidence in the Western world and a broad\\u000a spectrum of clinical features with potential fatal complications after surgery. The definition of risk factors associated\\u000a with postoperative infections, surgical complications and mortality could be helpful in clinical decision-making and optimizing\\u000a perioperative treatment.\\u000a \\u000a \\u000a \\u000a Materials and methods  Based on a prospective

D. Antolovic; C. Reissfelder; M. Koch; B. Mertens; J. Schmidt; M. W. Büchler; J. Weitz



Post-operative complications after removal of sporadic vestibular schwannoma via retrosigmoid-suboccipital approach: current diagnosis and management  

Microsoft Academic Search

The retrosigmoid (suboccipital) approach is one of four surgical approaches for the treatment of vestibular schwannomas (acoustic\\u000a neuromas). It is increasingly used by otologic surgeons, and in experienced hands is associated with improved results and\\u000a more limited complications. Mortality rates are minimal and often zero, while postoperative sequelae, on the other hand, are\\u000a not rare. In order to not only

Stylianos Charalampakis; Dimitrios Koutsimpelas; Haralampos Gouveris; Wolf Mann



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



Postoperative Cervical Haematoma Complicated by Ipsilateral Carotid Thrombosis and Aphasia after Anterior Cervical Fusion: A Case Report  

PubMed Central

Hematoma alone is the most common vascular complication reported after anterior cervical decompression and fusion (ACDF). We present this case to report the occurrence of postoperative cervical hematoma complicated by ipsilateral carotid thrombosis and aphasia after an uncomplicated C4–6 ACDF. This is a case of a 65-year-old woman who underwent revision fusions of the C4-5 and C6-7 levels complicated by postoperative cervical hematoma and carotid thrombosis. The patient's history, clinical examination, imaging findings, and treatment are reported. The revision fusions were performed and deemed routine. Approximately eight hours later 200?mL of blood was evacuated from a postoperative cervical hematoma. The patient became unresponsive and disoriented a few hours after evacuating the hematoma. Computed tomography and magnetic resonance imaging of the brain were normal, but magnetic resonance angiography demonstrated total occlusion of the left carotid artery. Thrombectomy was performed and the patient was discharged without residual deficits. At the latest followup she is fully functional and asymptomatic in her neck. We suggest, after evacuating a cervical hematoma, an evaluation of the carotids be made with MRA or cerebral angiography, as this may demonstrate a clot before the patient develops symptoms.

Chin, Kingsley R.; Seale, Jason; Butron, Veronica



Vacuum-assisted closure therapy for a complicated, open, above-the-knee amputation wound.  


Negative-pressure wound therapy (NPWT) with a vacuum-assisted closure system has been successfully used in the management of various wounds on the trunk and distal extremities, including diabetic foot ulcers. However, reported successful NPWT cases have involved distal wounds that were below the knee. The authors report a case of an elderly diabetic patient with recalcitrant wounds in his left lower extremity from an above-the-knee amputation. The patient had undergone 27 surgical débridement or revision procedures over the course of 3 months. On entering rehabilitation, the patient had a full-thickness wound in his residual limb that measured 9 × 8 cm. The patient received NPWT with a vacuum-assisted closure system, which resulted in a fully healed residual limb. After 120 days, the patient was ready to begin prosthetic restoration. PMID:23412679

Richter, Kenneth; Knudson, Brent



[Severe postoperative complications in colorectal surgery for cancer. Incidence related to the techniques employed: open versus laparoscopic colectomy].  


In this preliminary retrospective study, severe postoperative complications following surgery for colorectal cancer were analysed, comparing the results obtained with open versus laparoscopic colectomy. Over the period 2005-2007, 50 patients (29 female, 21 male; age range: 32-85 years) underwent surgical treatment for colorectal-anal cancer. Twenty-nine (58%) were submitted to the traditional open technique and 21 (42%) to the laparoscopic technique. No mortality occurred with either technique. None of the cases submitted to laparoscopy presented anastomotic dehiscence or severe intraoperative bleeding. In the group submitted to open surgery, 3 cases of severe complications occurred (10.3%), consisting in acute faecal peritonitis due to immediate dehiscence of the colorectal anastomosis; angulation of the intestinal loop with microdehiscence of the ileo-colic anastomosis; and pulmonary embolism. In the group submitted to laparoscopic surgery, 2 cases of severe complications occurred (9.5%), consisting in enterorrhagia due to haemoperitoneum; and intrafascial haematoma due to haemorrhage of the epigastric artery. The overall complication rate was 10%, corresponding to the minimum values reported in the literature. No statistically significant difference was observed in the incidence of these complications with the two methods employed. A very low incidence of minor complications was observed, limited to repercussions on the postoperative course. Furthermore, the laparoscopic technique led to early canalisation, a reduction in hospital stay, less need of drugs (antibiotics and pain killers) and better aesthetic results. The advantages obtained with the laparoscopic technique, with no significant differences in severe complications, indicate that this approach is preferable to the traditional technique in colorectal surgery for cancer. PMID:18709770

Procacciante, Fabio; Flati, Donato; Diamantini, Giulia; Angelakis, Konstantinos; Cerioli, Alessandra; Gaj, Fabio; Picozzi, Pietro; Trecca, Antonello; di Seri, Marisa


Confocal Microscopic Characterization of Wound Repair after Photorefractive Keratectomy  

Microsoft Academic Search

PURPOSE. Development of postoperative corneal haze and regression of refractive effect are unfa- vorable clinical complications of excimer laser photorefractive keratectomy (PRK). Although exact mechanisms remain to be elucidated, these outcomes have been attributed to post-PRK corneal wound healing. The purpose of this study was to evaluate corneal wound repair quantitatively after PRK in a rabbit model using a newly

W. M. Petroll; H. D. Cavanaugh; J. V. Jester



Postoperative complications of elective surgeries in dogs and cats determined by examining electronic and paper medical records.  


Postoperative complications (POC) that developed in dogs and cats that underwent elective ovariohysterectomy, castration, and declaw at a veterinary teaching hospital were determined by examining the computerized abstracts of the medical records and by examining a random sample of the paper medical records. When the computerized abstracts were examined, POC were found to have occurred in 62 (6.1%) of 1,016 dogs. One dog died and 6 others developed major complications. Postoperative complications were found to have occurred in 38 (2.6%) of 1,459 cats. Two cats died and 1 was euthanatized. Four other cats developed major complications. Complete paper medical records for 218 dogs and cats were examined. When the paper medical records were examined, the proportions of dogs and cats with POC were 19.4% and 12.2%, respectively. These proportions were 4 to 7 times higher than when the computerized abstracts were the data source. Results of this study indicate that the frequency of clinically relevant POC of elective surgeries in dogs and cats is substantial. Examination of the computerized abstracts of medical records at this hospital allowed us to rapidly identify cases that could be included in the study but the frequency of POC would be significantly underestimated if paper records were not also assessed. PMID:8675479

Pollari, F L; Bonnett, B N; Bamsey, S C; Meek, A H; Allen, D G



2-Octyl-cyanoacrylate for wound closure in cervical and lumbar spinal surgery  

Microsoft Academic Search

It is claimed that wound closure with 2-octyl-cyanoacrylate has the advantages that band-aids are not needed in the postoperative\\u000a period, that the wound can get in contact with water and that removal of stitches is not required. This would substantially\\u000a enhance patient comfort, especially in times of reduced in-hospital stays. Postoperative wound infection is a well-known complication\\u000a in spinal surgery.

Dorothee Wachter; Anja Brückel; Marco Stein; Matthias F. Oertel; Petros Christophis; Dieter-Karsten Böker



[Extraperitoneal complications in gun-shot penetrating wounds of the stomach].  


The article after a short literature review presents data of analyze of progression of extra-peritoneal visceral pathology by wounded persons with penetrating wound of stomach. There was described frequency of morbidity of extra-peritoneal organs in dependence on flow of peritonitis. Were marked differences in frequency of progression of peritonitis in conditions of fragment and ballistic wounds. In course of effectuated research was marked dependence between frequency of lethal outcomes and flow of peritonitis and added diseases of respiratory organs, uropoiesis, cardiovascular system. There was effectuated a comparative analysis of frequency of appearance of pathology of marked systems in dependence on localization of ballistic wound. Also there was shortly described a clinical-laboratorial presentation in conditions of appearance of diseases of extra-peritoneal organs. PMID:20017367

Igonin, V A; Perekhodov, S N; Zuev, V K; Gamolka, N N; Usmanov, D M



Liver injury and complications in the postoperative trauma patient: CT evaluation  

SciTech Connect

Twenty-eight patients with surgically documented and classified hepatic injury were studied by computed tomography (CT) in the postoperative period.CT demonstrated no abnormalities in 12 of these patients, most of whom has sustained simple lacerations of the liver. Of the 16 patients with abnormal scans, perihepatic fluid collections were present in six, five of whom had simple lacerations at surgery. The other 10 patients had CT evidence of parenchymal abnormalities, and all of these had sustained major hepatic injuries. CT is usful in depicting the postoperative anatomy, and in many cases demonstrates the nature and extent of damage; the likelihood of finding an abnormality varies with the severity of the injury, even though repair has been attempted. The frequent problem of postoperative sepsis is also amenable to CT evaluation, but the changes demonstrated are often nonspecific and the possibility of residual hepatic injury has to be considered. Finally, CT can document healing of parenchymal injury.

Haney, P.J.; Whitley, N.O.; Brotman, S.; Cunat, J.S.; Whitley, J.



Multidisciplinary panel discussion of a gynecologic oncology patient: preventing wound complications.  


At the 39th meeting of the Society of Gynecologic Oncologists, a multidisciplinary panel presented and discussed the current management strategies for the treatment of complex wounds. After the presentations, the panel discussed the management options for a morbidly obese endometrial cancer patient with a focus toward the complex wound that may delay discharge, healing, or the start of adjuvant treatment. This article highlights the clinical considerations discussed for these types of patients. PMID:18786719

Carlson, Jay W; Stojadinovic, Alexander; Ennis, William; Diegelmann, Robert; Attinger, Christopher



[Clinical effectiveness and safety of Seaprose S in the treatment of complications of puerperal surgical wounds].  


The aim of the study was the assessment of the efficacy and safety of Seaprose S in women out patients from the maternity ward with infiltrated surgical wounds subsequent to vaginal birth or caesarean section. The semialkaline proteolithic enzyme Seaprose S, available in 30 mg tablets was administered at a dosage of 3 tablets a day for a period of 8 days. Thirty-two puerpera with a mean age of 31 years +/- 0.9 SE were admitted to the study with an episiotomic wound in 13 cases and a laparotomic wound consequent on caesarean section in the remaining 19 cases. The clinical situation deriving from the surgical wound resolved on average on the 4th day, in particular the swelling and the congestion of the wound had already diminished in the first days of treatment (p less than 0.01). Safety of Seaprose S was good considering that in no cases were side effects attributable to the treatment observed. In conclusion, from the data obtained in this study one may confirm the validity of Seaprose S in the treatment of laparotomic and episiotomic wounds. PMID:2293075

Dindelli, M; Potenza, M T; Candotti, G; Frigerio, L; Pifarotti, G


[Dilemmas in indications for emergency revision surgery of postoperative complications in abdominal surgery - contribution to the problem].  


The percentage of complications following an interval or emergency operative interventions in the abdomen is different and depends on several factors: -Proper indication for surgery -Experience of the surgical team, anesthesia -Extent of pathological changes; -patient's general condition (presence of associated diseases, capacity of the cardiovascular system, a.o.). -The immediate postoperative treatment. In more experienced surgical departments this percentage is about 5%, but it can rise higher. Postoperative complications representing an indications for emergency re-laparotomy (besides bleeding, also appearing on the first postoperative day, or immediately following the surgery), usually appear from fourth to the seventh day and their common cause being disruption of the anastomosis at different levels of the guts: from gaster to colon and recto-sigmoid. The authors their ten years experience in 40 patients operated upon because of malignomas of the gastro-intestinal tract, but also because of benign processes. A delay of re-operation can--from one part--have fatal consequences, threatening the patient's life; and from another part the re-operation as a complementary (added) aggression on the almost exhausted patients, can by itself kill such patients. In every case, the mortality rate rises over 50%. The authors detail and systematically present their patients and they point out the importance of making decision, which represents the basic dilemma. PMID:7164721

Serafimov, K; Kosti?, N; Peev, A; Dzidrov, V; Stankov, D; Docevski, B; Gjosev, V



Serum Procalcitonin Levels Are Elevated in Esophageal Cancer Patients with Postoperative Infectious Complications  

Microsoft Academic Search

Background: The normal systemic inflammatory response to surgical stimuli often makes early diagnosis of postoperative infections difficult. Purpose: We investigated whether serum procalcitonin (PCT) levels may be a useful marker of bacterial infections in patients after invasive surgery. Subjects and Methods: The subjects were 40 patients who had undergone radical surgery for esophageal carcinoma by a right thoracoabdominal approach. Nine

S. Ito; N. Sato; M. Kojika; Y. Yaegashi; Y. Suzuki; K. Suzuki; S. Endo



Management for Postoperative Complications of Breast Augmentation by Injected Polyacrylamide Hydrogel  

Microsoft Academic Search

Polyacrylamide hydrogel, a new biomaterial, has been used for injected breast augmentation in China since 1997. A series of 30 patients with various complications after injected polyacrylamide hydrogel visited the author’s department. Most of these patients had undergone injection of both breasts. The average age of the patients was 27.6 years, and the time of consultation for the complications was

Qun Qiao; Xiancheng Wang; Jiaming Sun; Ru Zhao; Zhifei Liu; Yang Wang; Baodong Sun; Yinjun Yan; Keming Qi



Full-term abdominal extrauterine pregnancy complicated by post-operative ascites with successful outcome: a case report  

PubMed Central

Introduction Advanced abdominal (extrauterine) pregnancy is a rare condition with high maternal and fetal morbidity and mortality. Because the placentation in advanced abdominal pregnancy is presumed to be inadequate, advanced abdominal pregnancy can be complicated by pre-eclampsia, which is another condition with high maternal and perinatal morbidity and mortality. Diagnosis and management of advanced abdominal pregnancy is difficult. Case presentation We present the case of a 33-year-old African woman in her first pregnancy who had a full-term advanced abdominal pregnancy and developed gross ascites post-operatively. The patient was successfully managed; both the patient and her baby are apparently doing well. Conclusion Because most diagnoses of advanced abdominal pregnancy are missed pre-operatively, even with the use of sonography, the cornerstones of successful management seem to be quick intra-operative recognition, surgical skill, ready access to blood products, meticulous post-operative care and thorough assessment of the newborn.



Wound complications after median sternotomy: A study of 61 patients from a consecutive series of 9,279  

PubMed Central

Among a consecutive series of 9,279 sternotomies performed during a period of 2½ years, 61 (0.66%) patients developed significant wound complications. Of these, 58 (95.1%) survived. Sternal infection occurred in 36 patients (0.39%). Predisposing factors included chronic obstructive pulmonary disease, diabetes mellitus, obesity, closed chest massage, prolonged assisted ventilation, and excessive bleeding after operation. Positive end expiratory pressure (PEEP) did not, in itself, predispose to sternal dehiscence. Intermittent positive pressure breathing (IPPB) treatments caused excessive coughing, which may have increased the likelihood of dehiscence. Disposable drapes and expeditious surgery probably contributed to the low incidence of wound infection. Early diagnosis, surgical debridement, rewiring and primary closure with substernal drainage, without continuous antibiotic irrigation, resulted in satisfactory resolution in most patients.

Ott, David A.; Cooley, Denton A.; Solis, Robert T.; Harrison, Clanton B.



Postoperative cerebrospinal fluid leak after septoplasty: A potential complication of occult anterior skull base encephalocele  

PubMed Central

Postoperative cerebrospinal fluid (CSF) rhinorrhea after septoplasty is a known entity resulting from errors in surgical technique and improper handling of the perpendicular plate of the ethmoid bone. When these occur, urgent management is necessary to prevent deleterious sequelae such as meningitis, intracranial abscess, and pneumocephalus. Encephaloceles are rare occurrences characterized by herniation of intracranial contents through a skull base defect that can predispose patients to CSF rhinorrhea. In this report, we present a case of CSF rhinorrhea occurring 2 weeks after septoplasty likely from manipulation of an occult anterior skull base encephalocele. To our knowledge, no previous similar case has been reported in the literature. Otolaryngologists should be aware of the possibility of occult encephaloceles while performing septoplasties because minimal manipulation of these entities may potentially result in postoperative CSF leakage.

Soni, Resha S.; Choudhry, Osamah J.; Liu, James K.



Brewing complications: the effect of acute ethanol exposure on wound healing.  


Ethanol consumption is linked to a higher incidence of traumatic wounds and increases the risk for morbidity and mortality following surgical or traumatic injury. One of the most profound effects of acute ethanol exposure on wound healing occurs during the inflammatory response, and altered cytokine production is a primary component. Acute ethanol exposure also impairs the proliferative response during healing, causing delays in epithelial coverage, collagen synthesis, and blood vessel regrowth. The accumulated data support the paradigm that acute ethanol intoxication prior to injury significantly diminishes a patient's ability to heal efficiently. PMID:19675208

Radek, Katherine A; Ranzer, Matthew J; Dipietro, Luisa A



Brewing complications: the effect of acute ethanol exposure on wound healing  

PubMed Central

Ethanol consumption is linked to a higher incidence of traumatic wounds and increases the risk for morbidity and mortality following surgical or traumatic injury. One of the most profound effects of acute ethanol exposure on wound healing occurs during the inflammatory response, and altered cytokine production is a primary component. Acute ethanol exposure also impairs the proliferative response during healing, causing delays in epithelial coverage, collagen synthesis, and blood vessel regrowth. The accumulated data support the paradigm that acute ethanol intoxication prior to injury significantly diminishes a patient’s ability to heal efficiently.

Radek, Katherine A.; Ranzer, Matthew J.; DiPietro, Luisa A.



Postoperative mesenteric venous thrombosis: Potential complication related to minimal access surgery in a patient with undiagnosed hypercoagulability  

PubMed Central

Context: Mesenteric venous thrombosis is a rare but potentially fatal complication associated with laparoscopy which has now become common practice and gold standard for many procedures in general surgery. There are only few scattered case reports in the literature describing this postoperative thrombotic event. Case Report: In the present study, we describe a patient presenting with severe abdominal pain at 25 days following an uneventful laparoscopic paraesophageal hernia (PEH) repair and nissen fundoplication. Exploratory laparotomy revealed an extensive small bowel ischemia requiring bowel resection followed by a second look laparotomy. Retrospectively performed hematologic workup revealed a genetic mutation associated with hyperhomocysteinemia in addition to her hyperfibrinogenemia. Previously published data were collected and discussed. Conclusions: Mesenteric venous thrombosis is a rare but potentially serious complication after laparoscopic surgery especially in patients with underlying hypercoagulability. High index of suspicion is important in early diagnosis and subsequent treatment.

Sucandy, Iswanto; Gabrielsen, Jon D; Petrick, Anthony T



New Transverse Plate Fixation System for Complicated Sternal Wound Infection After Median Sternotomy  

Microsoft Academic Search

Wire fixation after median sternotomy is a safe proce- dure, but it is still associated with potential wound infection including bony dehiscence. In case of infection and dehiscence the sternum is re-fixated with steel wires. If this is insufficient, then flap reconstruction would be another option. We describe an alternative way for com- plicated sternal closure by using a rigid

Andre Plass; Jürg Grünenfelder; Oliver Reuthebuch; Robert Vachenauer; Jean-Marc Gauer; Gregor Zünd; Michele Genoni


Retained Descemet's membrane following penetrating keratoplasty for Fuchs' endothelial dystrophy: a case report of a post-operative complication  

PubMed Central

Purpose To report a case of retained Descemet’s membrane following penetrating keratoplasty in a patient suffering from Fuchs’ endothelial corneal dystrophy. The use of confocal microscopy, histopathological tissue analysis, and treatment options are discussed. Methods Case report of an 85-year-old man with a past ophthalmic history of atrophic macular degeneration, underwent a penetrating keratoplasty for Fuchs’ endothelial corneal dystrophy. Postoperative review revealed a retained retrocorneal membrane within the anterior chamber. Further surgery was performed to excise the membrane, with a subjective and objective postoperative improvement in visual acuity and without subsequent complications of the corneal graft. Results Histopathological assessment confirmed the clinical suspicion of a retained Descemet’s membrane, marrying with the initial histology from the corneal button excised during the penetrating keratoplasty, which showed only a very thin Descemet’s layer. Conclusion Retention of the Descemet’s membrane following penetrating keratoplasty is a rare but potential complication of this surgery, particularly in cases of Fuchs’ endothelial corneal dystrophy due to the thickened and abnormal histological nature of the endothelium and high index of suspicion is required.

McVeigh, Katherine; Cornish, Kurt Spiteri; Reddy, Aravind R; Vakros, Georgios



Frey’s Syndrome following Submandibular Gland Excision: An Unusual Postoperative Complication  

Microsoft Academic Search

Gustatory sweating and flushing, or Frey’s syndrome, is a fairly common complication following surgery or injury to the parotid gland and is thought to be caused by aberrant nerve regeneration. A similar condition has been reported in the literature following surgery to the submandibular region. Since this was first described in 1934, only 7 subsequent cases of submandibular sweating and

A. Teague; S. Akhtar; J. Phillips



Quantitative evaluation of myofibroblast apoptosis during wound healing in rat palate after post-operative administration of basic fibroblast growth factor (bFGF).  


Abstract Objective. Excessive wound contraction apparently inhibits maxillary growth; thus, myofibroblast apoptosis needs to be accelerated in mucoperiosteal denudation after palatoplasty. The aim of this study was to evaluate myofibroblast apoptosis during wound healing in mucoperiosteal denudation of rat palates immediately after post-operative administration of basic fibroblast growth factor (bFGF). Materials and methods. A total of 100 male Wistar rats aged 20 days were divided into control, scar, sham and bFGF groups (n = 25 each). In the scar, sham and bFGF groups, mucoperiosteum was removed from the palate and fibrin glue was applied to the exposed bone surface immediately after surgery. In the bFGF group, 10 ?L of 2 ?g/?L bFGF solution was injected into the operated area beneath the fibrin glue. At 2, 5, 7, 14 and 28 days post-operatively, myofibroblast apoptosis during the wound healing process was investigated by double immunofluorescence staining. The apoptotic area of myofibroblasts was measured using image software. Results. In the bFGF group, at 2 days, apoptosis of myofibroblasts in the lamina propria and submucosa was marked, as compared with the other three groups and apoptosis of myofibroblasts was scarcely seen at 5 days. At 5 and 7 days, the apoptotic area of myofibroblasts in the bFGF group was statistically significantly smaller when compared to the scar and sham groups. Conclusion. The results confirmed that bFGF injection immediately after surgery accelerated apoptosis of myofibroblasts in mucoperiosteal denudation of rats. This may reduce maxillary growth retardation due to excessive wound contraction. PMID:23445304

Hata, Yuichiro; Ishikawa, Hiroyuki; Ueki, Takeshi; Kajii, Takashi S; Tamaoki, Sachio; Tsuruga, Eichi; Sawa, Yoshihiko; Taniguchi, Kunihisa



Wound healing after radical vulvectomy and inguino-femoral lymphadenectomy: experience with granulocyte colony stimulating factor (filgrastim, r-metHuG-CSF)  

Microsoft Academic Search

After radical vulvectomy, infection and wound breakdown occurs in approximately 40–60% of patients resulting in significant morbidity and increased hospital stay. Wound breakdown is primarily due to infection of and tension on the wound. Post-operative defects in the immune system and neutrophil dysfunction may contribute to the high rate of this complication. To investigate this phenomenon in patients with a

A. C. M. van Lindert; E. A. Symons; B. F. M. Damen; A. P. M. Heintz



A Retrospective Analysis of 3,000 Primary Aesthetic Breast Augmentations: Postoperative Complications and Associated Factors  

Microsoft Academic Search

Background  A large retrospective analysis was performed on a homogeneous group of patients undergoing primary aesthetic breast augmentations\\u000a to define complication rates and find associated factors.\\u000a \\u000a \\u000a \\u000a Methods  Data were collected from the personal databases of two different surgeons working at the Crown House Hospital, Oldbury, Birmingham,\\u000a United Kingdom. The period considered was January 1996 to December 2001. All patients who received primary

A. Araco; G. Gravante; F. Araco; D. Delogu; V. Cervelli; K. Walgenbach



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.



Incidence, microbiological findings, and clinical presentation of sternal wound infections after cardiac surgery with and without local gentamicin prophylaxis  

Microsoft Academic Search

Sternal wound infection (SWI) is a serious complication after cardiac surgery. In a previous randomized controlled trial,\\u000a the addition of local collagen-gentamicin in the sternal wound before wound closure was found to significantly reduce the\\u000a incidence of postoperative wound infections compared with the routine intravenous prophylaxis of isoxazolyl-penicillin only.\\u000a The aims of the present study were to analyse the microbiological

Ö. Friberg; R. Svedjeholm; J. Källman; B. Söderquist



Usefulness of an Estimation of Physiologic Ability and Surgical Stress (E-PASS) Scoring System to Predict the Incidence of Postoperative Complications in Gastrointestinal Surgery  

Microsoft Academic Search

Surgical intervention induces various host responses to maintain homeostasis. When postoperative inflammation is intense and\\u000a persists for a long time, postoperative complications may occur, sometimes developing into multiple organ failure. Therefore,\\u000a it is very important to assess surgical stress and predict the risk of morbidity and mortality. Using a new scoring system,\\u000a an estimation of physiologic ability and surgical stress

Yoshio Oka; Junichi Nishijima; Kunihiko Oku; Tatsuo Azuma; Keiji Inada; Satoru Miyazaki; Hiroshi Nakano; Yukihiro Nishida; Kazuya Sakata; Masaaki Izukura



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.

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



Post-operative pulmonary complications in patients undergoing transoral odontoidectomy and posterior fixation for craniovertebral junction anomalies  

PubMed Central

Background: In patients with craniovertebral junction (CVJ) anomalies, the respiratory system is adversely affected in many ways. The sub-clinical manifestations may get aggravated in the postoperative period owing to anesthetic or surgical reasons. However, there is limited data on the incidence of postoperative pulmonary complications (PPCs) and associated risk factors in such patients, who undergo transoral odontoidectomy (TOO) and posterior fixation (PF) in the same sitting. Materials and Methods: Five years data of 178 patients with CVJ anomaly who underwent TOO and PF in the same sitting were analyzed retrospectively. Preoperative status, intraoperative variables, and PPCs were recorded. Patients were divided into two groups depending on the presence or absence of PPCs. Bivariate analysis was done to find out association between various risk factors and PPCs. Multivariate analysis was done to detect relative contribution of the factors shown to be significant in bivariate analysis. P < 0.05 was considered as significant. Results: The incidence of PPCs was found to be 15.7%. Factors significantly associated with PPCs were American Society of Anesthesiologists grade higher than II, preoperative lower cranial nerves palsy and respiratory involvement, duration of surgery, and intraoperative blood transfusion. In multivariate analysis, blood transfusion was found to be the sole contributing factor. The patients who developed PPCs had significantly prolonged stay in ICU and hospital. Conclusion: Patients with CVJ anomaly are at increased risk of developing PPCs. There is a strong association between intraoperative blood transfusion and PPCs. Patients with PPCs stay in the ICU and hospital for a longer period of time.

Marda, Manish; Pandia, Mihir P; Rath, Girija P; Bithal, Parmod K; Dash, Hari H



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:; 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)



Effects of urinary bladder retroflexion and surgical technique on postoperative complication rates and long-term outcome in dogs with perineal hernia: 41 cases (2002-2009).  


Objective-To evaluate the effects of urinary bladder retroflexion (UBR) and surgical technique on postoperative complication rates and long-term outcome in dogs with perineal hernia. Design-Retrospective case series. Animals-41 client-owned dogs with perineal hernia that underwent surgery between November 2002 and November 2009. Procedures-Medical records were reviewed for information on dog signalment, history, physical examination findings, ultrasonographic findings, surgical techniques, intraoperative complications, duration of hospital stay, postoperative complications, and long-term outcome. Results-31 dogs had no UBR, and 10 dogs had UBR. Internal obturator muscle transposition (IOMT) was performed in 20 dogs, and a cystopexy or colopexy was performed before the IOMT (LapIOMT) in 21. Postoperative complications included tenesmus (n = 8) and urinary incontinence (1). Rates of postoperative complications were not significantly different between the no-UBR and UBR groups or between the IOMT and LapIOMT groups. Thirty-two dogs were free of clinical signs at the time of the study. The median disease-free interval did not differ significantly between dogs in the no-UBR and UBR groups, but it was significantly lower in the LapIOMT group than in the IOMT group. None of the 7 dogs with UBR that were treated without cystopexy developed recurrence of UBR. Conclusions and Clinical Relevance-UBR was not associated with an increased rate of postoperative complications relative to no UBR and had no effect on the long-term outcome in dogs with perineal hernia. The use of IOMT alone may be recommended for clinical use because LapIOMT offered no clear advantage. PMID:24171374

Grand, Jean-Guillaume; Bureau, Stéphane; Monnet, Eric



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


Modified wound dissection preserving the greater occipital nerve in foramen magnum decompression: a technique to reduce postoperative pain.  


Patients undergoing foramen magnum decompression for Chiari malformation may experience severe postoperative pain in the area innervated by the greater occipital nerve (GON). We developed a modified dissection to lessen this pain. A midline skin incision was extended 2?cm in a cephalad direction to the inion and the skin was minimally retracted. After exposing the occipital bone, the semispinalis capitis and the trapezius muscles were detached subperiosteally in a caudal-to-cephalad direction. Consequently, the muscles and skin containing the GON were retracted in a single layer. We retrospectively compared the intensity of postoperative pain recorded on the visual analogue scale (VAS) by patients who underwent decompression using our (group A, n?=?5) and the conventional layer-by-layer dissection technique (group B, n?=?5). The VAS scores were not different on the day of surgery, but subsequently they fell faster in group A. Group A patients received a mild analgesic for a short period. Group B patients required a stronger analgesic for prolonged periods. Postoperative GON numbness/tenderness was observed only in group B. With respect to most evaluation criteria, the difference between the two groups was significant. Our anatomically rational dissection that protects the GON results in less postoperative pain. PMID:23904996

Shimizu, Satoru; Yamazaki, Tomoya; Kondo, Koji; Utsuki, Satoshi; Oka, Hidehiro; Nakayama, Kenji; Yamamoto, Isao; Fujii, Kiyotaka



Modified Wound Dissection Preserving the Greater Occipital Nerve in Foramen Magnum Decompression: A Technique to Reduce Postoperative Pain  

PubMed Central

Patients undergoing foramen magnum decompression for Chiari malformation may experience severe postoperative pain in the area innervated by the greater occipital nerve (GON). We developed a modified dissection to lessen this pain. A midline skin incision was extended 2?cm in a cephalad direction to the inion and the skin was minimally retracted. After exposing the occipital bone, the semispinalis capitis and the trapezius muscles were detached subperiosteally in a caudal-to-cephalad direction. Consequently, the muscles and skin containing the GON were retracted in a single layer. We retrospectively compared the intensity of postoperative pain recorded on the visual analogue scale (VAS) by patients who underwent decompression using our (group A, n?=?5) and the conventional layer-by-layer dissection technique (group B, n?=?5). The VAS scores were not different on the day of surgery, but subsequently they fell faster in group A. Group A patients received a mild analgesic for a short period. Group B patients required a stronger analgesic for prolonged periods. Postoperative GON numbness/tenderness was observed only in group B. With respect to most evaluation criteria, the difference between the two groups was significant. Our anatomically rational dissection that protects the GON results in less postoperative pain.

Shimizu, Satoru; Yamazaki, Tomoya; Kondo, Koji; Utsuki, Satoshi; Oka, Hidehiro; Nakayama, Kenji; Yamamoto, Isao; Fujii, Kiyotaka



[Medico-social characteristics of patients with septic complications after penetrating thoracic wounds].  


232 cases of septic complications after penetrating thoracic injury were analyzed. All patients were divided into groups according to the injury mechanism and inhabitancy. Patients with medico-social deviations, as well as patients with hemocontact infections, mental insanity and social deviations were marked out. 75% of patients were reported to have any medico-social deviations. Among them the distributing was as follows: persons with no fixed abode (100%), women (91%), patients over 50 years (86.2%) and patients after knife thoracic injury (77.4%). Among patients with hemocontact infection the majority were incomers from the near-abroad countries (37%), victims of assault (20%) and patients aged 31-40 years (18.4%). PMID:23887259



Unanticipated complication of a malpositioned central venous catheter  

Microsoft Academic Search

We report an unusual complication that occurred late in the postoperative period, due to a damaged and malpositioned peripherally\\u000a inserted central catheter (PICC) used for central venous pressure monitoring during esophagocoloplasty and for postoperative\\u000a parenteral nutrition. On the seventh postoperative day, the development of a leak from the neck wound coincided with the administration\\u000a of intravenous fluids via the PICC.

Pankaj Kundra; Bathala V. Sai Chandran; Kasturi S. V. K. Subbarao



Stan Scheller: The Forerunner of Clinical Studies on Using Propolis for Poor and Chronic Nonhealing Wounds  

PubMed Central

For hundreds of years poor and chronic nonhealing wounds have constituted a serious problem to medicine. What is more, treating such wounds is an expensive let alone a long-lasting process. The following paper describes Professor Scheller's achievements in using propolis for poor and chronic non-healing wounds. The authors' intention was to present the results connected with the use of the ethanolic extract propolis, in the treatment of patients suffering from burns, venous crural ulceration, local sacral bone pressure ulcers, suppurative osteitis and arthritis, suppurative postoperative local wound complications, and infected traumatic wounds.

Kucharzewski, M.; Kubacka, S.; Urbanek, T.; Wilemska-Kucharzewska, K.; Morawiec, T.



Female gender and oral anticoagulants are associated with wound complications in lower extremity vein bypass: An analysis of 1404 operations for critical limb ischemia  

PubMed Central

Background Infrainguinal bypass (IB) surgery is an effective means of improving arterial circulation to the lower extremity for patients with critical limb ischemia (CLI). However, wound complications (WC) of the surgical incision following IB can impart significant morbidity. Methods A retrospective analysis of WC from the 1404 patients enrolled in a multicenter clinical trial of vein bypass grafting for CLI was performed. Univariate and multivariable regression models were used to determine WC predictors and associated outcomes, including graft patency, limb salvage, quality of life (QoL), resource utilization (RU), and mortality. Results A total of 543 (39%) patients developed a reported WC within 30 days of surgery, with infections (284, 52%) and hematoma/hemorrhage (121, 22%) being the most common type. Postoperative anticoagulation (odds ratio [OR], 1.554; 95% confidence interval [CI] 1.202 to 2.009; P = .0008) and female gender (OR, 1.376; 95% CI, 1.076 to 1.757; P = .0108) were independent factors associated with WC. Primary, primary-assisted, and secondary graft patency rates were not influenced by the presence of WC; though, patients with WC were at increased risk for limb loss (hazard ratio [HR], 1.511; 95% CI 1.096 to 2.079; P = .0116) and higher mortality (HR, 1.449; 95% CI 1.098 to 1.912; P = .0089). WC was not significantly associated with lower QoL at 3 months (4.67 vs 4.79, P = .1947) and 12 months (5.02 vs 5.13, P = .2806). However, the subset of patients with serious WC (SWC) demonstrated significantly lower QoL at 3 months compared with patients without WC, (4.43 vs 4.79, respectively, P = .0166), though this difference was not seen at 12 months (4.94 vs 5.13, P = .2411). Patients with WC had higher RU than patients who did not have WC. Mean index length of hospital stay (LOS) was 2.3 days longer, mean cumulative 1-year LOS was 8.1 days longer, and mean number of hospitalizations was 0.5 occurrences greater for patients with WC compared with patients without WC (all P < .0001). Conclusions WC is a frequent complication of IB for CLI, associated with increased risk for major amputation, mortality, and greater RU. Further detailed investigation into the link between female gender and oral anticoagulation use with WC may help identify causes of WC and perhaps prevent or lessen their occurrence.

Nguyen, Louis L.; Brahmanandam, Soma; Bandyk, Dennis F.; Belkin, Michael; Clowes, Alexander W.; Moneta, Gregory L.; Conte, Michael S.



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.

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



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.

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



Usefulness of N-terminal pro-brain natriuretic peptide to predict postoperative cardiac complications and long-term mortality after emergency lower limb orthopedic surgery.  


After emergency orthopedic-geriatric surgery, cardiac complications are an important cause of morbidity and mortality. The utility of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) for the prediction of cardiac complications and mortality was evaluated. NT-pro-BNP was tested pre- and postoperatively in 89 patients >60 years of age. They were followed for 2 years for cardiac complications (defined as acute myocardial infarction, congestive cardiac failure, atrial fibrillation or major arrhythmia) or death. Receiver operating characteristic curves were constructed to determine the optimal discriminatory level for cardiac events and death using NT-pro-BNP. Twenty-three patients (25.8%) sustained an in-hospital postoperative cardiac complication. Total all-cause mortality was 3 of 89 (3.4%) in hospital, 21 of 89 (23.6%) at 1 year, and 27 of 89 (30.3%) at 2 years. Median preoperative and postoperative NT-pro-BNP levels were higher in patients who had an in-hospital cardiac event compared to those without (387 vs 1,969 pg/ml, p <0.001; and 676 vs 7,052 pg/ml, p <0.001 respectively). The optimal discriminatory level for preoperative NT-pro-BNP was 842 pg/ml and that for postoperative NT-pro-BNP was 1,401 pg/ml for the prediction of in-hospital cardiac events and 1- and 2-year mortality. Preoperative NT-pro-BNP >/=842 pg/ml (odds ratio 11.6, 95% confidence interval 2.1 to 65.0, p = 0.005) was an independent predictor of in-hospital cardiac complications using multivariate analysis and pre- and postoperative NT-pro-BNP levels were independent predictors of 2-year cardiovascular events. Patients who had preoperative NT-pro-BNP >/=842 pg/ml or postoperative NT-pro-BNP >/=1,401 pg/ml had significantly worse survival using log-rank testing (p <0.001) and these variables independently predicted 2-year mortality. In conclusion, increase pre- and postoperative NT-pro-BNP levels are independent predictors of in-hospital cardiac events and 1- and 2-year mortality in older patients undergoing emergency orthopedic surgery. PMID:20816130

Chong, Carol P; Ryan, Julie E; van Gaal, William J; Lam, Que T; Sinnappu, Rabindra N; Burrell, Louise M; Savige, Judy; Lim, Wen Kwang



Neoadjuvant Hormonal Therapy Preceding Radical Prostatectomy for Clinically Localized Prostate Cancer: Early Postoperative Complications and Biochemical Recurrence  

PubMed Central

Purpose The effect of neoadjuvant hormonal therapy (NHT) on radical retropubic prostatectomy (RRP) for prostate cancer is various and remains a controversy for urologists. We conducted this study to comparatively evaluate whether NHT before RRP is indicated and beneficial in the aspects of postoperative complications, positive surgical margin, and biochemical recurrence. Materials and Methods Between September 2006 and December 2009, 69 men were scheduled for RRP as a treatment for clinically localized and locally advanced prostate cancer and were divided into two groups. Group 1 (n=31, 44.9%) was treated with RRP only, and group 2 (n=38, 55.1%) underwent RRP with preoperative NHT. We evaluated clinical parameters, surgical parameters, and the positive margin rate in surgical specimens and the biochemical recurrence rate. Results There were no statistical differences in age, body mass index (BMI), preoperative biopsy Gleason score, initial serum prostate-specific antigen (PSA) levels, International Prostate Symptom Score (IPSS), or quality of life (QoL) between the two groups (p>0.05). We also observed no differences in the transfusion rate, mean catheterization time, or positive margin rate (p>0.05). However, the mean operative time was significantly higher in the RRP with preoperative NHT group than in the other group (p=0.034). There was no significant difference in the biochemical recurrence rate during the last follow-up according to NHT (p=0.102) or positive surgical margin (p=0.473). Conclusions These results suggest that there were no clinical benefits to the administration of NHT before RRP from the viewpoint of biochemical recurrence.

Yang, Seung Woo; Lim, Jae Sung; Sul, Chong Koo



The influence of iron status and genetic polymorphisms in the HFE gene on the risk for postoperative complications after bariatric surgery: a prospective cohort study in 1,064 patients  

Microsoft Academic Search

BACKGROUND: Gastric bypass surgery is a highly effective therapy for long-term weight loss in severely obese patients, but carries significant perioperative risks including infection, wound dehiscence, and leaks from staple breakdown. Iron status can affect immune function and wound healing, thus may influence peri-operative complications. Common mutations in the HFE gene, the gene responsible for the iron overload disorder hereditary

Glenn S Gerhard; Ravi Chokshi; Christopher D Still; Peter Benotti; G Craig Wood; Mollie Freedman-Weiss; Cody Rider; Anthony T Petrick



Endogenously acquired deep sternal wound infection after congenital cardiac surgery  

Microsoft Academic Search

A 10-month-old child from the Middle East received complete correction for tetralogy of Fallot. Despite an initially uneventful postoperative course, he developed severe deep sternal wound infection after 7 days. This complication was endogenously acquired caused by a resistant and rarely present in Europe, Streptococcus pneumonia. Following surgical debridement, betadine rinsing for 3 days and with a course of specific

Thomas Walther; Martin Elliott



NAFLD and Insulin Resistance Do Not Increase the Risk of Postoperative Complications Among Patients Undergoing Bariatric Surgery—A Prospective Analysis  

Microsoft Academic Search

Background  Nonalcoholic fatty liver disease (NAFLD) and insulin resistance are common consequences of obesity and are highly prevalent\\u000a among patients undergoing bariatric surgery. Insulin resistance and NAFLD have been reported to be associated with postoperative\\u000a complications following major surgery.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We prospectively evaluated complications in a cohort of 437 consecutive patients undergoing bariatric surgery. Detailed metabolic\\u000a profile was obtained prior to surgery,

Tarsila Ribeireiro; James Swain; Michael Sarr; Michael Kendrick; Florencia Que; Schuyler Sanderson; Anuradha Krishnan; Kimberly Viker; Kymberly Watt; Michael Charlton



Does the application of incisional negative pressure therapy to high-risk wounds prevent surgical site complications? A systematic review.  


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



The True Incidence of Near-Term Postoperative Complications in Prosthetic Breast Reconstruction Utilizing Human Acellular Dermal Matrices: A Meta-Analysis  

Microsoft Academic Search

Background  The use of human acellular dermal matrix (HADM) materials in prosthetic-based breast reconstruction has gained popularity\\u000a in recent years. Questions remain, however, regarding the nature and incidence of postoperative complications associated with\\u000a this technique. The results reported in the available literature vary widely. This meta-analysis examines this question further\\u000a with a broad review of the available literature in an effort

Martin I. NewmanKimberly; Kimberly A. Swartz; Michel C. Samson; Chris Brown Mahoney; Khaled Diab



Lack of increase in postoperative complications with low-dose methotrexate therapy in patients with rheumatoid arthritis undergoing elective orthopedic surgery  

Microsoft Academic Search

To determine the potential contribution of intermittent low-dose methotrexate (MTX) treatment (2–8mg\\/week) to postoperative\\u000a complications, we studied 122 patients with rheumatoid arthritis (RA) who had 201 surgical procedures. The patients with treatment\\u000a with MTX were allocated to two groups: those who continued MTX (group A, 77 procedures) and those who discontinued MTX more\\u000a than 1 week (group B, 21 procedures).

Koichi Murata; Tadashi Yasuda; Hiromu Ito; Makoto Yoshida; Makoto Shimizu; Takashi Nakamura



The effect of ranitidine on postoperative infectious complications following emergency colorectal surgery: A randomized, placebo-controlled, double-blind trial  

Microsoft Academic Search

Objective and Design: To study the potential effect of ranitidine on postoperative infectious complications following emergency colorectal surgery. A randomized, placebo-controlled, double-blind trial was carried out in three university clinics and two county hospitals in Denmark.¶Patients and Treatment: One hundred and ninety-four consecutive patients undergoing acute colorectal surgery for perforated and\\/or obstructed large bowel were randomized in a double-blind fashion

F. Moesgaard; L. S. Jensen; P. M. Christiansen; O. Thorlacius-Ussing; K. T. Nielsen; N. R. Rasmussen; L. Bardram; H. J. Nielsen



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:; 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)



Measuring postoperative complications in general surgery patients using an outcomes-based strategy: Comparison with complications presented at morbidity and mortality rounds  

Microsoft Academic Search

Background. This study was undertaken to compare the incidence of adverse postoperative outcomes recorded in a prospective general surgery database with that identified through weekly morbidity and mortality (M&M) rounds and to measure the impact of feedback of information to the providers of care.Methods. Data were collected on patients admitted to one general surgery service between October 1, 1995, and

Liane Feldman; Jeffrey Barkun; Alan Barkun; John Sampalis; Lawrence Rosenberg



The Relationship between PreOperative Lung Function Test Results and Post-Operative Complications in Carcinoma of the Bronchus  

Microsoft Academic Search

The results of lung function tests on 81 patients who subsequently developed cardiopulmonary complications after thoracotomy for carcinoma of the bronchus were compared with those from the same number of similar patients who suffered no complications. Simple statistical analysis showed that there was a correlation between the occurrence of the complications and abnormality in the test results. By comparing the

P. Lockwood



Postoperative Course After Emergency Colorectal Surgery for Secondary Peritonitis in the Elderly Is Often Complicated by Delirium  

PubMed Central

Postoperative delirium, morbidity, and mortality in our elderly patients with secondary perionitis of colorectal origin is described. This is a chart-based retrospective analysis of 63 patients who were operated on at the University Hospital Basel from April 2001 to May 2004. Postoperative delirium occurred in 33%. Overall morbidity was 71.4%. Surgery-related morbidity was 43.4%. Mortality was 14.4%. There was no statistical significance between delirium, morbidity and mortality (P ?=? 0.279 and P ?=? 0.364). There was no statistically significant correlation between the analyzed scores (American Society of Anesthesiologists classification, Mannheimer Peritonitis Index, Acute Physiology and Chronic Health Evaluation score II, physiological and operative surgical severity and enumeration of morbidity and mortality score‚ or short ‚cr-POSSUM’) and postoperative delirium, morbidity or mortality. Postoperative delirium occurred in one-third of the patients, who seem to have a trend to higher morbidity. Even if the different scores already had proven to be predictive in terms of morbidity and mortality, they do not help the risk stratification of postoperative delirium, morbidity, or mortality in our collective population.

Engelberger, Stephan; Zurcher, Manuel; Schuld, Jochen; Viehl, Carsten Thomas; Kettelhack, Christoph



Prevention of postoperative complications in skull base surgery for nasal or paranasal sinus carcinoma invading the skull base.  


With recent technical advances in skull base surgery, radical resection of a nasal or paranasal sinus carcinoma invading the skull base can now be achieved. To assure a satisfactory surgical result, it is essential to prevent postoperative infection. In our series of 14 cases, serious postoperative infections occurred in the earliest 10 cases, and only 2 of these patients are still alive. The vascularised abdominal muscle flap for skull base reconstruction was fixed with fibrin glue, but was not adequate to fill the dead space, resulting in cerebrospinal fluid leakage and subsequent meningitis. Once the infection occurred, a free bone flap became the focus of infection. Based on these earlier experiences, we used a ROC fastener system to completely fill the dead space with an abdominal muscle flap, and bone flap was primarily craniectomised in the four most recent cases. With this technique, there were no postoperative infections. PMID:11386830

Nishizawa, S; Yokota, N; Yokoyama, T; Mukodaka, H; Watanabe, T; Hoshino, T; Ueda, Y



Prospective Study of Postoperative Complications After Total Thyroidectomy for Multinodular Goiters by Surgeons With Experience in Endocrine Surgery  

Microsoft Academic Search

Objetives: (1) To show that total thyroidectomy (TT) can be performed in multinodular goiter (MG) by surgeons with experience in endocrine surgery with a definitive complication rate of 1% or less; and (2) to analyze the risk factors for complications in these patients. Summary Background Data: There is current controversy over the role of TT in the treatment of MG;

Juan Riquelme; Teresa Soria; Manuel Canteras; Pascual Parrilla



Prospective Study of Postoperative Complications After Total Thyroidectomy for Multinodular Goiters by Surgeons With Experience in Endocrine Surgery  

PubMed Central

Objetives: (1) To show that total thyroidectomy (TT) can be performed in multinodular goiter (MG) by surgeons with experience in endocrine surgery with a definitive complication rate of 1% or less; and (2) to analyze the risk factors for complications in these patients. Summary Background Data: There is current controversy over the role of TT in the treatment of MG; although there are potential benefits, high rates of complications are not acceptable in surgery for a benign pathology. Patients and Method: A prospective study was conducted on 301 MGs meeting the following criteria: (1) bilateral MG; (2) no prior cervical surgery; (3) operation by surgeons with experience in endocrine surgery; (4) no associated parathyroid pathology; (5) no initial thoracic approach; and (6) minimum follow-up of 1 year. Age, sex, time of evolution, symptoms, cervical goiter grade, intrathoracic component, thyroid weight, and presence of associated carcinoma were analyzed as risk factors for complications. The ?2 test and a logistic regression analysis were applied. Results: Complications were presented by 62 patients (21%), corresponding to 29 hypoparathyroidisms, 26 recurrent laryngeal nerve injuries, 4 lesions of the superior laryngeal nerve, 3 cervical hematomas, and 1 infection of the cervicotomy. The variables associated with the presence of these complications were hyperthyroidism (P = 0.0033), compressive symptoms (P = 0.0455), intrathoracic component (P = 0.0366), goiter grade (P = 0.0195), and weight of excised specimen (P = 0.0302); hyperthyroidism (relative risk [RR] 2.5) and intrathoracic component (RR 1.5) persisted as independent risk factors. Definitive complications appeared in 3 patients (1%), corresponding to 2 hypoparathyroidisms and 1 recurrent laryngeal nerve injury. Two cases corresponded to a toxic goiter, and the third to an intrathoracic goiter with compressive symptoms. Conclusion: In endocrine surgery units, TT can be performed for MG with a definitive complication rate of around 1%; the main independent risk factors for the development of complications are hyperthyroidism and goiter size.

Zambudio, Antonio Rios; Rodriguez, Jose; Riquelme, Juan; Soria, Teresa; Canteras, Manuel; Parrilla, Pascual



Efficacy of Postoperative Transarterial Chemoembolization and Portal Vein Chemotherapy for Patients with Hepatocellular Carcinoma Complicated by Portal Vein Tumor Thrombosis—a Randomized Study  

Microsoft Academic Search

Objectives  The aim of this single, randomized study was to explore the efficacy of postoperative transarterial chemoembolization (TACE)\\u000a and portal vein chemotherapy (PVC) for patients with hepatocellular carcinoma (HCC) complicated by portal vein tumor thrombosis\\u000a (PVTT) and to evaluate prognostic factors.\\u000a \\u000a \\u000a \\u000a Methods  The study cohort consisted of 112 patients with HCC and PVTT randomly divided into three groups: Group A (37 patients),

Q. Li; J. Wang; Y. Sun; Y. L. Cui; J. T. Juzi; H. X. Li; B. Y. Qian; X. S. Hao



Association of Clinical and Dosimetric Factors with Postoperative Pulmonary Complications in Esophageal Cancer Patients Receiving Intensity-Modulated Radiation Therapy and Concurrent Chemotherapy Followed by Thoracic Esophagectomy  

Microsoft Academic Search

Background  To investigate the association between clinical\\/dosimetric factors and postoperative pulmonary complications (PPC) in esophageal\\u000a cancer patients undergoing neoadjuvant chemotherapy and intensity-modulated radiation therapy (IMRT) followed by thoracic\\u000a esophagectomy.\\u000a \\u000a \\u000a \\u000a Methods  The data from 52 patients receiving combined modality treatment were analyzed. Chemotherapy was taxane-based in 43 and 5-fluorouracil-based\\u000a in 9 patients. IMRT (40–45 Gy, median 40 Gy, at 1.8–2 Gy per fraction) was given using

Feng-Ming Hsu; Yung-Chie Lee; Jang-Ming Lee; Chih-Hung Hsu; Chia-Chi Lin; Yu-Chieh Tsai; Jian-Kuen Wu; Jason Chia-Hsien Cheng



A Cochrane Systematic Review finds no significant difference in outcome or risk of postoperative complications between day care and in-patient cataract surgery.  


This review was conducted to determine reliable evidence regarding the safety, feasibility, effectiveness, and cost-effectiveness of cataract extraction performed as a day care versus in-patient procedure. The search to identify randomized controlled trials comparing day care and in-patient surgery for age-related cataract included the Cochrane Eyes and Vision Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and LILACS Latin American and Caribbean Literature on Health Sciences. Assessment of methodological quality was based on criteria defined by the Cochrane Collaboration. The primary outcome was the achievement of a satisfactory visual acuity 6 weeks after operation. Two trials, involving a total of 1284 people, are included. One trial reported statistically significant differences in early postoperative complication rates in the day care group, which had no clinical relevance to visual outcomes 4 months postoperatively. Mean change in visual acuity Snellen lines of the operated eye 4 months postoperatively was 4.1 standard deviation SD 2.3 for the day care group and 4.1 SD 2.2 for the in-patient group. Costs were 20% more for the in-patient group attributable to higher costs for overnight stay. PMID:16951761

Fedorowicz, Zbigniew; Lawrence, David J; Gutierrez, Peter



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.

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



Spontaneous C1 anterior arch fracture as a postoperative complication of foramen magnum decompression for Chiari malformation type 1  

PubMed Central

Background: C1 fracture accounts for 2% of all spinal column injuries and 10% of cervical spine fractures, and is most frequently caused by motor vehicle accidents and falls. We present a rare case of C1 anterior arch fracture following standard foramen magnum decompression for Chiari malformation type 1. Case Description: A 63-year-old man underwent standard foramen magnum decompression (suboccipital craniectomy and C1 laminectomy) under a diagnosis of Chiari malformation type 1 with syringomyelia in June 2009. The postoperative course was uneventful until the patient noticed progressive posterior cervical pain 5 months after the operation. Computed tomography of the upper cervical spine obtained 7 months after the operation revealed left C1 anterior arch fracture. The patient was referred to our hospital at the end of January 2010 and C1–C2 posterior fusion with C1 lateral mass screws and C2 laminar screws was carried out in March 2010. Complete pain relief was achieved immediately after the second operation, and the patient resumed his daily activities. Conclusion: Anterior atlas fracture following foramen magnum decompression for Chiari malformation type 1 is very rare, but C1 laminectomy carries the risk of anterior arch fracture. Neurosurgeons should recognize that fracture of the atlas, which commonly results from an axial loading force, can occur in the postoperative period in patients with Chiari malformation.

Hirano, Yoshitaka; Sugawara, Atsushi; Mizuno, Junichi; Takeda, Masaaki; Watanabe, Kazuo; Ogasawara, Kuniaki



[Dynamics of higher mental functions and complications in the early post-operative phase of carotid endarterectomy].  


Authors conducted a clinical-instrumental examination of 97 patients in the post-operative phase of reconstructive surgery of carotid arteries. Evaluation of neurological status, Luria's syndrome neuropsychological analysis for assessment of higher mental functions dynamics (HMF) were carried out. Pre-operative ultrasound duplex scanning of brachio-cephalic arteries and investigation of cerebral perfusion using spiral computed tomography (SCT-perfusion) were done before and 1 day after the surgery. The frequency of intrasurgery stroke in the area of the operated carotid artery was 2.1%. Pre-operative SCT-perfusion revealed the syndrome of cerebral hyperperfusion in 3.1% of patients with higher (>1 s) difference between the average time of blood transition in temporal areas. Dynamics of HMF was the key clinical indicator that allowed to evaluate the course of nearest post-operative phase and to compare it with an area of operated vessel. Changes of HMF were characterized by the decrease in dysfunction of the hemisphere ipsilateral to the side of operation or had differently directed character. The aggravation of HMF disturbances was found in 40% of patients and was represented by syndromes with different topical location. Causes and mechanisms of the development of these changes are discussed. PMID:22792749

Skvortsova, V I; Gavrilova, O V; Stakhovskaia, L V; Buklina, S B; Usachev, D Iu; Lukshin, V A; Beliaev, A Iu; Akhmetov, V V



Chronic sternum wound infection caused by Mycobacterium tuberculosis after cardiac surgery.  


The sternum wound infection, caused by Mycobacterium tuberculosis after a cardiac surgery, is an extremely rare postoperative complication. It requires a high degree of suspicion for a correct diagnosis. Often a successful treatment is impeded by the insidious nature of tuberculosis infection and the time-consuming diagnosis process. We report two cases in which we successfully treated this infection with sternum resection, wound debridement, and antituberculosis medication. PMID:23006691

Kim, Ho Jin; Kim, Joon Bum; Chung, Cheol Hyun



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.

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



Wound necrosis after total knee arthroplasty.  


Quickly evolutive skin necrosis and deep infection after total knee arthroplasty (TKA) are not uncommon. Several predisposing factors, such as immunosuppression, malnutrition, steroid use, rheumatoid arthritis, multiple scars, and vascular disease can be involved in the onset of wound complications, as well as long tourniquet time and early knee flexion. Skin necrosis after TKA can be treated in different ways, including local wound care, debridement, and soft tissue coverage with muscle or skin grafts. This article presents a rare case of skin necrosis occurring in a patient without any other apparent risk factor after TKA. A 78-year-old woman affected by primary osteoarthritis of the right knee who had no comorbidities and who had already undergone TKA for primary osteoarthritis on the left knee underwent a cemented TKA. Three days postoperatively, she developed a fever and wound problems, which soon after turned into skin necrosis. This complication was first treated surgically with a debridement of the wound with antibiotic therapy and local wound care, then with vacuum-assisted closure (Kinetic Concepts Inc, San Antonio, Texas) therapy and soft tissue coverage using skin grafting. She had a complete recovery in the next 3 months; the skin grafting was well tolerated and the range of motion and functional outcome were good. PMID:19292412

Patella, Vittorio; Speciale, Domenico; Patella, Silvio; Moretti, Biagio; Pesce, Vito; Spinarelli, Antonio



Case report - Congenital Endogenously acquired deep sternal wound infection after congenital cardiac surgery  

Microsoft Academic Search

A 10-month-old child from the Middle East received complete correction for tetralogy of Fallot. Despite an initially uneventful postoperative course, he developed severe deep sternal wound infection after 7 days. This complication was endogenously acquired caused by a resistant and rarely present in Europe, Streptococcus pneumonia. Following surgical debridement, betadine rinsing for 3 days and with a course of specific

Thomas Walther; Martin Elliott



Achieving international consensus for the prevention of orthopaedic wound blistering: results of a Delphi survey.  


This article presents the results of an international 2 stage Delphi survey carried out via e-mail to achieve consensus as to the most effective postoperative wound management to prevent blistering and other complications. Seventeen prospective participants were invited to be members of the Delphi Panel of which 13 agreed to be involved. The panel suggested that an ideal wound dressing would conform easily to the wound, be easy to apply and remove, allow for swelling and minimise pain on removal. Participants were in agreement that the primary wound dressing should be left in situ for as long as possible, providing there was no excessive oozing or signs of infection. The authors recognise that the Delphi Panel was relatively compact; however, the study arguably provides some useful data that can be used to identify the consequences of wound blistering and important factors that need to be considered when choosing a wound dressing to prevent blistering. PMID:22405132

Ousey, Karen; Gillibrand, Warren; Stephenson, John



Two-dimensional and color Doppler echocardiographic diagnosis of penetrating missile wounds of the heart: chronic complications from intracardiac course of a bullet.  


Two-dimensional echocardiography has gained a role in the management of the acute complications of penetrating cardiac trauma and in precisely localizing retained bullet fragments within the heart. We report the case of an 8-year-old boy with chronic symptoms after a bullet wound. In this case, traumatic mitral regurgitation caused by mitral leaflet perforation and retention of the bullet in the tricuspid annulus occurred because of an unusual intracardiac course of the projectile. The diagnosis was made by transthoracic echocardiography. The ability of two-dimensional echocardiography to delineate the true location of the foreign body within the heart and Doppler ultrasound to identify mitral valve perforation helped guide a prompt, efficient, and successful surgical procedure. PMID:1739476

Xie, S W; Picard, M H


Delayed postoperative neurological complication in a patient with congenital kyphoscoliosis: recovered by revision of the 4-rod instrumentation technique.  


The authors report a case of progressive congenital kyphoscoliosis in which the patient, a boy, originally underwent combined anterior and instrumented posterior spinal fusion at the age of 7 years and 3 months. Early proximal junctional kyphosis and implant failure mandated proximal extension of implants with 2 new rods connected to the old caudad short rods. At the 3-year follow-up, clinical and CT assessment revealed a thoracolumbar pseudarthrosis for which the patient underwent a 2-stage procedure without complication. Recordings of somatosensory evoked potentials intraoperatively were normal. Twelve hours after surgery, his neurological status started to progressively deteriorate. The patient was brought to the operating room, and the initially achieved correction was reversed by an apex-only exposure of the 4-rod system. After surgery the patient started to show progressive improvement in his neurological function. A final myelography was performed and showed free passage of the dye without evidence of obstruction. Clinically, the patient continued to improve and at his 3-month follow-up had near-complete resolution of his neurological deficits. Findings on his physical examination were normal at the final 12-year follow-up. Despite normal findings on intraoperative neuromonitoring, a delayed neurological deficit can occur after complex spine reconstruction. Preoperative risk assessment, surgical approach, and instrumentation deserve careful attention. Advantages of a 4-rod construct are discussed in this case. PMID:24053377

Javidan, Pooya; Kabirian, Nima; Mundis, Gregory M; Akbarnia, Behrooz A



Outcomes of wound closure with the reading man flap technique.  


Background:In dermatologic surgery, numerous flap types have been described for wound closure after skin cancer surgery. The reading man flap was first published in 2008 for the closure of skin defects of the face, trunk, and extremities. Technically, this flap is based on an asymmetrical Z-plasty.Objective:To investigate the feasibility, clinical outcomes, and postoperative complications for wound closure with the reading man flap technique.Methods:We treated seven patients (facial and extremity defects) after microscopically controlled surgery using the reading man flap technique. The median defect size was 491.71 mm2. All of the patients were treated under tumescent local anesthesia.Results:A tension-free defect closure was created in all patients. One minor complication, a wound infection on one leg, was observed.Conclusion:The described technique is an easy and safe dermatologic surgery procedure that can be performed under local anesthesia. PMID:24138973

Wagner, Justinus A; Simon, Jan C; Wetzig, Tino; Kendler, Michael


[Current aspects of postoperative thrombophlebitis and pulmonary artery thromboembolism].  


From analysis of clinical material of more than 1,000 patients with surgical diseases of the abdominal organs obtained by modern examination methods and processing developed by the author, including diagnostic, prognostic, and preventive procedures and methods, and from the results of pathopharmacological study of the venous bed in 500 patients who died in the early postoperative period, the main aspects of postoperative phlebothrombosis and thromboembolism of the pulmonary arteries were studied: their frequency, localization, early diagnosis, dynamics of changes, dependence on some risk factors, etc. The decisive rule of individual preoperative prognostication of postoperative venous thrombosis was developed and tested in the surgical clinic with 76% statistical significance. The use of the processing developed by the author reduced the incidence of postoperative thromboembolic complications in various groups of risk by 5-36 times and did not cause increased bleeding of the wound. PMID:7526026

Nozdrachev, Iu I



Wound botulism.  


All published cases of wound botulism were reviewed to describe the epidemiology, clinical manifestations, diagnosis, and treatment of this rare infection. The MEDLINE data base of English-language literature was searched from 1966 to 1992, using the keywords "wound botulism". Cases published during this period were identified, and the bibliographies of these articles were used to identify cases published before MEDLINE's search limit of 1966. Because of the limited number of published cases, all were reviewed. Data related to epidemiology, clinical manifestations, diagnosis and treatment were collected on each case. When possible, cross-references from case series or reviews were used to corroborate and supplement data for a given case. There were 40 cases identified as wound botulism. The case fatality rate was 10%. The 36 survivors had significant morbidity requiring prolonged medical care. Wound botulism is a rare life-threatening complication of trauma and i.v. drug abuse. The diagnosis should be considered in any patient with either of these risk factors who develop paresis of cranial nerves and a descending pattern of weakness. Treatment, including administration of antitoxin, should be initiated prior to definitive diagnosis by microbiologic laboratory tests. PMID:8066973

Mechem, C C; Walter, F G



A comparison of dipyridamole-thallium imaging and exercise testing in the prediction of postoperative cardiac complications in patients requiring arterial reconstruction  

SciTech Connect

The individual and combined predictive values of dipyridamole-thallium imaging and exercise testing were compared in a prospective study of 70 patients who had abdominal aortic aneurysms or aortoiliac occlusive disease that required surgical repair. All patients were evaluated clinically by the same cardiologist and had exercise stress testing and dipyridamole-thallium imaging before admission for surgery. Ten patients were excluded from the study because they had evidence of severe ischemia when tested (ST segment depression greater than 2 mm on exercise testing, severe multivessel disease on thallium imaging). The remaining 60 patients were operated on (abdominal aortic aneurysm repair, 40; aortobifemoral repair, 17; femorofemoral graft, 3). The test results were withheld from the surgeon, anesthetist, and cardiologist before surgery. A total of 22 patients experienced major cardiac complications postoperatively (acute pulmonary edema, 17; acute myocardial infarction, 5; cardiac death, 2). Thallium imaging showed myocardial ischemia in 31/60 patients. Exercise testing was positive (greater than or equal to 1 mm ST segment depression) in 10/60 patients. Dipyridamole-thallium imaging with a high sensitivity and reasonable specificity is the initial test of choice. Exercise testing is a poor screening test because of its low sensitivity. The combination of the two tests gives the highest positive predictive value and the greatest likelihood ratio. Thus patients assessed initially and found to have positive thallium scan results may be further stratified by exercise testing.

McPhail, N.V.; Ruddy, T.D.; Calvin, J.E.; Davies, R.A.; Barber, G.G.



Surgical complications in neuromuscular scoliosis operated with posterior- only approach using pedicle screw fixation  

PubMed Central

Background There are no reports describing complications with posterior spinal fusion (PSF) with segmental spinal instrumentation (SSI) using pedicle screw fixation in patients with neuromuscular scoliosis. Methods Fifty neuromuscular patients (18 cerebral palsy, 18 Duchenne muscular dystrophy, 8 spinal muscular atrophy and 6 others) were divided in two groups according to severity of curves; group I (< 90°) and group II (> 90°). All underwent PSF and SSI with pedicle screw fixation. There were no anterior procedures. Perioperative (within three months of surgery) and postoperative (after three months of surgery) complications were retrospectively reviewed. Results There were fifty (37 perioperative, 13 postoperative) complications. Hemo/pneumothorax, pleural effusion, pulmonary edema requiring ICU care, complete spinal cord injury, deep wound infection and death were major complications; while atelectesis, pneumonia, mild pleural effusion, UTI, ileus, vomiting, gastritis, tingling sensation or radiating pain in lower limb, superficial infection and wound dehiscence were minor complications. Regarding perioperative complications, 34(68%) patients had at least one major or one minor complication. There were 16 patients with pulmonary, 14 with abdominal, 3 with wound related, 2 with neurological and 1 cardiovascular complications, respectively. There were two deaths, one due to cardiac arrest and other due to hypovolemic shock. Regarding postoperative complications 7 patients had coccygodynia, 3 had screw head prominence, 2 had bed sore and 1 had implant loosening, respectively. There was a significant relationship between age and increased intraoperative blood loss (p = 0.024). However it did not increased complications or need for ICU care. Similarly intraoperative blood loss > 3500 ml, severity of curve or need of pelvic fixation did not increase the complication rate or need for ICU. DMD patients had higher chances of coccygodynia postoperatively. Conclusion Although posterior-only approach using pedicle screw fixation had good correction rate, complications were similar to previous reports. There were few unusual complications like coccygodynia.

Modi, Hitesh N; Suh, Seung-Woo; Yang, Jae-Hyuk; Cho, Jae Woo; Hong, Jae-Young; Singh, Surya Udai; Jain, Sudeep



[Gunshot wounds by military weapons].  


The review is based on 34 recent publications. Bullet-wounds by military weapons either in drill or war are to be regarded as special kinds of wounds, needing profound knowledge of wound ballistic. However, the therapy of late developing complications may lead to problems. PMID:437659

Fischer, H



Prevention of post-operative infections in spine surgery by wound irrigation with a solution of povidone–iodine and hydrogen peroxide  

Microsoft Academic Search

Introduction  Starting from January 2009, we systematically irrigated the surgical wounds of patients undergoing spine surgery with a solution\\u000a of povidone–iodine (PVP–I) and hydrogen peroxide (H2O2).\\u000a \\u000a \\u000a \\u000a \\u000a Method  We prospectively recorded the clinical data of patients who underwent spine surgery during 2009 and we compared the results\\u000a with retrospectively reviewed clinical records of patients operated during 2008. Patients were analyzed for preoperative risk

Simone Ulivieri; Stefano Toninelli; Carlo Petrini; Antonio Giorgio; Giuseppe Oliveri


Prvé výsledky analýzy ú?innosti antiseptík v prevencii poopera?ných infekcií v oblasti proximálneho femuru, bedrového k?bu a panvy u detských ortopedických pacientov Efficacy of Antiseptics in the Prevention of Post-Operative Infections of the Proximal Femur, Hip and Pelvis Regions in Orthopedic Pediatric Patients. Analysis of the First Results  

Microsoft Academic Search

PURPOSE OF THE STUDY In orthopedics an infected operative wound always presents a serious complication that, apart from many adverse effects on the patient, increases the costs of therapy. The aim of this study was to analyze the effectiveness of antiseptic agents in the prevention of postoperative complications associated with surgery on the proximal femur, hip and pelvis in children.




[Wounds and injuries to the colon].  


On the basis of a retrospective analysis of results of treatment of 1097 patients with wounds and injuries of the colon of the peace and war time as well as of experiments in 160 dogs it has been established that the level of lethal outcomes and amount of complications are dependent on the size, number and localization of the colon wounds, severity of peritonitis by the moment of primary operation, degree of traumatic shock, blood loss volume, severity of the coexisting injuries and the chosen method of surgical treatment. A classification of the wounds according to the volume of injuries of the colon is proposed. Different variants of surgical treatment and outcomes are considered. Experiments in dogs have shown the indisputable effectiveness of precise one-row sero-musculo-submucous sutures with the present-day sutural material as compared with other methods of treatment of wounds of the colon. The peritoneal sorption with liquid colloid sorbents at the early postoperative period facilitate the prophylaxis and treatment of peritonitis, reduce lethality. A surgical classification of injuries of the colon is developed and types of operative interventions are recommended. PMID:9490533

Sheianov, S D; Tsybuliak, G N



Management of "difficult" wounds.  


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



Medical hypnosis and orthopedic hand surgery: Pain perception, post-operative recovery, and adherence  

Microsoft Academic Search

Orthopedic hand-surgery patients experience severe pain post-operatively, yet they must engage in painful exercises and wound-care shortly after surgery; poor involvement results in complications that may lead to loss of function and\\/or disfigurement. This study tested a cognitive-behavioral intervention including relaxation, imagery, and therapeutic suggestions (hypnosis) designed to reduce pain perception, enhance post-surgical recovery, and facilitate rehabilitation.Sixty hand-surgery patients at

Magaly Hettinga Mauer



Puncture Wounds  


... wound during a puncture, along with dirt and debris from the object. All puncture wounds are dirty ... as a rusty nail, the more dirt and debris are dragged into the wound, increasing the chance ...


Deep sternal wound infection due to Pasteurella multocida : the first case report and review of literature  

Microsoft Academic Search

Pasteurella multocida is a Gram-negative bacterium recovered from a wide variety of wild and domestic animals and has mostly been associated with\\u000a infection following animal bites. We present the first reported case of a patient who developed a postoperative sternal wound\\u000a infection due to P. multocida complicated by bloodstream infection. The outcome was favorable following surgical debridement and antimicrobial therapy.

R. Baillot; P. Voisine; L. M. E. G. Côté; Y. Longtin


Intravitreal Fluorinated Gas Preference and Occurrence of Rare Ischemic Postoperative Complications after Pars Plana Vitrectomy: A Survey of the American Society of Retina Specialists  

PubMed Central

Objective. To perform a survey of the American Society of Retina Specialists (ASRS) regarding the use of vitreous cavity fluorinated gas as an adjunct to pars plana vitrectomy for retinal detachment or macular hole repair. Methods. A multiple-choice online questionnaire was administered to members of ASRS. Physician experience, gas preference for vitrectomy, and categorical estimate of observation of blinding postoperative ischemic events were recorded. Results. 282 questionnaires were completed. Mean years in vitreoretinal practice were 15 ± 10. A decrease in yearly vitrectomy volume was associated with increased number of years in practice (P = 0.011). Greater than 95% of respondents preferred fluorinated gas to air alone for both retinal detachment and macular hole repair. 38% of respondents reported at least one observation of a blinding ischemic postoperative event. Overall estimated incidence of blinding postoperative ischemic event was 0.06 events/year in practice. Conclusions. Currently, C3F8 and SF6 are the postoperative gas preference for ASRS respondents, in contrast to previous North American surveys. The occurrence of blinding ischemic events appears unrelated to number of years in practice, was reported by less than half of those surveyed, and has occurred at an infrequent rate of approximately once for every ten years of practice for those observing the phenomena.

Sigler, Eric J.; Randolph, John C.; Charles, Steve; Calzada, Jorge I.



Intravitreal fluorinated gas preference and occurrence of rare ischemic postoperative complications after pars plana vitrectomy: a survey of the american society of retina specialists.  


Objective. To perform a survey of the American Society of Retina Specialists (ASRS) regarding the use of vitreous cavity fluorinated gas as an adjunct to pars plana vitrectomy for retinal detachment or macular hole repair. Methods. A multiple-choice online questionnaire was administered to members of ASRS. Physician experience, gas preference for vitrectomy, and categorical estimate of observation of blinding postoperative ischemic events were recorded. Results. 282 questionnaires were completed. Mean years in vitreoretinal practice were 15 ± 10. A decrease in yearly vitrectomy volume was associated with increased number of years in practice (P = 0.011). Greater than 95% of respondents preferred fluorinated gas to air alone for both retinal detachment and macular hole repair. 38% of respondents reported at least one observation of a blinding ischemic postoperative event. Overall estimated incidence of blinding postoperative ischemic event was 0.06 events/year in practice. Conclusions. Currently, C3F8 and SF6 are the postoperative gas preference for ASRS respondents, in contrast to previous North American surveys. The occurrence of blinding ischemic events appears unrelated to number of years in practice, was reported by less than half of those surveyed, and has occurred at an infrequent rate of approximately once for every ten years of practice for those observing the phenomena. PMID:22997567

Sigler, Eric J; Randolph, John C; Charles, Steve; Calzada, Jorge I



Metabolic response to abdominal surgery: the 2-wound model.  


An abdominal operation combines a somatic abdominal wall wound with a second autonomic wound to the peritoneal cavity and viscera and little attention has been paid the autonomic/peritoneal wound that communicates directly to the brain by the vagus nerve. Moreover, vagal input originating from the peritoneum modulates and regulates postoperative recovery. Consequently, blockade of the afferent neural and inflammatory input from this autonomic/peritoneal wound will reduce postoperative neurohormonal stress and enhance patient recovery from an abdominal operation. PMID:21145570

Kahokehr, Arman; Sammour, Tarik; Srinivasa, Sanket; Hill, Andrew G



Outbreak of Staphylococcal Infections in Postoperative Primates.  

National Technical Information Service (NTIS)

In late October 1974, a Staphylococcus aureus postoperative wound infection was recorded in a primate which had recently undergone surgery at the Veterinary Sciences Division, Brooks AFB, Texas. A second case was noted approximately two weeks later, follo...

L. E. Blouse R. M. Brockett P. J. Homme E. F. Jones



Surgical strategy for combined wounds of vessels and internal organs.  


Surgical strategy and outcomes were analysed for 51 patients with combined wounds of internal organs and major blood vessels, with total 87 organ and 65 vessel injures. In 29 cases intracavity vessels were injured, in 22 - peripheral ones. In 47 cases (92.1%) traumas were gunshot. On admission 43 patients were in poor clinical condition with III-IV grade shock. The delay of surgical intervention did not exceed 30-40 min, all patients were operated in emergency, regardless of complete preoperative preparation. Blood reinfusion was used for all intracavity bleedings. The consequence of surgical steps was determined by localization of vascular trauma, bleeding intensity and severity of organ injuries. In order to decrease invasiveness and duration of surgery, conventional wound suturing was used for 53 organs, vascular plasty and sutures - in 35 cases, ligation of vessels - in 27. Lobectomy was executed in 1 case, intestinal resection and anastomosis - in 8, ileo-and colostomy - in 7 patients. Total 73 internal organs and 62 vessels were reconstructed. Postoperative complications have developed in 30 patients (58.8%), lethal outcome occurred in 3 patients during operation and in 10 (25.4%) - postoperatively. The majority of complications and deaths were observed for thoracoabdominal traumas. High postoperative mortality was also seen for patients with combined injuries of abdominal organs and vessels (13.7%). PMID:14657937

Gul'muradov, T G; Gaibov, A D; Sultanov, D D; Zhuraev, T Kh



Rectocutaneous fistula: a rare complication of the posterior intravaginal sling.  


The posterior intravaginal sling (IVS) is a device used to correct apical vaginal prolapse; there are limited data on associated complications. We present a case report of a rectocutaneous fistula forming after placement of a posterior IVS in a 59-year-old woman 2 months postoperatively. The sling was resected during sigmoidoscopy with scissors, and the colon laceration was closed. The buttock wound underwent delayed healing 2 weeks later. More data regarding complications associated with use of this device are needed before widespread use. PMID:17928934

Yee, Yoke-Hong; Lu, Chien-Chang; Kung, Fu-Tsai; Huang, Kuan-Hui



Pathophysiology and prevention of postoperative peritoneal adhesions  

PubMed Central

Peritoneal adhesions represent an important clinical challenge in gastrointestinal surgery. Peritoneal adhesions are a consequence of peritoneal irritation by infection or surgical trauma, and may be considered as the pathological part of healing following any peritoneal injury, particularly due to abdominal surgery. The balance between fibrin deposition and degradation is critical in determining normal peritoneal healing or adhesion formation. Postoperative peritoneal adhesions are a major cause of morbidity resulting in multiple complications, many of which may manifest several years after the initial surgical procedure. In addition to acute small bowel obstruction, peritoneal adhesions may cause pelvic or abdominal pain, and infertility. In this paper, the authors reviewed the epidemiology, pathogenesis and various prevention strategies of adhesion formation, using Medline and PubMed search. Several preventive agents against postoperative peritoneal adhesions have been investigated. Their role aims in activating fibrinolysis, hampering coagulation, diminishing the inflammatory response, inhibiting collagen synthesis or creating a barrier between adjacent wound surfaces. Their results are encouraging but most of them are contradictory and achieved mostly in animal model. Until additional findings from future clinical researches, only a meticulous surgery can be recommended to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery. In the current state of knowledge, pre-clinical or clinical studies are still necessary to evaluate the effectiveness of the several proposed prevention strategies of postoperative peritoneal adhesions.

Arung, Willy; Meurisse, Michel; Detry, Olivier



[Wounds and dermatoses].  


Wounds are a hallmark of various skin diseases. Most patients with wounds suffer from chronic venous insufficiency or other vascular diseases. Autoimmune, infective, metabolic, malignant, some psychiatric and diseases caused by environmental factors like radiation, present with skin and mucosal erosions and ulcerations. Lichen planus, lichen sclerosus, toxic epidermal necrolysis, Kaposi sarcoma, genodermatoses like Hailey-Hailey and Darier's disease belong to different dermatological entities, they have different etiology, pathogenesis and clinical presentation, but at some stage ulcerations and erosions dominate through the disease course as a result of complications of untreated disease or as part of a complex clinical presentation. Wounds demand a different multidisciplinary therapeutic approach, sometimes even in intensive care unit, where special care is available. Most patients are followed-up to avoid fatal complications like sepsis, as well as a potential malignant transformation of cells in the environment of chronic inflammation. Wounds are found in female genital lichen planus and lichen sclerosus. Oral lichen planus has a potential for malignant transformation and is considered a precancerous disease. Toxic epidermal necrolysis is a life threatening disease similar to burns. Wounds cover most of the body surface as well as mucosa. The high mortality rate is due to complications like sepsis, loss of thermoregulation, electrolyte and fluid disbalance and shock. Chronic wounds are also a hallmark of skin tumors and other skin malignancies like Kaposi sarcoma and lymphoma. The primary treatment goal in genodermatoses like epidermolysis bullosa is wound care, and to a less extent in other inherited skin diseases like Hailey-Hailey and Darier's disease wound healing is important for sustaining a good quality of life in affected individuals. PMID:23193818

Buli?, Suzana Ozani?; Kotrulja, Lena; Sjerobabski-Masnec, Ines



Lung perfusion and ventilation during implantation of left ventricular assist device as a strategy to avoid postoperative pulmonary complications and right ventricular failure.  


Right ventricular failure is a major contributor to increased morbidity and mortality in patients undergoing left ventricular assist device implantation. Cardiopulmonary bypass is associated with increased pulmonary ischaemia and pulmonary vascular resistance. Continuous pulmonary perfusion and ventilation represents an emerging strategy for pulmonary protection during cardiac surgery. We hypothesize that this technique may have a pivotal role in reducing postoperative right ventricular dysfunction in high-risk patients undergoing LVAD placement. PMID:23933964

Macedo, Francisco Igor B; Panos, Anthony L; Andreopoulos, Fotios M; Salerno, Tomas A; Pham, Si M



Postoperative Outcome of Colectomy for Pediatric Patients With Ulcerative Colitis  

PubMed Central

Background Few studies have reported on the surgical outcomes of colectomy in pediatric patients with ulcerative colitis (UC). Patients and Methods We conducted a retrospective chart review of all pediatric patients diagnosed with UC who underwent colectomy at UCSF between 1980 and 2005 to identify early (within 30 days) and later complications of surgery. Results Complete medical records were available for 31 patients [12.4 ± 3.3 (range 6–19) years] with UC who underwent colectomy at UCSF Children’s Hospital. Total colectomy with ileal pouch anal anastomosis (IPAA) was performed in 21 of the 31 patients (12 without diverting ileostomy). Five of the 31 patients had an initial colectomy with IPAA and J-pouch performed later; 4 had an initial subtotal colectomy for urgent indications. Only one of 31 had IPAA with S-pouch. The median number of early postoperative complications was 1.0; 4 required additional surgery to treat complications. The most common early complications were small intestinal obstruction in 6 (19%) and wound infection in 4 (13%). Preoperative medications included corticosteroids in 25 (81%), 6-mercaptopurine/azathioprine in 10 (32%), and 5-aminosalicylates in 19 (61%). Medication exposure was not related to postoperative complications. Late complications included pouchitis in 12 (39%), anastomotic, anal, or rectal strictures in 5 (16%), and fistulas in 5 (16%); 1 (3%) was subsequently diagnosed as having Crohn disease. Conclusions Postcolectomy morbidity is common among pediatric patients with UC. Preoperative medications were not associated with postoperative complications. Investigations to determine preoperative factors affecting surgical outcomes and long-term satisfaction following this surgery in a large pediatric cohort are needed.

Patton, Dana; Gupta, Neera; Wojcicki, Janet M.; Garnett, Elizabeth A.; Nobuhara, Kerilyn; Heyman, Melvin B.



Detachment and dislocation of thermoreactive clips from sternum in late postoperative period due to misuse  

PubMed Central

Median sternotomy is the most common method of access to the heart and great vessels in cardiac surgical procedures. However, particularly in obese and diabetic patients, complications such as dehiscence, osteomyelitis, mediastinitis and superficial wound infection or fistula formation may be encountered. To overcome these complications, some alternative surgical techniques and surgical equipment are designed for sternal closure. ‘Nitinol thermoreactive clips’ is one of them. In this study, we report a patient with detachment of thermoreactive clips from sternum in the late postoperative period due to wrong measurement of distance between intercostal spaces.

Tavlasoglu, Murat; Kurkluoglu, Mustafa; Arslan, Zekeriya; Durukan, Ahmet Bar?s



Emerging new drugs for wound repair.  


Every year, millions of people experience burns, suffer from nonhealing wounds, or have acute wounds that become complicated by infection, dehiscence or problematic scarring. Effective wound treatment requires carefully considered interventions often requiring multiple clinic or hospital visits. The resulting costs of wound care are staggering, and more efficacious and cost-effective therapies are needed to decrease this burden. Unfortunately, the expenses and difficulties encountered in performing clinical trials have led to a relatively slow growth of new treatment options for the wound management. Research efforts attempting to examine wound pathophysiology have been hampered by the lack of an adequate chronic wound healing model, and the complexity of the wound healing cascade has limited attempts at pharmacological modification. As such, currently available wound healing therapies are only partially effective. Therefore, many new therapies are emerging that target various aspects of wound repair and the promise of new therapeutic interventions is on the immediate horizon. PMID:16503824

Meier, Karen; Nanney, Lillian B



Epidural Analgesia in the Postoperative Period.  

National Technical Information Service (NTIS)

Postoperative pain is an unwanted side effect of surgery, and is associated with many postoperative complications. This descriptive study was conducted to determine which surgical patients experienced the most analgesia with the fewest side effects when r...

C. E. Mathsen R. C. Smith



Managing complications of posterior spinal instrumentation and fusion.  


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



Local anaesthetic infusion for postoperative pain  

Microsoft Academic Search

The role of continuous bupivacaine infusion either into the wound or as a local nerve block, following hand surgery was investigated in 100 patients. After excluding six patients with complex pain problems in whom neither the bupivacaine infusion nor any other conventional analgesic techniques provided adequate analgesia post-operatively, 86 of 94 (91%) patients were adequately treated for post-operative pain by

M. Kulkarni; D. Elliot



Bioelectrical Impedance Assessment of Wound Healing  

PubMed Central

Objective assessment of wound healing is fundamental to evaluate therapeutic and nutritional interventions and to identify complications. Despite availability of many techniques to monitor wounds, there is a need for a safe, practical, accurate, and effective method. A new method is localized bioelectrical impedance analysis (BIA) that noninvasively provides information describing cellular changes that occur during healing and signal complications to wound healing. This article describes the theory and application of localized BIA and provides examples of its use among patients with lower leg wounds. This promising method may afford clinicians a novel technique for routine monitoring of interventions and surveillance of wounds.

Lukaski, Henry C; Moore, Micheal



Perioperative Hyperglycemia and Postoperative Infection after Lower Limb Arthroplasty  

PubMed Central

Background One of the most serious complications after major orthopedic surgery is deep wound or periprosthetic joint infection. Various risk factors for infection after hip and knee replacement surgery have been reported, including patients' comorbidities and surgical technique factors. We investigated whether hyperglycemia and diabetes mellitus (DM) are associated with infection that requires surgical intervention after total hip and knee arthroplasty. Methods We reviewed our computerized database for elective primary total hip and knee arthroplasty from 2000 to 2008. Demographic information, past medical history of patients, perioperative biochemistry, and postoperative complications were reviewed. Patients were divided into two groups: infected group (101 patients who had surgical intervention for infection at our institution within 2 years after primary surgery) and noninfected group (1847 patients with no intervention with a minimum of one year follow-up. The data were analyzed using t, chi-squared, and Fisher's exact tests. Results There were significantly more diabetes patients in the infected group compared with the noninfected group (22% versus 9%, p < .001). Infected patients had significantly higher perioperative blood glucose (BG) values: preoperative BG (112 ± 36 versus 105 ± 31 mg/dl, p = .043) and postoperative day (POD) 1 BG (154 ± 37 versus 138 ± 31 mg/dl, p < .001). Postoperative morning hyperglycemia (BG >200 mg/dl) increased the risk for the infection more than two-fold. Non-DM patients were three times more likely to develop the infection if their morning BG was >140 mg/dl on POD 1, p = .001. Male gender, higher body mass index, knee arthroplasty, longer operative time and hospital stay, higher comorbidity index, history of myocardial infarction, congestive heart failure, and renal insufficiency were also associated with the infection. Conclusions Diabetes mellitus and morning postoperative hyperglycemia were predictors for postoperative infection following total joint arthroplasty. Even patients without a diagnosis of DM who developed postoperative hyperglycemia had a significantly increased risk for the infection.

Mraovic, Boris; Suh, Donghun; Jacovides, Christina; Parvizi, Javad



Oral health care reduces the risk of postoperative surgical site infection in inpatients with oral squamous cell carcinoma  

Microsoft Academic Search

Purpose  Postoperative wound infection (WI) is a main complication after head and neck surgery. Poor oral health may be a risk factor\\u000a for WI. We therefore assessed the contribution of oral health care in preventing postoperative WI in patients with oral squamous\\u000a cell carcinoma (OSCC).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A total of 66 consecutive inpatients with OSCC (mean age, 68 years) was divided into two groups

Jun Sato; Jun Goto; Ayako Harahashi; Tsubasa Murata; Hironobu Hata; Yutaka Yamazaki; Akira Satoh; Ken-ichi Notani; Yoshimasa Kitagawa



[Timing of dressing removal in the healing of surgical wounds by primary intention: a meta-analysis].  


An appropriate postoperative wound management helps to prevent surgical site infections. However, ideal timing of dressing removal is an unresolved issue in current practice. The objective of this systematic review therefore was to provide a comprehensive synthesis of existing evidence concerning the efficacy of different periods of postoperative dressing removal in surgical wounds which are healing by primary intention. We searched MEDLINE, EMBASE, CINAHL, The Cochrane Library (all in August 2011), and hand-searched additional sources. All randomised controlled trials that were comparing different periods of leaving dressings in place, including not dressing the surgical site at all, and covering wounds until suture removal were included. We conducted our systematic review and meta-analysis in accordance with the recommendations of the Cochrane Collaboration. Eight trials with a total of 2097 participants were included in our meta-analysis. All studies were at high or unclear risk of bias. This meta-analysis did not show a higher rate of wound infections or other wound complications associated with an early dressing removal in wounds that are healing by primary intention: risk difference (RD) -0.01; 95%-confidence interval (CI) -0.03, 0.01. However, conclusions are limited due to bad study quality of included studies. Finally more sound research is needed. PMID:23876662

Eberhardt, Doris; Berg, Almuth; Fleischer, Steffen; Langer, Gero



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.



Postoperative fatigue  

Microsoft Academic Search

Uncomplicated major surgery is followed by a pronounced increased feeling of fatigue extending throughout the first month in about one-third of patients. Postoperative fatigue correlates with the degree of surgical trauma but is not related to duration of general anesthesia and surgery or to preoperative nutritional status, age, or sex. Fatigue also correlates with postoperative deterioration in nutritional parameters and

Tom Christensen; Henrik Kehlet



Usefulness of C-reactive protein, serum amyloid A component, and haptoglobin determinations in bitches with pyometra for monitoring early post-ovariohysterectomy complications.  


The aim of this study was to assess changes in serum concentrations of C-reactive protein (CRP), serum amyloid A component (SAA), and haptoglobin (Hp) in bitches with pyometra undergoing ovariohysterectomy that developed postoperative wound infection-related complications. The study revealed that difficulties in postoperative wound healing were induced by infections with Escherichia coli and Staphylococcus spp. leading to re-increased levels of CRP and SAA immediately after surgery and persistently high Hp levels throughout the experiment. Our results indicate that acute-phase proteins in bitches undergoing surgery because of pyometra are useful markers for monitoring the postoperative period. Moreover, they enable prompt therapeutic management once complications develop. PMID:19477501

Dabrowski, R; Kostro, K; Lisiecka, U; Szczubia?, M; Krakowski, L



Infection in conflict wounded  

PubMed Central

Although mechanisms of modern military wounding may be distinct from those of ancient conflicts, the infectious sequelae of ballistic trauma and the evolving microbial flora of war wounds remain a considerable burden on both the injured combatant and their deployed medical systems. Battlefield surgeons of ancient times favoured suppuration in war wounding and as such Galenic encouragement of pus formation would hinder progress in wound care for centuries. Napoleonic surgeons eventually abandoned this mantra, embracing radical surgical intervention, primarily by amputation, to prevent infection. Later, microscopy enabled identification of microorganisms and characterization of wound flora. Concurrent advances in sanitation and evacuation enabled improved outcomes and establishment of modern military medical systems. Advances in medical doctrine and technology afford those injured in current conflicts with increasing survivability through rapid evacuation, sophisticated resuscitation and timely surgical intervention. Infectious complications in those that do survive, however, are a major concern. Addressing antibiotic use, nosocomial transmission and infectious sequelae are a current clinical management and research priority and will remain so in an era characterized by a massive burden of combat extremity injury. This paper provides a review of infection in combat wounding from a historical setting through to the modern evidence base.

Eardley, W. G. P.; Brown, K. V.; Bonner, T. J.; Green, A. D.; Clasper, J. C.



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.

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



Wound dressings.  


There are currently hundreds of dressings on the market to aid in wound management. Before selecting a dressing for a particular wound, a practitioner must assess carefully the needs of the wound to understand which dressing would provide maximal benefit. Frequently, there is not one clear best choice, and it is crucial that the pros and cons of each dressing modality be understood. This article has provided a framework to assist in dressing assessment. PMID:12822729

Lionelli, Gerald T; Lawrence, W Thomas



Utility of the Omentum in the Reconstruction of Complex Extraperitoneal Wounds and Defects  

PubMed Central

Objective To examine donor-site complications after omental harvest for the reconstruction of extraperitoneal wounds and defects. Summary Background Data The omentum, with its immunologic and angiogenic properties, is a versatile organ with well-documented utility in the reconstruction of complex wounds and defects. However, the need for laparotomy and the potential for intraabdominal complications have been cited as relative contraindications to the use of the omentum as a reconstructive flap. Further, few series have assessed long-term results, and no reports have focused on donor-site complications. Methods Patients who underwent reconstruction of extraperitoneal defects with the omentum at a single university healthcare system were identified by searching discharge databases and office records. Charts were reviewed to determine patient demographics, surgical indications and technique, postoperative complications, and outpatient follow-up. Patients with donor-site complications were compared with patients who had no complications using the Student t test and chi-square analysis. Statistical significance was defined at P < .05. Results From 1975 to 2000, the authors successfully harvested 135 omental flaps (64 pedicled, 71 free transfer) for reconstruction of the following defects: scalp (n = 16), intracranial (n = 1), orbitofacial (n = 33), neck (n = 8), upper extremity (n = 7), lower extremity (n = 4), intrathoracic (n = 3), sternal (n = 34), breast (n = 3), chest wall (n = 18), abdominal wall (n = 1), and perineal (n = 7). Donor-site complications in 25 patients (18.5%) included abdominal wall infection (n = 9), fascial dehiscence (n = 8), symptomatic hernia (n = 8), unplanned reexploration (n = 6), postoperative ileus (n = 3), gastrointestinal hemorrhage (n = 2), delayed splenic rupture (n = 1), gastric outlet obstruction (n = 1), and late partial small bowel obstruction (n = 1). Factors associated with increased donor-site complications included the use of pedicled flaps (compared with free tissue transfer), mediastinitis, advanced age, and pulmonary failure. Of note, 53 patients had undergone previous abdominal surgery; of these, 26 patients required extensive adhesiolysis and 4 patients sustained enterotomies. Eleven patients (8.1%) had partial flap loss and three patients (2.2%) had total flap loss. Mean length of stay was 28 days. Average follow-up was 2.4 years. The death rate was 5.9%. Conclusions The omentum can be safely harvested and reliably used to reconstruct a diverse range of extraperitoneal wounds and defects. Donor-site complications can be significant but are usually limited to abdominal wall infection and hernia. Risk factors associated with complications include the use of pedicled flaps, mediastinitis, and pulmonary failure. This low rate of donor-site complications strongly supports the use of the omentum in the reconstruction of complex wounds and defects.

Hultman, C. Scott; Carlson, Grant W.; Losken, Albert; Jones, Glyn; Culbertson, John; Mackay, Gregory; Bostwick, John; Jurkiewicz, M. J.



Fake Wounds  

NSDL National Science Digital Library

In this gross science activity, follow an easy recipe to make fake wounds to fool your friends or gross someone out during Halloween. Explore how and why scabs form to heal wounds and protect our bodies from infections. This activity guide includes a step-by-step instructional video.

Center, Saint L.



Wound cat’  

Microsoft Academic Search

Wound man’ refers to a stylised diagram used in early medical textbooks to illustrate the various injuries that the human body can sustain in battle. We have adapted this concept to create ‘Wound cat’, as a way to emphasise the type and location of injuries cats may inflict on one another during combat. We have further extended this concept to

Richard Malik; Jacqueline Norris; Joanna White; Bozena Jantulik



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.

Sen, Chandan K.



Gastrointestinal complications of the Ehlers-Danlos syndrome  

PubMed Central

The gastrointestinal abnormalities encountered in 125 patients with the Ehlers-Danlos syndrome have been described. Spontaneous perforation of the intestine and massive gastrointestinal haemorrhage are uncommon but potentially lethal complications of the Ehlers-Danlos syndrome. Less dangerous abnormalities, such `as external hernia, hiatus hernia, eventration of the diaphragm, intestinal diverticula, and rectal prolapse were all encountered in patients in the series. Abdominal surgery in affected patients may be made difficult by fragility of tissues and a bleeding tendency. In the postoperative period, tearing out of sutures and wound dehiscence may occur.

Beighton, Peter H.; Murdoch, J. Lamont; Votteler, Theodore



Rate of conversion and complications of laparoscopic cholecystectomy in a tertiary care center in Saudi Arabia  

PubMed Central

BACKGROUND AND OBJECTIVES: Problems during laparoscopic cholecystectomy include bile duct injury, conversion to open operation, and other postoperative complications. We retrospectively evaluated the causes for conversion and the rate of conversion from laparoscopic to open cholecystectomy and assessed the postoperative complications. METHODS: Of 340 patients who presented with symptomatic gall bladder disease over a 2-year period, 290 (85%) patients were evaluated on an elective basis and scheduled for surgery, while the remaining 50 (14.7%) patients were admitted emergently with a diagnosis of acute cholecystitis. RESULTS: The mean age of the patients was 41.9 (12.6) years. Conversion to laparotomy occurred in 17 patients (5%). The incidence of complications was 3.2%. The most common complication was postoperative transient pyrexia, which was seen in four patients (1.2%) followed by postoperative wound infection in three patients (0.9%), postoperative fluid collection and bile duct injury in two patients each (0.6%). CONCLUSION: Laparoscopic cholecystectomy remains the ‘gold standard’ by which all other treatment modalities are judged. Conversion from laparoscopic to open cholecystectomy should be based on the sound clinical judgment of the surgeon and not be due to a lack of individual expertise.

Ghnnam, Wagih; Malek, Jawid; Shebl, Emad; Elbeshry, Turky; Ibrahim, Ahmad



Pediatric wound infections: a prospective multicenter study.  

PubMed Central

OBJECTIVE: Surgical wound infections remain a significant source of postoperative morbidity. This study was undertaken to determine prospectively the incidence of postoperative wound infections in children in a multi-institutional fashion and to identify the risk factors associated with the development of a wound infection in this population. SUMMARY BACKGROUND DATA: Despite a large body of literature in adults, there have been only two reports from North America concerning postoperative wound infections in children. METHODS: All infants and children undergoing operation on the pediatric surgical services of three institutions during a 17-month period were prospectively followed for 30 days after surgery for the development of a wound infection. RESULTS: A total of 846 of 1021 patients were followed for 30 days. The overall incidence of wound infection was 4.4%. Factors found to be significantly associated with a postoperative wound infection were the amount of contamination at operation (p = 0.006) and the duration of the operation (p = 0.03). Comparing children who developed a wound infection with those who did not, there were no significant differences in age, sex, American Society of Anesthesiologists (ASA) preoperative assessment score, length of preoperative hospitalization, location of operation (intensive care unit vs. operating room), presence of a coexisting disease or remote infection, or the use of perioperative antibiotics. CONCLUSIONS: Our results suggest that wound infections in children are related more to the factors at operation than to the overall physiologic status. Procedures can be performed in the intensive care unit without any increase in the incidence of wound infection.

Horwitz, J R; Chwals, W J; Doski, J J; Suescun, E A; Cheu, H W; Lally, K P



Sternal wound infections.  


Deep sternal wound infections (DSWI) continue to be a relatively uncommon event occurring in about 1%-2% of all patients undergoing cardiac surgery. However, the sheer number of cardiac surgery patients and the relatively high mortality associated with DSWIs makes them of clinical relevance. This review will describe the current incidence of DSWIs and their associated morbidity and mortality as well as risk factors for the development of this complication. The microbiology of DSWIs will be reviewed and strategies to prevent these complications will be discussed with a focus on interventions that may be undertaken by the clinical anesthesiologist. PMID:18831296

Mauermann, William J; Sampathkumar, Priya; Thompson, Rodney L



Randomized Clinical Trial of Postoperative Subfascial Infusion with Bupivacaine following Ambulatory Open Mesh Repair of Inguinal Hernia  

Microsoft Academic Search

Background: Wound pain remains the commonest problem after ambulatory open repair of inguinal hernia. Postoperative subfascial infusion of the wound with bupivacaine extends local analgesia at home and may achieve superior analgesia compared with oral analgesics alone. The objective of the present trial was to evaluate the efficacy of postoperative subfascial infusion of the wound with 0.5% bupicavaine at 2

Hung Lau; Nivritti G. Patil; Francis Lee



[Epidemiology of postoperative cognitive disorders].  


The literature review concisely considers a relatively new problem of postoperative cognitive disorders occurring in surgical patients. The paper considers the present views of the etiology of postoperative cognitive disorders and their contributing and aggravating factors. Particular emphasis is laid on a factor, such as a surface anesthetic level and sudden intraoperative consciousness recovery, as well as on the prevention of this complication through the monitoring of anesthesia depth. PMID:19670491

Bol'shedvorov, R V; Kichin, V V; Fedorov, S A; Likhvantsev, V V


Risk factors for wound dehiscence after laparotomy - clinical control trial.  


Abstract Described in the literature dehiscence rate in the adult population is 0.3-3.5%, and in the elderly group as much as 10%. In about 20-45% evisceration becomes a significant risk factor of death in the perioperative period. The aim of the study was to identify the main risk factors for abdominal wound dehiscence in the adult population. Material and methods. The study included patients treated in the 3rd Department of General Surgery, Jagiellonian University Collegium Medicum in Cracow in the period from January 2008 to December 2011, in which at that time laparotomy was performed and was complicated by wound dehiscence in the postoperative period. For each person in a research group, 3-4 control patient were selected. Selection criteria were corresponding age (± 2-3 years), gender, underlying disease and type of surgery performed. Results. In 56 patients (2.9%) dehiscence occurred in the postoperative period with 25% mortality. The group consisted of 37 men and 19 women with the mean age of 66.8 ± 12.6 years. Univariate analysis showed that chronic steroids use, surgical site infection, anastomotic dehiscence/fistula in the postoperative period and damage to the gastrointestinal tract are statistically significant risk factors for dehiscence. Two first of these factors occurred to be independent risk factors in the multivariate analysis. In addition, due to the selection criteria, a group of risk factors should also include male gender, emergency operation, midline laparotomy, colorectal syrgery and elderly age (> 65 years). Logistic regression analysis did not show that a particular surgeon, time of surgery or a particular month (including holiday months) were statistically significant risk factor for dehiscence. Conclusions. Wound dehiscence is a serious complication with relatively small incidence but also high mortality. Preoperative identification of risk factors allows for a more informed consent before patient's treatment and to take measures to prevent or minimize the consequences of complication associated with it. PMID:23399620

Kenig, Jakub; Richter, Piotr; Zurawska, Sabina; Lasek, Anna; Zbierska, Katarzyna; Nowak, W



Postoperative Complications Leading to Death after Coagulum Pyelolithotomy in a Tetraplegic Patient: Can We Prevent Prolonged Ileus, Recurrent Intestinal Obstruction due to Adhesions Requiring Laparotomies, Chest Infection Warranting Tracheostomy, and Mechanical Ventilation?  

PubMed Central

A 22-year-old male sustained C-6 tetraplegia in 1992. In 1993, intravenous pyelography revealed normal kidneys. Suprapubic cystostomy was performed. He underwent open cystolithotomy in 2004 and 2008. In 2009, computed tomography revealed bilateral renal calculi. Coagulum pyelolithotomy of left kidney was performed. Pleura and peritoneum were opened. Peritoneum could not be closed. Following surgery, he developed pulmonary atelectasis; he required tracheostomy and mechanical ventilation. He did not tolerate nasogastric feeding. CT of abdomen revealed bilateral renal calculi and features of proximal small bowel obstruction. Laparotomy revealed small bowel obstruction due to dense inflammatory adhesions involving multiple small bowel loops which protruded through the defect in sigmoid mesocolon and fixed posteriorly over the area of previous intervention. All adhesions were divided. The wide defect in mesocolon was not closed. In 2010, this patient again developed vomiting and distension of abdomen. Laparotomy revealed multiple adhesions. He developed chest infection and required ventilatory support again. He developed pressure sores and depression. Later abdominal symptoms recurred. This patient's general condition deteriorated and he expired in 2011. Conclusion. Risk of postoperative complications could have been reduced if minimally invasive surgery had been performed instead of open surgery to remove stones from left kidney. Suprapubic cystostomy predisposed to repeated occurrence of stones in urinary bladder and kidneys. Spinal cord physicians should try to establish intermittent catheterisation regime in tetraplegic patients.

Vaidyanathan, Subramanian; Soni, Bakul; Singh, Gurpreet; Hughes, Peter



Imaging of the postoperative knee.  


In the typical radiology practice, magnetic resonance (MR) imaging of the postoperative knee is a common and almost daily occurrence. Postoperative patients present with a wide array of complaints including persistent or recurrent knee pain and instability. A thorough knowledge of the commonly performed procedures along with the normal postoperative appearance and potential postoperative complications will ensure that the radiologist provides an optimal evaluation of the postoperative MRI. This article reviews some of the most common arthroscopic procedures performed on the knee including ligament, meniscal, and articular cartilage procedures. A description of the most common procedures is provided along with a discussion of the expected postoperative appearance of the knee. The most common complications and reasons for recurrent symptoms are discussed. MR imaging techniques are reviewed including the various options available for evaluating the postoperative meniscus. A thorough discussion is provided regarding the advantages and disadvantages of the use of conventional MRI versus direct and indirect MR arthrography in the setting of prior meniscal surgery. PMID:21928161

Sanders, Timothy G



Overview and Management of Sternal Wound Infection  

PubMed Central

Sternal wound infection is a life-threatening complication after cardiac surgery associated with high morbidity and mortality. Past treatment options have included closed suction and continuous irrigation. Current paradigms in the management of sternal wound infection include surgical debridement, vacuum-assisted closure therapy, flap coverage, and sternal plating. We provide a general overview of sternal wound infection and treatment options for the plastic surgeon.

Singh, Kimberly; Anderson, Erica; Harper, J. Garrett



MDCT Evaluation of Aortic Root Surgical Complications.  


OBJECTIVE. CT is the primary imaging modality used after aortic root repair. Distinction of normal findings from postoperative complications is imperative and requires optimization of acquisition parameters and interpretation with advanced postprocessing tools. CONCLUSION. After aortic root surgery, findings can be categorized as complications within the aorta, complications outside the aorta, and benign postoperative changes. Distinction of normal findings from postoperative complications requires proper CT technique and an understanding of CT findings that require intervention. PMID:24059362

Chu, Linda C; Johnson, Pamela T; Cameron, Duke E; Fishman, Elliot K



Postoperative Delirium  

Microsoft Academic Search

\\u000a Postoperative Delirium (PD) is common, costly, and often fatal. The etiology of PD is multifactorial and there are multiple\\u000a risk factors which predispose and precipitate an episode of PD. Predisposing factors are preoperative and may not be modifiable\\u000a but serve to increase the index of suspicion for diagnosis. Precipitating factors are often iatrogenic. The incidence of PD\\u000a ranges from 2%

Alok Kapoor; Joleen Elizabeth Fixley


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



[Peacetime gunshot wounds].  


The article describes main principles of treatment of civilian gunshot wounds: rational organization of medical care to wounded at the prehospital stage, combination of diagnostic and medical process in specialized centers, early detection and eradication of menacing to life consequences of the wound, valuable intensive therapy at all stages of medical care and treatment, the shortest in time and full in volume specialized surgical care. Results of treatment of 507 patients with gunshot injuries of different localization in the clinic of military surgery for the last 15 years show that during this period the amount of such patients rose from 6.4% to 12.2% of all patients with different injuries, slight wounds taking place in 30.8%, of mean gravity--in 7.1%, grave--in 46.4%, critically grave--in 14.9%. Lethality made up 17.2%, incidence of complications--31.2%, duration of hospital treatment was 33 +/- 1.8 days. PMID:9915060

Gumanenko, E K



Complications after cryosurgery with new miniature cryoprobes in long hollow bones: An animal trial  

PubMed Central

Background In vitro studies show that new miniature cryoprobes are suitable for cryoablation of bone tissue. The aim of this animal trial on 24 sheep was to examine the perioperative complications, particularly the danger of embolism, of cryoablation when using miniature cryoprobes. Methods Cryoablations with 2 freeze-thaw cycles each were carried out in the epiphysis of the right tibia and the metaphysis of the left femur. Pulmonary artery pressure (PAP) and central venous pressure (CVP) were measured. Throughout the intra- and perioperative phase, heart rate and oxygen saturation by pulse oxymetry, blood gas and electrolytes were monitored regularly. Postoperative complications were examined up to 24 weeks postoperativ. Results As result, no significant increase of PAP, CVP or heart rate were observed. Blood gases were unremarkable, with pO2 and pCO2 remaining constant throughout the operation. Regarding pH, standard bicarbonate and base excess, only a non-significant shift towards a slight acidosis was seen. There was a mean hemoglobin decrease of 0.5 g/dl. One animal showed postoperative wound infection and wound edge necrosis. No major peri- and postoperative complications associated with cryosurgery of bone were observed, especially regarding clinically relevant pulmonary embolism. Conclusion Surgery with new types of miniature cryoprobes appears to be a safe alternative to or a complement to conventional resection of abnormal bone tissue.

Popken, Frank; Meschede, Peter; Erberich, Heike; Koy, Timmo; Bosse, Marfalda; Fischer, Jurgen H; Eysel, Peer



Economic aspects of deep sternal wound infections  

Microsoft Academic Search

Objectives: Surgical-site infections are a very expensive complication in cardiac surgery. Thus, the total costs for coronary artery bypass grafting (CABG) surgery may substantially increase when a deep sternal wound infection (DSWI) occurs. This may be due to an extended length of stay (LOS), the need for additional surgical procedures, vacuum-assisted wound dressing and antibiotic therapy. This study compares the

Karolin Graf; Ella Ott; Ralf-Peter Vonberg; Christian Kuehn; Axel Haverich; Iris Freya Chaberny



Biomechanics and wound healing in the cornea  

Microsoft Academic Search

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

William J. Dupps; Steven E. Wilson



Necrotizing postsurgical infection complicating midurethral sling procedure with unrecognized cystotomy.  


A 39-year-old woman with stress urinary incontinence underwent a retropubic midurethral sling procedure. On postoperative day 1, she presented with persistent abdominal pain and fever. A computed tomographic scan showed subcutaneous lower abdominal wall edema and gas above the fascia suggesting a necrotizing soft tissue infection. She was surgically debrided twice, which included removal of the mesh sling on postoperative day 4. Cystoscopy suggested unrecognized bladder perforation had occurred during the initial procedure, and record rerevealed untreated bacteriuria before sling placement. The patient required wound vacuum therapy and a later secondary wound closure procedure. Six months after the initial surgery, she was reevaluated for stress urinary incontinence and underwent a transobturator midurethral sling procedure with resolution of these symptoms. Necrotizing postsurgical infection is a rarely described complication of midurethral slings. Treatment for this potentially life-threatening complication includes aggressive surgical debridement, administration of broad-spectrum antibiotic, removal of infected implants, and supportive therapy. Unrecognized bladder injury and preoperative bacteriuria are discussed as potential risk factors for postsling necrotizing infection. PMID:22543774

Mahal, Amandeep Singh; Bradley, Catherine S


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


Pre- or postoperative radiotherapy in rectal and rectosigmoid carcinoma. Report from a randomized multicenter trial.  

PubMed Central

Between October 1980 and December 1985, 471 patients with a resectable rectal carcinoma entered a randomized multicenter trial for comparison of pre- and postoperative irradiation. Two hundred thirty-six patients were allocated to receive high-dose fractionated preoperative irradiation (total dosage, 25.5 Gy in five to seven days) and 235 patients to receive postoperative irradiation to a very high dosage level with conventional fractionation (60 Gy in a total 8 weeks). The postoperative treatment was delivered only to a high-risk group of patients (Astler-Coller stages B2, C1, and C2). The preoperative irradiation was well tolerated, with no immediate irradiation-related complications and no increased postoperative mortality (3%, 7 of 217 patients, compared to 5%, 10 of 215 patients in the postoperatively irradiated group). More patients in the preoperative irradiation group had perineal wound sepsis after abdominoperineal resection and this prolonged the stay in hospital after surgery. In 50% of the patients the postoperative treatment could not be commenced until more than 6 weeks after surgery. The postoperative treatment was not as well tolerated as the preoperative one. The local recurrence rate was statistically significantly lower after preoperative than after postoperative radiotherapy (12% versus 21%; p = 0.02). In both groups more patients developed a local recurrence if the bowel was perforated at surgery or if the resection line was microscopically close to the tumor. To date, with a minimum follow-up of 3 years and a mean follow-up of 6 years, there is no difference in survival rates between the two groups.

Pahlman, L; Glimelius, B



Complications following Harrington instrumentation for fractures of the thoracolumbar spine.  


The purposes of using Harrington instrumentation for the treatment of thoracolumbar fractures are to reduce the fracture, decompress the spinal canal, create stability at the fracture site, and shorten the hospitalization period. However, technical problems or the injudicious use of Harrington-instrumentation systems can also complicate the management of these fractures. We have studied forty patients (forty-five Harrington-instrumentation stabilization procedures) who had significant complications. Twenty-six of the thirty patients who were followed for more than two years required additional spinal reconstructive surgical procedures. Five patients had neurological deterioration (one died), nine patients had an inadequate reduction of translational displacement of a vertebral fracture, sixteen patients had dislodgment or disengagement of the Harrington components with resultant loss of fixation, six patients had a deep wound infection, three patients had a complete wound dehiscence with exposure of metal, and sixteen patients had persistent unrecognized neural compression. Several factors were associated with these failures of Harrington instrumentation: translational (flexion-rotation) injuries of the osteoligamentous middle column; failure to obtain either myelographic or computed tomographic studies, or both, postoperatively; failure to identify persistent neural compression; wound dehiscence; the use of distraction rods for high thoracic kyphosis; and instrumentation across the lumbosacral joint. PMID:3997920

McAfee, P C; Bohlman, H H



Effect of laparoscopic cholecystectomy techniques on postoperative pain: a prospective randomized study  

PubMed Central

Purpose Minimally invasive surgical technics have benefits such as decreased pain, reduced surgical trauma, and increased potential to perform as day case surgery, and cost benefit. The primary aim of this prospective, randomized, controlled study was to compare the effects of single incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC) procedures regarding postoperative pain. Methods Ninety adult patients undergoing elective laparoscopic cholecystectomy were included in the study. Patients were randomized to either SILC or CLC. Patient characteristics, postoperative abdominal and shoulder pain scores, rescue analgesic use, and intraoperative and early postoperative complications were recorded. Results A total of 83 patients completed the study. Patient characteristics, postoperative abdominal and shoulder pain scores and rescue analgesic requirement were similar between each group except with the lower abdominal pain score in CLC group at 30th minute (P = 0.04). Wound infection was seen in 1 patient in each group. Nausea occurred in 13 of 43 patients (30%) in the SILC group and 8 of 40 patients (20%) in the CLC group (P > 0.05). Despite ondansetron treatment, 6 patients in SILC group and 7 patients in CLC group vomited (P > 0.05). Conclusion In conclusion, in patients undergoing laparoscopic surgery, SILC or CLC techniques does not influence the postoperative pain and analgesic medication requirements. Our results also suggest that all laparoscopy patients suffer moderate and/or severe abdominal pain and nearly half of these patients also suffer from some form of shoulder pain.

Arun, Oguzhan; Apiliogullari, Seza; Acar, Fahrettin; Alptekin, Husnu; Calisir, Ak?n; Sahin, Mustafa



Evidence-based Management Strategies for Treatment of Chronic Wounds  

Microsoft Academic Search

The care and management of patients with chronic wounds and their far-reaching effects challenge both the patient and the practitioner. Further complicating this situation is the paucity of evidence-based treatment strategies for chronic wound care. After searching both MEDLINE and Cochrane databases, we reviewed currently available articles con- cerning chronic wound care. Utilizing this information, we have outlined a review

Frank Werdin; Hans-Eberhardt Schaller; Hans-Oliver Rennekampff


Wounded Warriors  

Microsoft Academic Search

Soldiers have been killed and wounded in wars throughout history. With new medical technologies, more soldiers survive their injuries and return home. Unfortunately, those injuries often include permanent disabilities either through loss of limb(s) or brain injury or post-traumatic stress disorder, among other possibilities. Perhaps equally unfortunate is the way that soldiers with disabilities and persons with disabilities generally are

Marilyn Martone



Characterization of a preclinical model of chronic ischemic wound  

PubMed Central

Chronic ischemic wounds presenting at wound clinics are heterogeneous with respect to etiology, age of the wound, and other factors complicating wound healing. In addition, there are ethical challenges associated with collecting repeated biopsies from a patient to develop an understanding of the temporal dynamics of the mechanisms underlying chronic wounds. The need for a preclinical model of ischemic wound is therefore compelling. The porcine model is widely accepted as an excellent preclinical model for human wounds. A full-thickness bipedicle flap approach was adopted to cause skin ischemia. Closure of excisional wounds placed on ischemic tissue was severely impaired resulting in chronic wounds. Histologically, ischemic wounds suffered from impaired re-epithelialization, delayed macrophage recruitment and poorer endothelial cell abundance and organization. Compared with the pair-matched nonischemic wound, unique aspects of the ischemic wound biology were examined on days 3, 7, 14, and 28 by systematic screening of the wound tissue transcriptome using high-density porcine GeneChips. Ischemia markedly potentiated the expression of arginase-1, a cytosolic enzyme that metabolizes the precursor of nitric oxide l-arginine. Ischemia also induced the SOD2 in the wound tissue perhaps as survival response of the challenged tissue. Human chronic wounds also demonstrated elevated expression of SOD2 and arginase-1. This study provides a thorough database that may serve as a valuable reference tool to develop novel hypotheses aiming to elucidate the biology of ischemic chronic wounds in a preclinical setting.

Roy, Sashwati; Biswas, Sabyasachi; Khanna, Savita; Gordillo, Gayle; Bergdall, Valerie; Green, Jeanne; Marsh, Clay B.; Gould, Lisa J.; Sen, Chandan K.



Post colon surgery complications: imaging findings.  


Several standardized types of colonic resections are available in the clinical practice. All of them may produce early and late complications. Diagnostic imaging plays a pivotal role in the recognition of post-operative colorectal complications and provides fundamental information for therapeutic planning. In this paper we review the imaging findings of early and late post-operative complications of colorectal surgery. PMID:15741013

Scardapane, Arnaldo; Brindicci, Domenico; Fracella, Maria Rosaria; Angelelli, Giuseppe



Apixaban and Rivaroxaban Decrease Deep Venous Thrombosis But Not Other Complications After Total Hip and Total Knee Arthroplasty.  


Apixaban and rivaroxaban are oral direct factor Xa (FXa) inhibitors used for VTE prevention after total hip (THA) and total knee arthroplasty (TKA). A meta-analysis of level I studies comparing rivaroxaban 10 mg daily or apixaban 2.5 mg twice daily to enoxaparin for the prevention of VTE after THA or TKA was performed analyzing efficacy and safety outcomes. Seven studies met the inclusion criteria including 24,385 patients. Oral FXa inhibitors were superior to enoxaparin in preventing DVT (p<0.00001). There was no difference in the rate of PE, death, major bleeding, blood transfusion requirement, reoperation for bleeding or postoperative wound infections. Oral FXa inhibitors are superior to enoxaparin in preventing DVT after THA and TKA. There is no difference in the rate of PE, death, or postoperative wound complications. PMID:23540535

Russell, Robert D; Huo, Michael H



Complications observed during and after ovariohysterectomy of 142 bitches at a veterinary teaching hospital.  


The clinical, anaesthetic and surgical records of 142 bitches admitted into the primary care clinic at the Small Animal Hospital, University of Liverpool, between January 2002 and August 2004 for routine ovariohysterectomy by final-year students were analysed for complications during and after the surgery. The time taken to perform the surgical procedure was recorded, to allow assessment of the time involved in one-to-one surgical teaching during live-recovery surgeries of client-owned pets. The types of complications were similar to those reported in earlier studies: nine bitches suffered haemorrhage of the ovarian arteries during surgery, and there were four cases of haemorrhage after surgery, 12 cases of wound inflammation and four other types of complication. The rates of intraoperative, postoperative and total complications were 6.3, 14.1 and 20.6 per cent, respectively. PMID:16377787

Burrow, R; Batchelor, D; Cripps, P


[The characteristics of the complications following early rehabilitative operations in cancer of the oral cavity organs].  


Characteristic features of complications after radical surgery carried out in 47 patients with carcinomas of the organs of the oral cavity are analyzed. General complications explained by respiratory and cardiovascular insufficiency were observed in 6 (12.7 percent) patients. Of the local complications suppuration and separation of the wound edges were the most frequent, occurring in 21.2 percent of cases. Suppuration and necrosis of the distal end of the flap, that developed in 17 percent of patients, resulted in one case in arrosive bleeding from the carotid arteries. The authors consider that early rehabilitation measures help reduce the number of grave postoperative complications and prevent the development of severe functional and structural disorders of the maxillofacial organs. PMID:2087721

Klim, K I; Stoliarov, V G


Multimodality imaging of the postoperative shoulder  

Microsoft Academic Search

Multimodality imaging of the postoperative shoulder includes radiography, magnetic resonance (MR) imaging, MR arthrography,\\u000a computed tomography (CT), CT arthrography, and ultrasound. Target-oriented evaluation of the postoperative shoulder necessitates\\u000a familiarity with surgical techniques, their typical complications and sources of failure, knowledge of normal and abnormal\\u000a postoperative findings, awareness of the advantages and weaknesses with the different radiologic techniques, and clinical\\u000a information

Klaus Woertler



Acceleration of wound healing by topical drug delivery via liposomes  

Microsoft Academic Search

Background: Despite intensive research, impaired wound healing remains a considerable complication. Therefore, topically applied liposome-encapsulated\\u000a buflomedil hydrochloride was investigated for its ability to improve wound repair in normal (n=16) and ischemic (n=16) skin tissue. Methods: Experiments were performed using the wound healing model of the ear of hairless mice. Standardized skin wounds (4.25 mm2) were created by circular excision of

Frank Roesken; Eberhard Uhl; Sergio B. Curri; Michael D. Menger; Konrad Messmer



A mathematical model of ischemic cutaneous wounds.  


Chronic wounds represent a major public health problem affecting 6.5 million people in the United States. Ischemia, primarily caused by peripheral artery diseases, represents a major complicating factor in cutaneous wound healing. In this work, we sought to develop a mathematical model of ischemic dermal wounds. The model consists of a coupled system of partial differential equations in the partially healed region, with the wound boundary as a free boundary. The extracellular matrix (ECM) is assumed to be viscoelastic, and the free boundary moves with the velocity of the ECM at the boundary. The model equations involve the concentration of oxygen, PDGF and VEGF, the densities of macrophages, fibroblasts, capillary tips and sprouts, and the density and velocity of the ECM. Simulations of the model demonstrate how ischemic conditions may limit macrophage recruitment to the wound-site and impair wound closure. The results are in general agreement with experimental findings. PMID:19805373

Xue, Chuan; Friedman, Avner; Sen, Chandan K



Postoperative radiotherapy for ependymoma  

PubMed Central

Purpose To evaluated the patterns of failure, survival rate, treatment-related toxicity and prognostic factors in postoperative radiotherapy of patients with ependymoma. Materials and Methods Thirty patients who underwent surgery and postoperative radiotherapy for ependymoma between the period of June 1994 and June 2008 were reviewed retrospectively. The age of patients ranged from 21 months to 66 years (median, 19 years). Seventeen patients had grade II ependymoma, and 13 had grade III anaplastic ependymoma according to the World Health Organization grading system. The postoperative irradiation was performed with 4 or 6 MV photon beam with median dose of 52.8 Gy (range, 45 to 63 Gy), and radiation field including 2 cm beyond the preoperative tumor volume. Median follow-up period was 51 months (range, 12 to 172 months). Results Fourteen out of 30 (46.7%) patients experienced recurrence, and 12 of those died. Among those 14 patients who experienced recurrence, 11 were in-field and 3 were out-of-field recurrence. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 66.7% and 56.1%, respectively. On univariate analysis, tumor grade was a statistically significant prognostic factor for OS and PFS. There were two complications after surgery and postoperative radiotherapy, including short stature and facial palsy on the left side. Conclusion We observed good survival rates, and histologic grade was a prognostic factor affecting the OS and PFS. Almost all recurrence occurred in primary tumor site, thus we suggest further evaluation on intensity-modulated radiotherapy or stereotatic radiosurgery for high-risk patients such as who have anaplastic ependymoma.

Jung, Jinhong; Choi, Wonsik; Park, Jin Hong; Kim, Su Ssan; Kim, Young Seok; Yoon, Sang Min; Song, Si Yeol; Lee, Sang-Wook; Kim, Jong Hoon; Choi, Eun Kyung



Does chemotherapy increase the risk of respiratory complications after pneumonectomy?  

Microsoft Academic Search

Objective: The impact of induction chemotherapy on postoperative complications after pneumonectomy remains unclear. The aim of the study was to test the hypothesis that chemotherapy may increase the risk of postoperative respiratory complications. Methods: Data from 202 consecutive standard pneumonectomies performed for lung cancer were collected and analyzed. Postoperative and 90-day mortality, overall morbidity, and respiratory complication rates were evaluated

Francesco Leo; PierGiorgio Solli; Giulia Veronesi; Davide Radice; Antonio Floridi; Roberto Gasparri; Francesco Petrella; Alessandro Borri; Domenico Galetta


Deep sternal wound infection: a sternal-sparing technique with vacuum-assisted closure therapy  

Microsoft Academic Search

BackgroundVacuum-assisted closure therapy is a novel treatment employed to aid wound healing in different areas of the body and recently also in sternotomy wounds. Aggressive vacuum-assisted closure treatment of the sternum in postoperative deep wound infection enhances sternal preservation and the rate of possible rewiring.

Ronny I Gustafsson; Johan Sjögren; Richard Ingemansson



Sternal wound care to prevent infections in adult cardiac surgery patients.  


Sternal wound infection post-cardiac surgery is a serious complication that can lead to increased length of stay, substantial financial impact, and increased mortality. The occurrence of sternal wound infections has been reported from 0.4% to 4% of postoperative cardiac surgeries. It is imperative that every heart surgery program implements the best practice to prevent the detrimental effects of sternal wound infections. In an effort to improve the cardiothoracic (CT) surgery program in a community hospital, a decision was made to create a specialty floor including specialized nurses to care for open-heart surgery patients. In October 2010, a group of these nurses formed a working committee to explore ways to improve the overall care of our CT surgery patients. A vision and purpose for this committee were identified: (1) update and improve practice for CT surgery patients utilizing evidence-based standards, (2) successfully disseminate this information to all staff caring for the CT surgery patients, and (3) evaluate the impact of any practice changes on patient outcomes. An initial focus for the committee was to standardize sternal wound care among all staff members on the cardiovascular floors, cardiac care unit, and progressive care unit. PMID:22157494

Stoodley, Lynda; Lillington, Linda; Ansryan, Lianna; Ota, Reiko; Caluya, Jun; Camello, Edwin; Huskins, Maria; Franco, Daniella; Silvino, Cherry Mae; Nwokafor, Ezioma; Van Zitter, Brandy; Olton, Maria; Howard, Linda; Bailey, Lorri; Mohler, Rhonda


The management of wounds following primary lower limb arthroplasty: a prospective, randomised study comparing hydrofibre and central pad dressings.  


Wound care following lower limb arthroplasty has not been subject to in-depth clinical research, primarily because such wounds usually heal without complication. However, when prosthetic implants are used, serious wound problems can be disastrous (Whitehouse et al. Infect Control Hosp Epidemiol 2002;23:183-9; Lindwell OM. Clin Orthop Relat Res 1986;211:91-103). We report the results of a prospective, randomised, controlled trial comparing a hydrofibre (Aquacel) and central pad (Mepore) dressing in the management of acute wounds following primary total hip or knee arthroplasty left to heal by primary intention. Dressing performance was measured in 61 patients receiving total hip or knee replacements. There was a significant reduction in the requirement for dressing changes before five postoperative days in the hydrofibre group (43% compared with 77% in the central pad group), and there were fewer blisters amongst patients in the hydrofibre group (13% compared with 26% in the central pad group). We conclude that there is a potential role for hydrofibre dressing in the management of arthroplasty wounds. PMID:17007343

Abuzakuk, Tarek M; Coward, Pamela; Shenava, Y; Kumar, V Senthil; Skinner, John A



Efficacy and safety of a low-molecular-weight heparin and standard unfractionated heparin for prophylaxis of postoperative venous thromboembolism: European multicenter trial.  


A randomized, double-blind multicenter trial was performed to compare the safety and efficacy of a new low-molecular-weight heparin (LMWH) (LU 47311, Clivarine) and standard unfractionated heparin for the prophylaxis of postoperative venous thromboembolism. Altogether 1351 patients scheduled to undergo abdominal surgery were included. Main outcome measures included the incidence of thromboembolic events (deep vein thrombosis, pulmonary embolism, or both) and bleeding complications, including wound hematoma. A total of 655 patients received 1750 anti-Xa IU of LMWH plus a placebo injection daily; 677 patients received 5000 IU of unfractionated heparin (UFH) twice a day. Both drugs were found to be equally effective, as 4.7% of patients in the LMWH group and 4.3% in the UFH group developed postoperative thromboembolic complications. However, the incidence of bleeding complications was significantly reduced in the LMWH group: 55 (8.3%) patients in the LMWH group and 80 (11.8%) in the UFH group developed bleeding complications, a relative risk (RR) of 0.70 (95% CI 0.51-0.97;p = 0.03); wound hematoma occurred in 29 (4.4%) of the LMWH group compared with 55 (7.7%) in those in the UFH group for an RR of 0.57 (95% CI 0.37-0.88;p = 0.01). This study confirmed that a very low dose of 1750 anti-Xa IU daily of this new LMWH is as effective as 10,000 IU of UFH for preventing postoperative deep vein thrombosis. At this dose its administration is associated with a significant reduction in the risk of bleeding including wound hematoma. PMID:8943170

Kakkar, V V; Boeckl, O; Boneu, B; Bordenave, L; Brehm, O A; Brücke, P; Coccheri, S; Cohen, A T; Galland, F; Haas, S; Jarrige, J; Koppenhagen, K; LeQuerrec, A; Parraguette, E; Prandoni, P; Roder, J D; Roos, M; Rüschemeyer, C; Siewert, J R; Vinazzer, H; Wenzel, E



Colon operations without wound infection. Principles and techniques in 101 cases.  


A total of 101 consecutive elective colon operations were performed with no postoperative wound infection. Patients with a wide variety of diagnoses and procedures were included in the series. Many factors contribute to the formation of postoperative wound infections. A comprehensive approach with attention to preoperative nutritional assessment, bowel preparation, wound protection, sterile technique, closure of the incision, and systemic prophylactic antibiotics contributed to the overall good results. PMID:6430140

Pello, M J; Beauregard, W; Shaikh, K; Camishion, R C



[Hand wounds].  


Hand wounds represent a major problem in regard of the number of patients as well as the economic burden associated with it. The close relationship of the different anatomical structures increase the probability of involvement of multiple structures, which require a multidisciplinary approach. Paucity of clinical signs of certain lesions render surgical exploration necessary. Regarding replantation, multiple factors need to be taken into consideration, principally the condition of the amputated part, which is influenced by the trauma but also by the initial care applied to the severed part. Transfer delay to a specialized center should be minimize. PMID:20085204

Vostrel, P; Beaulieu, J-Y



Understanding wound bed preparation and wound debridement.  


Wound bed assessment and optimum local wound care are essential to facilitate the wound healing process. The presence of devitalized tissue, for instance necrotic tissue or slough, is common in hard-to-heal wounds and acts as a barrier to healing. There are several debridement options available to the practitioner with the choice of wound debridement technique being made following a holistic assessment of the patient and the wound. The method of debridement should be discussed with the patient and family where appropriate and consent to treatment obtained prior to the procedure being undertaken. PMID:20220634

Ousey, Karen; McIntosh, Caroline



[Management of combined thoracoabdominal wounds].  


Last years in the country gace rise to the problem of treatment of fire-arm's wounds in civil population. The results of treatment of victims with firearm thoracoabdominal wounds have evidenced unprepareness of surgeons for rendering specialized aid in conditions of "military-urban" surgery. The study performed by the authors has shown that there are substantial and principal differences between many postulates of war-field surgery and "military-urban" surgery. It consists in early hospitalization of victims with combined thoraco-abdominal injuries, prevalence of bullet wounds over fire-mine explosive injuries which have an effect on the extent of surgical intervention, results of treatment and development of complications. The proposed treatment modalities in victims with combined penetrated thoracoabdominal injuries in great measure may contribute to optimization of surgical aid in conditions of "military-urban" surgery. PMID:9791984

Solov'ev, G M; Bagdasarov, V V



[Wound healing as affected by constitutional immunity factors].  


The authors examined 52 patients with gunshot wounds of various localization. Besides the type of wound healing, they determined the ABO system blood groups, the value of phagocytosis intensity and the value of connective tissue saturation with ascorbic acid, which, as it was shown earlier, are unrelated to the current condition of the wound process and may serve for predicting the risk of wound purulent complications. The distribution features of the studied values in patients with gunshot wounds were compared with those in individuals with gunshot-inflicted wounds. It is shown that such signs of constitutional immunity as the B blood group, weak phagocytosis intensity, and low saturation of the connective tissue with ascorbic acid are risk factors of purulent complications in both traumatic and gunshot wounds. PMID:1921192

Shaposhnikov, Iu G; Tabatadze, K G; Zhukova, O V; Kondrat'eva, I E; Filianin, A M; Rychkov, Iu G



Complication Related to Medical Conditions  

Microsoft Academic Search

\\u000a In this chapter, we discuss the medical conditions that can complicate the perioperative period and postoperative outcome\\u000a of cervical spine surgery. In particular, we discuss about comorbidities determining an increased risk of perioperative complications\\u000a and cardiac events, and about medical conditions associated with postoperative spinal infections, failure of spinal fusion,\\u000a and poor neurologic recovery after surgery. When the published studies

Umberto Vespasiani Gentilucci; Antonio Picardi


Radiology of cholecystectomy complications.  


Postoperative problems following simple removal of the gallbladder are infrequent. Radiographic studies may be valuable in suggesting or confirming the diagnosis when not clinically evident. Plain films, contrast studies, ultrasound, and computed tomography (CT) all can be useful modalities in this area. Several examples of complications related specifically to the operative field in cholecystectomy are reviewed. PMID:761742

Love, L; Kucharski, P; Pickleman, J



Post-operative urinary retention.  


Urinary retention is a common complication of surgery and anaesthesia. The risk of post-operative urinary retention is increased following certain surgical procedures and anaesthetic modalities, and with patients' advancing age. Patients at increased risk of post-operative urinary retention should be identified before surgery or the condition should be identified and treated in a timely manner following surgery. If conservative measures do not help the patient to pass urine, the bladder will need to be drained using either an intermittent catheter or an indwelling urethral catheter, which can result in catheter-associated urinary tract infections. This article provides an overview of normal bladder function, risk factors for developing post-operative urinary retention, and treatment options. Guidance drawn from the literature aims to assist nurses in identifying at-risk patients and inform patient care. PMID:24093416

Steggall, Martin; Treacy, Colm; Jones, Mark



[Gunshot wounds of the large intestine].  


The results of treatment of 262 patients with gunshot wounds of the large intestine are described. 207 (79%) patients had colic injuries and the rest 55 (21%) - gunshot wounds of the rectum. Authors adduce and substantiate the differential approach to each case, taking into consideration various factors, such as localization, size of the wound, grade of bacterial contamination and peritonitis etc In case of an injured colic segment resection necessity, obstructive resection was preferred. In case of intraperitoneal rectum injury wound closure with decompressive sigmostomy was justified. Extraperitoneal rectum injury requires surgical debridement without intestinal wall reconstruction and further sphincteroplasty. Postoperative lethality was 26,6% for colic injuries and 34,5% for rectal injuries. 85 patients experienced further reconstructive operations. PMID:19156070

Aliev, S A; Salakhov, Z A



[Prevention of postoperative adhesions].  


Postoperative adhesions represent a common consequence in patients who underwent abdominal or pelvic surgery. Such adhesions can be asymptomatic, but they can cause complications such as chronic abdomino-pelvic pain, secondary infertility, an increase in bowel obstruction risk and more complexity for future surgery, including longer surgery times and an increase in morbidity. Normally, adhesions appear after offences against the peritoneum, causing flogosys, and develop both in new sites, previously not involved, and in sites already interested in adhesiolysis. Previous laparotomy is an important risk factor, as after laparatomy a minimum of 93% of patients present adhesions during a following surgery. Furthermore, the rate of recurrence after adhesiolysis is 85%. Among several strategies employed, valid prevention methods are: using minimally invasive surgery techniques, reducing the incision area, containing tissue dehydration during surgery and an accurate hemostasis. Also, for preventing and reducing adhesions, the usage of NSAIDs, fibrinolytics and anticoagulants, as well as the application of substances acting as a physical barrier, have been proposed. Recently, crystalloid solutions have been introduced, using the hydro-flotation principle for intraperitoneal organs. This research aims to analyze causes and epidemiology for postoperative adhesions, with particular regard to gynecological operations and to describe and compare the means available to prevent them. PMID:19204662

Palaia, I; Boni, T; Angioli, R; Muzii, L; Polidori, N F; Andrei, N F; Musella, A; De Oronzo, M A; Guzzo, F; Benedetti Panici, P



[The treatment of wounds of the anal canal and perineum].  


Analysis of processes of wound healing in 215 patients after operations for hemorrhoids, anal fissures and rectal fistulas was carried out. Clinico-cytologic control of healing of postoperation wound has shown that ultra-violet irradiation of wound surface is most effective at early stages of wound healing due to its pronounced bactericidal and antiinflammatory action. Low frequency laser irradiation intensifies tissue reparative and hastens healing of wounds. The proposed method for treatment of wounds by successive use of ultra-violet and laser irradiation of wound surface combined with conventional ointment medications, improves the results of treatment and decreases the rate of purulent complications 2 times, promotes rapid healing of wounds. PMID:9753930

Protsenko, V M; Muradov, B Kh; Maksimova, L V; Titov, A Iu; Poletov, N N



A guide to wound managment in palliative care.  


Wound management in palliative patients is often a very challenging area of care. There are many unique issues that can combine to produce complicated wound management scenarios, including the types of wounds and wound symptoms most commonly affecting palliative care patients, as well as the presence of concurrent disease and associated treatment. Problems exist with the availability of suitable dressings and balancing life expectancy with the goals of wound care. A significant, and possibly under-recognized, issue is the emotional and social distress experienced by these patients, which can be directly attributed to their wound. These problems must all be recognized and addressed in order to manage wounds effectively in this patient population. This article aims to explore these issues and offer advice on the management of wound-related symptoms, with the ultimate goal of improving patients' quality of life. PMID:16471044

Naylor, Wayne A



Technique and complications of reconstruction of the pelvic floor with polyglactin mesh  

SciTech Connect

A polyglactin mesh sling was used to reconstruct the pelvis in eight patients after colorectal or urologic resections in preparation for postoperative radiation therapy. There were three perioperative complications--a pelvic abscess requiring percutaneous drainage, a wound dehiscence and a herniation of the small intestine between the pelvic sidewall and mesh requiring small intestinal resection. There were two delayed complications, both partial small intestinal obstructions. One occurred just after the conclusion of radiation treatment and the other occurred five months after the conclusion of radiation therapy. Both obstructions responded to conservative management. None of the common acute radiation effects occurred during radiotherapy. One patient with delayed partial small intestinal obstruction had possible late radiation effects. The median follow-up period after radiation therapy was 12.5 months. Despite the complications described in this report, the use of a polyglactin mesh sling as an adjunct to resection of carcinoma of the pelvis has merit and should be studied further.

Sener, S.F.; Imperato, J.P.; Blum, M.D.; Ignatoff, J.M.; Soper, T.G.; Winchester, D.P.; Meiselman, M.



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


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



Postoperative splinting of the pediatric upper extremity.  


The protective splint described above provides appropriate immobilization and protection for our postoperative pediatric population. The major advantages of this splint over plaster of paris include direct access to the wound, easy reapplication, and unnecessary use of the plaster-cast saw. In addition, thermoplastic splints are lightweight, less bulky, more durable, water-resistant, and easily remolded. The therapist's approach to the patient and parents is of utmost importance and will affect the outcome of the splint. In conclusion, postoperative pediatric splinting can be a challenging experience that requires a significant amount of patience, knowledge, and creativity on the part of the hand therapist. PMID:2269679

Osterhout, B M



Four-fold benefit of wound closure under high magnification  

PubMed Central

Background: Unaffected wound healing and good cosmetic result after a neurosurgical procedure are important factors measuring a level of care. The usefulness of high magnification of the operating microscope during closure of neurosurgical wounds is evaluated. Methods: During a one-year microneurosurgical fellowship, the first author (JK) performed wound closure under the microscope in 200 of 524 neurosurgical operations carried out by the senior author (JH) at the Department of Neurosurgery, Helsinki University Central Hospital. Supratentorial approaches were employed most frequently in 143 patients (72%). Surgeries for infratentorial lesions and the spinal canal comprised 48 (24%) and 9 procedures (4%), respectively. Mean duration of the surgery from skin to skin was 1.8 (range 0.5-6.2) hours. After intradural hemostasis was completed by the senior author, further steps including dural suturing, bone flap fixation, and wound closure were performed by the first author. Wound condition was assessed during the early and late postoperative period. Mean follow-up was 3.2 (range 1-10) months. Results: Early postoperative healing of the wound was uneventful in 180 patients (90%). No wound rupture or postoperative hematoma occurred. In five patients (2.5%), lumbar puncture or spinal drainage was necessary due to significant subcutaneous liquor collection. No wound revision was required. At follow-up, in 196 patients (98%) the postoperative scar was in perfect condition. Neither skin necrosis nor healing problems occurred. Conclusion: Based on our results, we found the high magnification of operating microscope to be beneficial when closing neurosurgical wounds; it allows (1) better hemostasis, (2) precise wound margin approximation, (3) atraumatic handling of the tissues, and (4) improvement of the manual dexterity of the neurosurgeon.

Kivelev, Juri; Hernesniemi, Juha



Factors Affecting Postoperative Morbidity and Mortality in Destroyed Lung  

Microsoft Academic Search

Background. The presence of specific risk factors can increase the postoperative complication rate of pneumonectomy for destroyed lung.Methods. Our experience in 118 consecutive patients who underwent pneumonectomy for destroyed lung over a 10-year period was retrospectively analyzed to evaluate the effect of specific risk factors on postoperative complications. The significance of tuberculosis, right pneumonectomy, preoperative empyema, and duration of illness

Semih Halezeroglu; Murat Keles; Aziz Uysal; Muharrem Celik; Canan Senol; Gokhan Haciibrahimoglu; Bulent Arman



Fulminant Clostridium difficile Colitis: A Complication of Perioperative Antibiotic Prophylaxis.  


Antibiotic prophylaxis for maxillofacial surgical wounds remains common practice. Surgeons must weigh the risks (eg, Clostridium difficile colitis) against the benefits before administering antibiotics for any reason and the relative risk and morbidity of C difficile colitis against those of a potential postoperative wound infection. In addition, the possibility of C difficile infection as a complication of perioperative antibiotic prophylaxis should be discussed with patients before surgery, especially those with concomitant baseline risk factors. This report describes the case of a young healthy patient with few risk factors for C difficile infection who received a standard perioperative course of antibiotic therapy. Subsequently, the patient developed severe fulminant C difficile infection that required a protracted hospital admission, subtotal colectomy, and ileostomy. This case underscores that antibiotic prophylaxis continues in widespread use and is not benign therapy. PMID:23871314

Hansen, Donovan; Pollan, Lee D; Fernando, Hiran



Wound healing primer.  


Surgeons often care for patients with conditions of abnormal wound healing, which include conditions of excessive wound healing, such as fibrosis, adhesions, and contractures, as well as conditions of inadequate wound healing, such as chronic nonhealing ulcers, recurrent hernias, and wound dehiscences. Despite many recent advances in the field, which have highlighted the importance of adjunct therapies in maximizing the healing potential, conditions of abnormal wound healing continue to cause significant cost, morbidity, and mortality. To understand how conditions of abnormal wound healing can be corrected, it is important to first understand the basic principles of wound healing. PMID:21074032

Goldberg, Stephanie R; Diegelmann, Robert F



Wound Healing in PatientsWith Cancer  

PubMed Central

Objective: The treatment of patients with cancer has advanced into a complex, multimodal approach incorporating surgery, radiation, and chemotherapy. Managing wounds in this population is complicated by tumor biology, the patient's disease state, and additional comorbidities, some of which may be iatrogenic. Radiation therapy, frequently employed for local-regional control of disease following surgical resection, has quantifiable negative healing effects due to local tissue fibrosis and vascular effects. Chemotherapeutic agents, either administered alone or as combination therapy with surgery and radiation, may have detrimental effects on the rapidly dividing tissues of healing wounds. Overall nutritional status, often diminished in patients with cancer, is an important aspect to the ability of patients to heal after surgical procedures and/or treatment regimens. Methods: An extensive literature search was performed to gather pertinent information on the topic of wound healing in patients with cancer. The effects that surgical procedures, radiation therapy, chemotherapy, and nutritional deficits play in wound healing in these patients were reviewed and collated. Results: The current knowledge and treatment of these aspects of wound healing in cancer patients are discussed, and observations and recommendations for optimal wound healing results are considered. Conclusion: Although wound healing may proceed in a relatively unimpeded manner for many patients with cancer, there is a potential for wound failure due to the nature and effects of the oncologic disease process and its treatments.

Payne, Wyatt G.; Naidu, Deepak K.; Wheeler, Chad K.; Barkoe, David; Mentis, Marni; Salas, R. Emerick; Smith, David J.; Robson, Martin C.



Penetrating wounds of the neck.  


The management of penetrating wounds of the neck provides several decision-making steps that remain controversial. The two basic concepts of management include the idea that all wounds deep to the platysma should be explored and (the more conservative concept) that selective neck exploration should be based on a battery of tests to identify traumatic injuries. The areas of agreement within these two schools of thought include exploration of wounds with obvious injury, exploration of wounds in which patients cannot be stabilized satisfactorily for further testing, and the idea that all patients with wounds deep to the platysma should be admitted to the hospital. The remaining issues, including the need for angiography, barium swallow, or endoscopy, still are contested. Mandatory exploration of neck wounds became popular during World War II. The weapons used, the lack of accurate testing, and delays in treatment caused by transport problems played significant roles in the development of this policy. Proponents of mandatory exploration of neck wounds contend that delays in treatment result in increased mortality rates. Also delays caused by lengthy diagnostic testing have resulted in rapid exsanguination of patients who might otherwise have been surgically salvageable. These factors, along with the potential for undetected injuries and the associated complications (including false aneurysms and mediastinitis) favor mandatory exploration. Advocates of routine neck explorations also note the low morbidity rates associated with a neck exploration. Reported rates of negative exploration are high, however, approaching 45%, and mortality rates vary from 2% to 9%. Selective neck exploration has gained popularity in some centers because of the lower negative exploration rates associated with this treatment, while comparable mortality rates are achieved. May found a negative exploration rate of 12% in his series of selective neck explorations and a mortality rate of approximately 3%. Furthermore, Noyes found that the hospital stay for patients with selective observation management not requiring a neck exploration was 2.8 days, compared with 4.2 days for patients with mandatory but negative neck explorations. A summary of diagnostic techniques and their indications in selecting patients with penetrating neck wounds for surgery is presented in Table 5. It has become apparent that both selective and mandatory explorations of neck wounds play important roles in treatment.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:2027695

Miller, R H; Duplechain, J K



Integrated Detection of Pathogens and Host Biomarkers for Wounds  

SciTech Connect

The increasing incidence and complications arising from combat wounds has necessitated a reassessment of methods for effective treatment. Infection, excessive inflammation, and incidence of drug-resistant organisms all contribute toward negative outcomes for afflicted individuals. The organisms and host processes involved in wound progression, however, are incompletely understood. We therefore set out, using our unique technical resources, to construct a profile of combat wounds which did or did not successfully resolve. We employed the Lawrence Livermore Microbial Detection Array and identified a number of nosocomial pathogens present in wound samples. Some of these identities corresponded with bacterial isolates previously cultured, while others were not obtained via standard microbiology. Further, we optimized proteomics protocols for the identification of host biomarkers indicative of various stages in wound progression. In combination with our pathogen data, our biomarker discovery efforts will provide a profile corresponding to wound complications, and will assist significantly in treatment of these complex cases.

Jaing, C



Facial reconstruction in the developing world: a complicated matter.  


Around the world there is a small industry of non-governmental organisations that provide health care in niche areas that cannot be met by national health care provision. One topic is facial deformity that can have a dramatic effect on quality of life. In this study we investigate the morbidity and outcome of a British surgical team working for a 2-week period in Ethiopia. Thirty-five patients who presented with facial deformities had 47 operations during a 2-week period. Data were recorded for a minimum of 3 weeks postoperatively. Operative techniques were classified as simple or complex. Postoperative complications were assessed and classified as major, intermediate, and minor. In addition, the character of each complication was recorded and the cause elucidated. After 3 weeks the clinical objectives had been achieved in 14/17 who had simple procedures but in only 5/18 who had complex operations (p=0.004). We conclude that complex procedures are technically possible within an under-privileged health care system but successful outcome depends on paying attention to multiple factors in patients' care and wound management. Early outcome studies may be a useful way to measure the quality of humanitarian surgical missions. PMID:20728253

Huijing, Marijn A; Marck, Klaas W; Combes, James; Mizen, Kelvin D; Fourie, Leroux; Demisse, Yohannes; Befikadu, Sissay; McGurk, Mark



Abdominal stab wounds: self-inflicted wounds versus assault wounds.  


Intentional penetrating wounds, self inflicted or inflicted by others, are increasingly common. As a result, it can be difficult for the forensic examiner to determine whether the cause is self-inflicted or not. This type of trauma has been studied from a psychological perspective and from a surgical perspective but the literature concerning the forensic perspective is poorer. The objective of this study was to compare the epidemiology of abdominal stab wounds so as to distinguish specific features of each type. This could help the forensic scientist to determine the manner of infliction of the wound. We proposed a retrospective monocentric study that included all patients with an abdominal wound who were managed by the visceral surgery department at Angers University Hospital. Demographic criteria, patient history, circumstances and location of the wound were noted and compared. A comparison was drawn between group 1 (self inflicted wound) and group 2 (assault). This study showed that the only significant differences are represented by the patient's prior history and the circumstances surrounding the wound, i.e. the scene and time of day. In our study, neither the site, nor the injuries sustained reveal significant clues as to the origin of the wound. According to our findings, in order to determine the cause, the forensic examiner should thus carefully study the circumstances and any associated injuries. PMID:23622473

Venara, Aurélien; Jousset, Nathalie; Airagnes, Guillaume; Arnaud, Jean-Pierre; Rougé-Maillart, Clotilde



Novel Composite Antibiotic-Eluting Structures for Wound Healing Applications  

Microsoft Academic Search

\\u000a There are various wounds with tissue loss. These include burn wounds, wounds caused as a result of trauma, diabetic ulcers\\u000a and pressure sores. Every year in the United States more than 1.25 million people experience burns and 6.5 million experience\\u000a various chronic skin ulcers. In burns, infection is the major complication after the initial period of shock and it is

Jonathan J. Elsner; Israela Berdicevsky; Adaya Shefy-Peleg; Meital Zilberman


Adjuvant treatment of deep sternal wound infection with collagenous gentamycin  

Microsoft Academic Search

Background. The treatment of deep sternal wound infections remains controversial. Currently advocated procedures carry the risk of reinfections. The significance of local antibiotic-releasing systems as an adjuvant therapy to avoid reinfections is the subject of the presented study.Methods. Forty-two patients with deep sternal wound complication were treated with radical wound debridement, sternal refixation, retrosternal suction drainage, bilateral pectoralis major muscle

Rainer G Leyh; Claus Bartels; Hans-Hinrich Sievers



Complications after breast cancer surgery in patients treated with concomitant preoperative chemoradiation: a case–control analysis  

Microsoft Academic Search

Background\\u000a   Nearly 60% of breast cancer cases in Mexico are in advanced stages. At our institution, concomitant preoperative chemoradiation\\u000a is being used in patients with advanced breast cancer. In the present study, we evaluated the postoperative wound complications\\u000a and risk factors associated.\\u000a \\u000a \\u000a \\u000a \\u000a Patients and methods\\u000a   The study included breast cancer patients from January 2000 to December 2002 treated with concomitant

Eva Ruvalcaba-Limón; Carlos Robles-Vidal; Adela Poitevin-Chacón; Mariana Chávez-MacGregor; Carlos Gamboa-Vignolle; Diana Vilar-Compte



A Repot of Surgical Complications in a Series of 262 Consecutive Pediatric Cochlear Implantations in Iran  

PubMed Central

Objective Cochlear implantations have become a routinely performed and successful surgical intervention in both adults and children. The current article reports the complications encountered in various age groups of consecutive children who underwent implantation in our center. Methods We performed a prospective analysis of all profoundly deaf children who underwent cochlear implantation from March 2006 to July 2009 at Baqhiyatallah Cochlear Implantation Center. All patients were younger than 5 years old at the time of implantation. Findings The minor complications occurred in 49 (18.7%) cases, The most common postoperative complications were temporary facial weakness detected in 15 cases (5.7%) all of which were reversible. Magnet wound was observed in 14 (5.3%) patients, keloid formation in 10 (3.8%), wound infection in 2 (0.8%), otitis media in 5 (2%), and electrode movement, meningitis, vertigo, Laryngospasm each in 1 (0.4%) case was detected among our patients. Conclusion Cochlear implantation in children continues to be reliable and safe in experienced hands, with a low percentage of severe complications as long as the patient is monitored closely.

Ajallouyean, Mohammad; Amirsalari, Susan; Yousefi, Jaleh; Raeesi, Mohammad-Ali; Radfar, Shokofeh; Hassanalifard, Mahdieh



Some somatic complications after small intestinal bypass operations for obesity. Possible factors of significance in the incidence.  


The complications after intestinal bypass operations in 103 massively obese subjects were recorded postoperatively for a maximum of 5 years. The surgical procedures were jejuno-ileostomy, end-to-side (op. I) in 35, and end-to-end with ileocaecostomy (op. II) in 68 cases. Wound dehiscence was the cause of the sole early postoperative death. The early complications found were those commonly seen after abdominal surgery, namely wound infection (n=24), wound dehiscence (n=5), anastomotic leak (n=2), leg thrombosis (n=2). One of the latter 2 patients probably also had pulmonary embolism. In 6 cases early intestinal obstruction occurred; 3 of them required reoperation. The late complications were divided into unspecific and specific in relation to the surgically induced malabsorption. Their incidence was analysed in 80 subjects observed for longer than 1.5 years after the operation. Unspecific late complications consisted of intestinal obstruction in 5 cases and incidional hernias in 18 cases. Intussusception was not seen. There seemed to be no increase in the incidence of gallstone disease or gastroduodenal ulcer after the operation. Specific late complications were electrolyte disturbances (ED) in 13, signs of liver injury (LI) in 9, urinary-tract calculi (UTC) in 15, and immunopathy (IM) in 19 cases. The IM group had skin rashes, arthralgia, and fever. Besides these somatic complications, a number of specific pyschictric complications were also observed (not published). Three subjects died after the operation with signs of liver insufficiency. The following factors were found to be of importance in the occurence of the specific complications ED and LI: 1. The presence of preoperative abnormalities in serum-electrolyte concentration and pathological liver tests, mainly occuring in the heavies patients. 2. Most ED and LI occurred during the period of main weight loss, in general during the first postoperative year. ED and LI did not appear after body weight had stabilised. 3. The rate of weight loss: ED and LI occurred, with a few exceptions, in the subjects with a rate of weight loss higher than 0.0130 weight-index units per week during the period of constant weight loss (see article). PMID:1217445

Backman, L; Hallberg, D



Recent Advances in Postoperative Pain Management  

PubMed Central

Good pain control after surgery is important to prevent negative outcomes such as tachycardia, hypertension, myocardial ischemia, decrease in alveolar ventilation, and poor wound healing. Exacerbations of acute pain can lead to neural sensitization and release of mediators both peripherally and centrally. Clinical wind up occurs from the processes of N-Methyl D-Aspartate (NMDA) activation, wind up central sensitization, long-term potentiation of pain (LTP), and transcription-dependent sensitization. Advances in the knowledge of molecular mechanisms have led to the development of multimodal analgesia and new pharmaceutical products to treat postoperative pain. The new pharmacological products to treat postoperative pain include extended-release epidural morphine and analgesic adjuvants such as capsaicin, ketamine, gabapentin, pregabalin dexmetomidine, and tapentadol. Newer postoperative patient-controlled analgesia (PCA) in modes such as intranasal, regional, transdermal, and pulmonary presents another interesting avenue of development.

Vadivelu, Nalini; Mitra, Sukanya; Narayan, Deepak



Ethics of treating postoperative pain.  


You received a call advising that Mr S. H. Irk was in the emergency room having considerable wound pain following an above-knee amputation you performed 6 months ago. You discharged him from your clinic 6 weeks postoperatively to his primary care physician, still complaining of more pain than usual. Your examination, clinical lab tests, and X-rays do not reveal any serious problems, but he is writhing in pain and begging for relief. Mr Irk has been to a number of different physicians in the interlude including a chiropractor, a pain specialist, several primary care physicians, and a psychiatrist without relief. He has braced up with increasing amounts of analgesics, the latest of which was oral Dilaudid. His last source of pain meds on the street has dried up. You admit him with orders for analgesics. What should your treatment plan be? PMID:22264808

Jones, James W; McCullough, Laurence B



[Gunshot wounds: forensic pathology].  


Gunshot wounds are among the most complex traumatic lesions encountered in forensic pathology. At the time of autopsy, careful scrutiny of the wounds is essential for correct interpretation of the lesions. Complementary pathological analysis has many interests: differentiation between entrance and exit wounds, estimation of firing distance, differentiation between vital and post mortem wounds and wounds dating. In case of multiple headshots, neuropathological examination can provide arguments for or against suicide. Sampling of gunshot wounds at autopsy must be systematic. Pathological data should be confronted respectively to autopsy and death scene investigation data and also ballistic studies. Forensic pathologist must be aware of the limits of optic microscopy. PMID:22325312

Lorin de la Grandmaison, Geoffroy



In-hospital complications and mortality following major lower extremity amputations in a series of predominantly diabetic patients.  


The purpose of this study was to analyze the outcomes of major lower extremity amputations (MLEAs) in a series, including diabetic patients, with the aim to study whether diabetes mellitus is a risk factor of in-hospital mortality and perioperative complications. A retrospective analysis of 283 MLEAs (221 of these patients were diabetic and 62 were nondiabetic) performed between January 1, 1998, and December 31, 2008, at the General Surgery Department and Diabetic Foot Unit of La Paloma Hospital in Las Palmas de Gran Canaria (Canary Islands) was done. The significant risk factors of mortality were >" xbd="324" xhg="301" ybd="1481" yhg="1446"/>75 years of age (odds ratio [OR] = 4.1, 95% confidence interval [CI] = 1.4-11.7), postoperative cardiac complications (OR = 12.3, 95% CI = 3.7-40.2) and postoperative respiratory complications (OR = 3.8, 95% CI = 1.0-13.3). No statistically significant risk factors were found related to the presence of systemic and wound-related complications. In diabetic patients, the significant risk factors of mortality were postoperative cardiological complications (OR = 13.6, 95% CI = 3.1-59.6), postoperative respiratory complications (OR = 5.9, 95% CI = 1.0-35.5), and first episode of amputation (OR = 5.9, 95% CI = 1.4-24.3). There were no statistically significant differences in the outcome of major amputations between diabetic and nondiabetic patients. Hospital stay was significantly longer in diabetic patients (P < .01) though when the patients with diabetic foot infections were excluded, this difference was not found. PMID:20207619

Aragón-Sánchez, Javier; Hernández-Herrero, Maria J; Lázaro-Martínez, Jose L; Quintana-Marrero, Yurena; Maynar-Moliner, Manuel; Rabellino, Martín; Cabrera-Galván, Juan J



Timing of skin wounds.  


Wound examination is indispensable in forensic practice. It is always necessary to determine wound vitality or wound age to correctly evaluate the relationship between death and any wounds. Thus, the determination of wound vitality or wound age is a classic but still modern theme in forensic pathology. Skin wound healing is a primitive but well orchestrated biological phenomena consisting of three sequential phases, inflammation, proliferation, and maturation. Many biological substances are involved in the process of wound repair, and this short and simplified overview of wound healing can be adopted to determine wound vitality or wound age in forensic medicine. With the development of immunohistochemistry and chemical analyses, the scientific field of wound age determination has advanced progressively during recent years. In particular, it has been demonstrated that collagens, cytokines, and growth factors are useful candidates and markers for the determination of wound vitality or age. In this review article, some interesting and instructive results are presented, contributing to the future practice of every forensic pathologist. PMID:17275383

Kondo, Toshikazu



The effect of low level laser therapy (LLLT) on wound healing in horses.  


Laser therapy is used in many countries, including South Africa, for the treatment of skin wounds. Low level galium aluminium arsenide (GaAlAs) laser was administered to full thickness skin wounds (3 x 3 cm) induced surgically on the dorsal aspect of the metacarpophalangeal joints of 6 crossbred horses in a randomised, blind, controlled study. Treated wounds that received a daily laser dosage of 2 J/cm2 were compared with nontreated control wounds on the opposite leg. There were no wound complications. Both groups of wounds were cleaned daily using tap water. Wound contraction and epithelialisation were evaluated using photoplanimetry. There were no significant differences in wound contraction or epithelialisation between the laser treated and the control wounds. It was therefore concluded that laser therapy had no clinically significant effect on second intention wound healing in this study. PMID:10402136

Petersen, S L; Botes, C; Olivier, A; Guthrie, A J



Postoperative management after thymectomy  

Microsoft Academic Search

This paper reports a retrospective study of the preoperative and postoperative management of 28 patients who underwent thymectomy between 1956 and 1973. Patients who received postoperative artificial ventilation were compared with the group who did not with respect to sex, age, severity of disease, preoperative vital capacity, and thymic histology. Evidence is presented that postoperative artificial ventilation is required when

A. B. Loach; A. C. Young; J. M. K. Spalding; A. Crampton Smith



Management of gunshot wounds to the mandible.  


The gunshot wound to the mandible is a unique traumatic injury. The resultant injury from the gunshot wound is diverse because of the variability of the projectile, motion, velocity, and tissue characteristics. When a high-velocity projectile strikes the mandible, often times the wound will consist of a severely comminuted mandible surrounded by nonvital soft tissues and the implantation of multiple foreign bodies. This represents a challenge for the treating surgeon. The anatomy and function of the mandible make it such that the care of the gunshot wound requires a combination of trauma and reconstructive surgeries. There are varying techniques advocated for the management of gunshot wound to the face. However, for the comminuted mandible fracture sustained from a gunshot wound, an approach involving the fabrication of an occlusal splint, intermaxillary fixation, aggressive debridement of hard and soft tissues, and immediate reconstruction with a titanium plate is a comprehensive approach that can restore the appropriate function and contour of the patient. At the Division of Oral and Maxillofacial Surgery, University of Miami, this approach to the comminuted mandible fracture secondary to the gunshot wound has led to the effective management of this specific subset of injury. The complication rate is comparable with the current literature and provides an advantage as a 1-stage management to restore appropriate function and cosmesis to the patient. PMID:20613603

Peleg, Michael; Sawatari, Yoh



[Complications of liposuction].  


Liposuction is the most frequent aesthetic procedure worldwide for adipose tissue reduction and treatment of lipedema. It is being employed with increasing frequency. In 2010, in the USA more than 200.000 liposuctions were performed. Apart from aesthetic indications, liposuction also is suitable for treatment of benign adipose tissue diseases. This intervention is not a simple procedure but requires extensive knowledge and experience to prevent irreversible medical or aesthetic complications. Severe complications including necrotizing fasciitis, toxic shock syndrome, hemorrhage, perforation of inner organs und pulmonary embolism - some even with lethal outcome - occasionally have been reported. These complications were mostly due to inadequate hygiene measures, inappropriate patient selection, use of excessive local anesthesia during mega-liposuction (tumescent technique) and inadequate post-operative surveillance. The complication rate usually reflects a lack of medical experience as well as technical inadequacies. PMID:23494094

Sattler, G; Eichner, S



Prophylactic use of cephazolin against wound sepsis after cholecystectomy  

Microsoft Academic Search

A trial of antibiotic prophylaxis with cephazolin against postoperative wound sepsis was carried out on 201 patients undergoing routine cholecystectomy. Wound sepsis occurred in 11 out of 65 controls (16.9%), who were not given the drug; two out of 63 patients (3.2%) given a single dose preoperatively; and four out of 73 patients (5.5%) given the single preoperative dose plus

C J Strachan; J Black; S J Powis; T A Waterworth; R Wise; A R Wilkinson; D W Burdon; M Severn; B Mitra; H Norcott



[Risks of wound infection caused by drainage].  


Postoperative wound drainages are a possible tool of infections during the whole time of its use. Bacterial spreading within the drainage system is promoted by retrograde movement of secretions and by suspending gas bubbles. It is facilitated by wrong handling. Disconnecting the drainage system will lead to a bacterial contamination in 7%. Changing the bottles too often will increase the infection rates of wounds, may be dangerous for the staff and wastes money. The physical properties must be known, and daily measuring and documentation of the amount of wound secretions are mandatory. Non-disposable suction drainages with a high suction pressure, made of plastic material, are proven to be better than other systems. PMID:2815960

Brunner, W; Härle, A


Missile-Caused Wounds.  

National Technical Information Service (NTIS)

Wound profiles made under controlled conditions in the wound ballistics laboratory using gelatin tissue simulant that has been calibrated against living animal soft tissue show the location along the tissue path and amount of both crush (permanent cavity)...

M. L. Fackler



Wound Care: Preventing Infection  


... in groin or armpits wound has thick, brown/gray discharge skin around the wound turns black or ... and spirit. Eat well and drink plenty of water to strengthen your body’s own natural healing abilities. ...


Wound Healing and Care  


... frustrating having to hold back on activities like sports while a wound heals. But if you take ... Dealing With Cuts and Wounds Dealing With Falls Sports and Exercise Safety Contact Us Print Additional resources ...


Difficult wounds: an update.  


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



Treating wounds in small animals with maggot debridement therapy: A survey of practitioners  

Microsoft Academic Search

Many small animals succumb to complications of serious wounds. Sometimes infection and sepsis overwhelm the animal; sometimes the costs of intensive care overwhelm the owner. Maggot therapy, a method of wound debridement using live fly larvae, could provide effective, simple, low cost wound care. All eight US veterinarians who had been provided with medicinal maggots were surveyed to determine if

Ronald A. Sherman; Howard Stevens; David Ng; Eve Iversen



Complications and safety aspects of kyphoplasty for osteoporotic vertebral fractures: a prospective follow-up study in 102 consecutive patients  

PubMed Central

Background Kyphoplasty represents an established minimal-invasive method for correction and augmentation of osteoporotic vertebral fractures. Reliable data on perioperative and postoperative complications are lacking in the literature. The present study was designed to evaluate the incidence and patterns of perioperative complications in order to determine the safety of this procedure for patients undergoing kyphoplasty. Patients and Methods We prospectively enrolled 102 consecutive patients (82 women and 20 men; mean age 69) with 135 operatively treated fractured vertebrae who underwent a kyphoplasty between January 2004 to June 2006. Clinical and radiological follow-up was performed for up 6 months after surgery. Results Preoperative pain levels, as determined by the visual analogous scale (VAS) were 7.5 +/- 1.3. Postoperative pain levels were significantly reduced at day 1 after surgery (VAS 2.3 +/- 2.2) and at 6-month follow-up (VAS 1.4 +/- 0.9). Fresh vertebral fractures at adjacent levels were detected radiographically in 8 patients within 6 months. Two patients had a loss of reduction with subsequent sintering of the operated vertebrae and secondary spinal stenosis. Accidental cement extravasation was detected in 7 patients in the intraoperative radiographs. One patient developed a postoperative infected spondylitis at the operated level, which was treated by anterior corporectomy and 360 degrees fusion. Another patient developed a superficial wound infection which required surgical revision. Postoperative bleeding resulting in a subcutaneous haematoma evacuation was seen in one patient. Conclusion The data from the present study imply that percutaneous kyphoplasty can be associated with severe intra- and postoperative complications. This minimal-invasive surgical procedure should therefore be performed exclusively by spine surgeons who have the capability of managing perioperative complications.

Robinson, Yohan; Tschoke, Sven Kevin; Stahel, Philip F; Kayser, Ralph; Heyde, Christoph E



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



Methods for reduction of sternal wound infection  

Microsoft Academic Search

Deep sternal wound infections continue to be an uncommon but potentially devastating complication of cardiac surgical procedures. Numerous risk factors have been identified but only a few can be characterized as modifiable. These risk factors and their modifications are reviewed in the following article.

Francis Fynn-Thompson; Thomas J. Vander Salm



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 Central

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.

Topaz, Moris



Chronic Morphine Administration Delays Wound Healing by Inhibiting Immune Cell Recruitment to the Wound Site  

PubMed Central

Patients prescribed morphine for the management of chronic pain, and chronic heroin abusers, often present with complications such as increased susceptibility to opportunistic infections and inadequate healing of wounds. We investigated the effect of morphine on wound-healing events in the presence of an infection in an in vivo murine model that mimics the clinical manifestations seen in opioid user and abuser populations. We show for the first time that in the presence of an inflammatory inducer, lipopolysaccharide, chronic morphine treatment results in a marked decrease in wound closure, compromised wound integrity, and increased bacterial sepsis. Morphine treatment resulted in a significant delay and reduction in both neutrophil and macrophage recruitment to the wound site. The delay and reduction in neutrophil reduction was attributed to altered early expression of keratinocyte derived cytokine and was independent of macrophage inflammatory protein 2 expression, whereas suppression of macrophage infiltration was attributed to suppressed levels of the potent macrophage chemoattractant monocyte chemotactic protein-1. When the effects of chronic morphine on later wound healing events were investigated, a significant suppression in angiogenesis and myofibroblast recruitment were observed in animals that received chronic morphine administration. Taken together, our findings indicate that morphine treatment results in a delay in the recruitment of cellular events following wounding, resulting in a lack of bacterial clearance and delayed wound closure.

Martin, Josephine L.; Koodie, Lisa; Krishnan, Anitha G.; Charboneau, Richard; Barke, Roderick A.; Roy, Sabita



Closure of traumatic wounds without cleaning and suturing  

PubMed Central

Background: In less than ideal situations wounds have to be closed without extensive cleaning using sterile adhesive strips (Steristrips). This prospective analyses the efficiency of this technique and compares it to the more conventional approach. Methods: Altogether 147 lacerations were closed with sterile strips with no wound cleaning. Patients were subsequently followed up for a minimum of three months. Results: The sepsis rate in compliant patients was 1.4% with a total complication rate of 2.7%. Conclusion: This technique, while contradicting the "sacred tenets" of wound closure, is a cheap, quick, and effective alternative to routine closure of traumatic wounds in a casualty department.

Maharaj, D; Sharma, D; Ramdass, M; Naraynsingh, V



Wound trauma alters ionizing radiation dose assessment  

PubMed Central

Background Wounding following whole-body ?-irradiation (radiation combined injury, RCI) increases mortality. Wounding-induced increases in radiation mortality are triggered by sustained activation of inducible nitric oxide synthase pathways, persistent alteration of cytokine homeostasis, and increased susceptibility to bacterial infection. Among these factors, cytokines along with other biomarkers have been adopted for biodosimetric evaluation and assessment of radiation dose and injury. Therefore, wounding could complicate biodosimetric assessments. Results In this report, such confounding effects were addressed. Mice were given 60Co ?-photon radiation followed by skin wounding. Wound trauma exacerbated radiation-induced mortality, body-weight loss, and wound healing. Analyses of DNA damage in bone-marrow cells and peripheral blood mononuclear cells (PBMCs), changes in hematology and cytokine profiles, and fundamental clinical signs were evaluated. Early biomarkers (1 d after RCI) vs. irradiation alone included significant decreases in survivin expression in bone marrow cells, enhanced increases in ?-H2AX formation in Lin+ bone marrow cells, enhanced increases in IL-1?, IL-6, IL-8, and G-CSF concentrations in blood, and concomitant decreases in ?-H2AX formation in PBMCs and decreases in numbers of splenocytes, lymphocytes, and neutrophils. Intermediate biomarkers (7 – 10 d after RCI) included continuously decreased ?-H2AX formation in PBMC and enhanced increases in IL-1?, IL-6, IL-8, and G-CSF concentrations in blood. The clinical signs evaluated after RCI were increased water consumption, decreased body weight, and decreased wound healing rate and survival rate. Late clinical signs (30 d after RCI) included poor survival and wound healing. Conclusion Results suggest that confounding factors such as wounding alters ionizing radiation dose assessment and agents inhibiting these responses may prove therapeutic for radiation combined injury and reduce related mortality.



Non-equilibrium Air Plasma for Wound Bleeding Control  

NASA Astrophysics Data System (ADS)

A low temperature non-equilibrium air plasma spray is tested as a blood coagulator. Emission spectroscopy of the plasma effluent indicates that it carries abundant reactive atomic oxygen (RAO), which can activate erythrocyte - platelet interactions to enhance blood coagulation for plug formation. Tests of the device for wound bleeding control were performed on pigs. Four types of wounds, straight cut and cross cut in the ham area, a hole in an ear saphenous vein, and a cut to an ear artery, were examined. The results showed that this plasma spray could effectively stop the bleeding and reduced the bleeding time considerably. Post-Operative observation of straight cut and cross cut wound healing was carried out. It was found that the plasma treatment had a positive impact on wound healing, in particular, of the cross cut wound; its healing time was shortened by a half.

Kuo, Spencer P.; Chen, Cheng-Yen; Lin, Chuan-Shun; Chiang, Shu-Hsing


Antibiotic concentration in human wound fluid after intravenous administration.  

PubMed Central

Since the wound is the most common focus of infection in the surgical patient, adequate levels of antibiotic within the wound ar essential. This study examines the concentrations of antibiotic achieved in human wounds. Fluid was collected at timed intervals on the first postoperative day from the wounds of 56 patients receiving antibiotics after regional lymph node dissection. Antibiotic concentration was determined by bioassay. Six antibiotics were studied: cephalothin, cefazolin, cephapirin, oxacillin, ampicillin and clindamycin. The cephalosporins and penicillins showed similar patterns of appearance in the wound fluid. The peak level occurred early (1--1 1/2 hours) with subsequent slow decrease. Clindamycin produced nearly constant levels in wound fluid. The concentration of each antibiotic in wound fluid surpassed the serum levels after 2.5 hours. At the dosages studied each antibiotic produced wound fluid concentrations greater than the MIC for most susceptible organisms. Higher doses provided higher wound fluid levels. The rate of appearance and the levels achieved should be considered in the choice of antibiotics in the surgical subject. Images Fig. 1.

Bagley, D H; Mac Lowry, J; Beazley, R M; Gorschboth, C; Ketcham, A S



Platelet-derived growth factor acts via both the Rho-kinase and p38 signaling enzymes to stimulate contraction in an in vitro model of equine wound healing  

Microsoft Academic Search

Horses are more prone to complications in the wound healing process than other species, and problems such as chronic inflammation, delayed epithelialization, poor wound contraction, and exuberant granulation tissue are commonly seen, particularly in wounds on the distal limbs. In comparison, wounds of the oral mucosa heal rapidly in a scarless fashion with a high degree of wound contraction. The

E. J. Watts; M. T. Rose



Forensic wound examination.  


Wound examination is of prime importance in forensic pathology, and it is desirable to establish a wound examination system in order to evaluate and record the nature of wound more accurately and objectively. Modern diagnostic techniques and devices as well as advanced cell-biological methods should be introduced as the means for this aim. For example, radiological, endoscopic or magnetic resonance imaging (MRI) examination have been used in addition to examination with the naked eye. In our department, a binocular surgical operating microscope is routinely employed at forensic autopsy, which is useful for elucidating the nature of wound in more detail. It is also necessary to determine whether a wound has vitality, and, if antemortem, how long before death the wound has been sustained. For the determination of wound age including vitality, various biological factors such as cytokines and extracellular matrix components involved in wound healing have been examined by histopathological methods. Our studies have shown that interleukin (IL)-1alpha, IL-1 b, IL-6, IL-10 and tumor necrosis factor-alpha are possibly useful markers for wound age determination as well as cell-biological indicators of vitality. Furthermore, molecular biological techniques have been intended to be applied to wound examination; our experimental study has shown that even mRNA of cytokines mentioned above can be histologically detected by reverse transcriptase-polymerase chain reaction or in situ hybridization. A trial of forensic wound examination from macroscopic to molecular level is discussed. PMID:10978618

Ohshima, T



Phases of wound healing.  


The phases of wound healing--inflammatory, fibroblastic, and maturation--are continuous, though they overlap and do not always occur in an orderly fashion. Wound healing may be retarded by age, diabetes, smoking, immunosuppression, poor nutrition, cell hypoxia, dehydration, bacteria, and other factors. Bacteria and pus may be so great at the inflammatory phase that the wound remains at that phase. It is important that the nurse recognize when pus is a major factor in an unhealed wound and initiate local care to assist in cleaning the wound bed. It is also important to recognize a clean wound and to initiate appropriate local care that facilitates wound healing. New information about wound healing at the cellular level continues to become available. Epidermal growth factors, platelet-derived growth factors, and the growth hormone somatomedin are being studied, and new methods based on these studies may change local wound care measures. It is essential to understand the phases of wound healing to determine appropriate wound care measures for individual patients. PMID:1823567

Gilmore, M A



G-CSF Enhances Resolution of Staphylococcus aureus Wound Infection in an Age-Dependent Manner.  


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



Impaired wound healing.  


Nonhealing wounds represent a significant cause of morbidity and mortality for a large portion of the population. One of the underlying mechanisms responsible for the failure of chronic wounds to heal is an out-of-control inflammatory response that is self-sustaining. Underappreciation of the inherent complexity of the healing wound has led to the failure of monotherapies, with no significant reduction in wound healing times. A model of the inflammatory profile of a nonhealing wound is one in which the equilibrium between synthesis and degradation has been shifted toward degradation. This review summarizes the current information regarding acute wound healing responses as contrasted to the delayed response characteristic of chronic wounds. In addition, some initial complexity theoretical models are proposed to define and explain the underlying pathophysiology. PMID:17276197

Menke, Nathan B; Ward, Kevin R; Witten, Tarynn M; Bonchev, Danail G; Diegelmann, Robert F


Running closure of clean and contaminated abdominal wounds using a synthetic monofilament absorbable looped suture  

Microsoft Academic Search

The effectiveness of using an absorbable suture material for continuous closure of abdominal wounds, especially contaminated\\u000a wounds, has not yet been determined. Thus, the present study was conducted to investigate the wound complications that developed\\u000a following continuous closure of clean and contaminated abdominal wounds using polydioxanone (PDS), compared with those that\\u000a developed following interrupted closure using braided silk. Running closure

Kazuhiro Iwase; Jun Higaki; Yasushi Tanaka; Haruhiko Kondoh; Masato Yoshikawa; Wataru Kamiike



Nonhealing scalp wound infected with Aspergillus niger in an elderly patient.  


Cutaneous aspergillosis is a rare infection most often seen in immunocompromised patients. We report a case of primary cutaneous aspergillosis infection in a nonhealing scalp wound of an immunocompetent elderly patient. The patient had a cutaneous malignancy of the scalp treated with surgical excision but complicated by poor wound healing. Fungal culture of the nonhealing wound revealed Aspergillus niger. The nonhealing wound subsequently resolved with retapamulin ointment 1% and ketoconazole gel 2%. PMID:21644495

Robinson, Amanda; Fien, Sari; Grassi, Marcelle A



[Optimization of aspiration-irrigation drainage of purulent wounds].  


The aim of the investigation was to improve the methods of sanitation of purulent foci. Efficacy of the purulent cavity lavage increased due to the changed direction of the flow of antiseptic solution. Experimental investigations showed that the down-flow lavage of purulent wounds with antiseptics was not enough. The drainage tube was irrigated and contact-exposure of the antiseptic with the wound discharge and microbes was not fulfilled completely. The changed flow of the liquid upwards, in vertical drainage the irrigation solution came outside the limits of the drain and irrigated the wound canal walls filling the whole wound cavity. Bacteriological investigations showed decreased bacterial dissemination of the purulent wounds due to the adequate filling of the wound cavity through the drain. The number of complications considerably decreased, the period of hospital treatment was 1.5 times shorter. PMID:23227746

Osintsev, E Iu; Slobodsko?, A B; Mel'sitov, V A; Kulinski?, A N; Osintsev, B E



The importance of definitions and methods in surgical wound infection audit  

Microsoft Academic Search

We investigated the value of a full-time audit nurse personally following up every patient from admission to 30 days postoperatively in order to obtain accurate surgical wound infection rates. Our results show that this type of audit is an effective, although time-consuming, way of collecting accurate data on wound infection rates. It enabled the early identification of problem areas in

J. S. Reilly; D. Baird; R. Hill



Topical ampicillin in the appendicectomy wound: Report of double-blind trial  

Microsoft Academic Search

One hundred and thirty unselected patients undergoing appendicectomy were treated with topical ampicillin powder or topical placebo powder (lactose) before closing the wound. The postoperative wound infection rates were 3% in the ampicillin-treated group and 24% in the control group, a significant difference. This difference was not influenced by the degree of inflammation in the appendix. No side-effects of treatment

J. W. S. Rickett; B. T. Jackson



The use of transposed rectus femoris muscle in the treatment of infected abdominal wounds  

Microsoft Academic Search

Summary  A recent publication, where three experienced workers in the field of managing post-operative contaminated open wounds, especially\\u000a of the abdominal wall, underscores the considerable number of different methods that are in vogue. Infected abdominal wounds\\u000a are usually treated by debridement, the administration of appropriate antibiotics and wound closure on a delayed basis. In\\u000a the presence of a surgical implant, the

R. Ger; G. Angus



An outbreak of post-surgical wound infections due to Mycobacterium abscessus  

Microsoft Academic Search

An outbreak of post-operative wound infections due to Mycobacterium abscessus is described. During a 5-month period 45 post-surgical patients developed wound infection, manifested by wound breakdown,\\u000a cellulitis, and discharge and progressing slowly to suppuration and sinus formation. The majority (43\\/45) had undergone out-patient\\u000a operations, and 40 had had surgery in the inguinal region. The source of infection was identified as

R. Chadha; M. Grover; A. Sharma; A. Lakshmy; M. Deb; A. Kumar; G. Mehta



Wound Chemotherapy by the Use of Negative Pressure Wound Therapy and Infusion  

PubMed Central

Introduction: Although the use of negative pressure wound therapy (NPWT) is broadly efficacious, it may foster some potentially adverse complications. This is particularly true in patients with diabetes who have a wound colonized with aerobic organisms. Traditional antiseptics have been proven useful to combat such bacteria but require removal of some NPWT devices to be effective. Methods: In this article, we describe a method of “wound chemotherapy” by combining NPWT and a continuous infusion of Dakins' 0.5% solution either as a standardized technique in one device (ITI Sved) or as a modification of standard technique in another (KCI VAC) NPWT device. The twin goals of both techniques are to effectively reduce bacterial burden and to promote progressive wound healing. Results: We present several representative case examples of our provisional experience with continuous streaming therapy through 2 foam-based negative pressure devices. Discussion: Wound chemotherapy was successfully applied to patients with diabetes, without adverse reactions, complications, or recolonization during the course of treatment. We believe this to be a promising method to derive the benefits of NPWT without the frequent adverse sequela of wound colonization.

Giovinco, Nicholas A.; Bui, Trung D.; Fisher, Timothy; Mills, Joseph L.; Armstrong, David G.



Postoperative maxillary cyst after maxillary sinus augmentation.  


The posterior edentulous maxilla is a critical anatomic region for dental implant therapy. Because of severe alveolar bone resorption and maxillary sinus pneumatization, low bone volume is often presented clinically. Although maxillary sinus augmentation has been developed to promote bone reconstruction and oral rehabilitation, complications have been reported. Possible complications include paranasal sinusitis, loss of the graft, and displacement of an implant into the antrum. In this study, we present an observed rare complication of maxillary sinus augmentation, a postoperative maxillary cyst that occurred 10 years after treatment. PMID:24036833

Kim, Jae Jin; Freire, Marcelo; Yoon, Jung-Hoon; Kim, Hak Kyun



Clinical study on the treatment of chronic wound with negatively-charged aerosol  

PubMed Central

Background: Aerosols are defined as the mixture of liquid or solid particles/droplets that are stably suspending in air. When carrying a certain amount of negative charge, they will be defined as negatively-charged aerosol. This report investigates the effect of negatively-charged aerosol on the healing of chronic wound. Methods: 140 patients with chronic wound were assigned randomly into two groups. Normal, routine treatment was applied on chronic wounds of 73 patients depending on wounds situation (control group). While another 67 similar patients received negatively-charged aerosol therapy (2 hours per time, twice a day) and were used as experimental group. Wound healing assessment including the patients’ complication, detection of bacteria in wound secretions, and evaluation of wound healing. Results: The results of our study showed that after the application of negatively-charged aerosols, and condition and infection rate of wounds from experiment group were better and lower than that of control group. In comparison with control group, the relative size of wounds from experiment group was significantly smaller (P<0.05) at post-treatment day 0, 7, 14, 21 and 28. Also, the time required for wound healing in the experimental group was significantly shorter (P<0.05) than that in the control group. Conclusion: Negatively-charged aerosol therapy can accelerate wound healing speed and improve the healing of chronic wounds. Thus, we wound recommend the consideration of Negatively-charged aerosol therapies in addition to normal wound treatment in cases of chronic wound.

Xie, Xiaoxia; Chen, Lei; Zhang, Zhao-Qiang; Shi, Yan; Xie, Julin



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


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



Postoperative apnea, respiratory strategies, and pathogenesis mechanisms: a review.  


Recovery from anesthesia is ideally routine and uneventful. After extubation, the recovering postoperative patient ought to breathe without supportive care or additional oxygenation. It has been demonstrated in previous studies that postoperative pulmonary complications are clinically relevant in terms of mortality, morbidity, and length of hospital stay. Compromised postoperative ventilation can be described as the condition in which the postoperative patient does not have satisfactory spontaneous ventilation support and adequate oxygenation. Causes of impaired ventilation, oxygenation, and airway maintenance can be mechanical, hemodynamic, and pharmacologic. This review describes prevalence and differential diagnosis, including co-morbidities of postoperative apnea. The physiological mechanisms of breathing and prolonged postoperative apnea are also reviewed; these mechanisms include influences from the brainstem, the cerebral cortex, and chemoreceptors in the carotid and aortic body. Causes of prolonged postoperative apnea and management are also discussed. PMID:23179739

Kaye, Alan D; Hollon, McKenzie Mayo; Vadivelu, Nalini; Kodumudi, Gopal; Kaye, Rachel J; Bueno, Franklin Rivera; Baluch, Amir R



LASIK Complications  

Microsoft Academic Search

Laser in situ keratomileusis (LASIK) is a rapidly evolving ophthalmic surgical procedure. Several anatomic and refractive complications have been identified. Anatomic complications include corneal flap abnormalities, epithelial ingrowth, and corneal ectasia. Refractive complications include unexpected refractive outcomes, irregular astigmatism, decentration, visual aberrations, and loss of vision. Infectious keratitis, dry eyes, and diffuse lamellar keratitis may also occur following LASIK. By

Samir A Melki; Dimitri T Azar



[Postoperative fistulas. How to close them].  


Postoperative enterocutaneous fistulas are usually the result of an anastomotic leak. The likelihood of a postoperative fistula developing depends on concomitant diseases. An established gastrointestinal fistula is associated with considerable morbidity and mortality. Appreciable losses of fluid, protein and electrolytes often result in malnutrition, which has a negative impact on wound infection and the mental performance of the patient. Conservative treatment must aim to compensate these deficits as early as possible. Adequate amounts of energy (carbohydrates and fats) vitamins and trace elements must be ensured by replacement measures. In addition to appropriate drainage of the intra-abdominal focus and the use of antibiotics, treatment with octreotide (somatostatin analogues) may be considered. For conservative treatment, however, free intestinal transit distal to the fistula must be ensured. If an enterocutaneous fistula fails to heal within two or three months under conservative treatment, surgical management must be applied. PMID:12534059

Baumgartner, U



Surgical treatment of complicated duodenal ulcers: controlled trials.  


Indications for surgery of duodenal ulcer (DU) have changed radically because of the efficacy of H(2)-antagonists, endoscopic procedures, and eradication of Helicobacter pylorus. The aim of this study was to analyze the current literature to determine if definitive surgery is still relevant for complicated DU (bleeding, perforation, gastric outlet obstruction). Two studies have compared early to late surgery in terms of bleeding. One recommended early surgery (significant reduction in mortality) in the elderly, but no statistically significant difference was found when analyzed with "intention to treat." In the other, mortality with early surgery was five times higher than with expectant therapy (when it was possible). Two studies comparing different surgical techniques for bleeding favored the radical procedure. Of at least 15 studies comparing endoscopic treatments, however, none has compared endoscopic therapy to surgical intervention for bleeding DU. One trial, comparing nonoperative to surgical treatment for perforation, found similar rates of morbidity, intraabdominal abscess, and mortality; but the hospital stay was longer (p < 0.001). Nonoperative treatment failed more often (p < 0.05) in patients over age 70. In three trials, postoperative morbidity (excepting wound sepsis in one) was not significantly increased by definitive surgery, with less ulcer recurrence (p < 0.05) compared with simple closure. Laparoscopy (versus laparotomy) was shown to take longer (p < 0.001) but required less postoperative analgesics (p < 0.03); there were no statistically significant differences as concerns the duration of nasogastric aspiration, intravenous drips, hospital stay, time to resume normal diet, Visual Analogous Scale pain scores for the first 24 hours after surgery, morbidity, reoperation rate, or mortality. Of 48 laparoscopic patients, 11 (23%) underwent conversion to open surgery. Three surgical techniques [highly selective vagotomy (HSU) + gastrojejunostomy (group 1), HSV + Jaboulay gastroduodenostomy (group 2), or selective vagotomy (group 3) + antrectomy) for gastric outlet obstruction (GOO)] showed that although postoperative results were similar (except wound sepsis in one trial), long-term Visick scores were significantly (p < 0.01) better in group 1 than in group 2, but not in group 3. Further studies are needed to determine the exact prevalence of Helicobacter pylori in complicated DU and to compare (1) definitive to minimal surgery (stop the bleeding or close the perforation) combined with antisecretory drugs and eradication of H. pylori; (2) surgery to endoscopic treatment combined with eradication of H. pylori; and (3) for GOO, surgery to balloon dilatation combined with eradication of H. pylori. PMID:10658064

Millat, B; Fingerhut, A; Borie, F



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.

Guo, S.; DiPietro, L.A.



Prophylaxis of postoperative infections  

Microsoft Academic Search

Summary The antibiotic most appropriate for prophylaxis of postoperative infections depends on the nature of the operation. In aseptic (clean) operations, grampositive postoperative infections are the primary concern, and cefazolin is recommended because of its excellent pharmacokinetics and good activity against grampositive pathogens, including staphylococci. In those operations where violation of the digestive tract creates a contaminated field, a cefotaxime-generation

D. H. Wittmann; R. E. Condon



Chronic Postoperative Roseomonas Endophthalmitis?  

PubMed Central

We report one case with chronic postoperative endophthalmitis caused by Roseomonas species. Roseomonas spp. induced chronic endophthalmitis, which might result in misdiagnosis and delayed treatment and causes ocular damage and severe visual loss. This report is the first one related to a case with postoperative endophthalmitis secondary to Roseomonas infection.

Chen, Kuan-Jen; Lai, Chi-Chun; Kuo, Ya-Hui; Wu, Wei-Chi; Chen, Tun-Lu



Ageing and wound healing  

Microsoft Academic Search

Cutaneous wound healing is a complex process encompassing a number of overlapping events including leukocyte recruitment,\\u000a matrix deposition, epithelialization, and ultimately resolution of inflammation with the formation of a mature scar. Morbidity\\u000a associated with age-related delayed wound healing imposes an enormous social and financial burden; unless improved wound care\\u000a strategies are developed the projected relative and absolute increase in the

Gillian S. Ashcroft; Stuart J. Mills; Jason J. Ashworth



Complications of tonsillectomy and adenoidectomy  

Microsoft Academic Search

Adenotonsillectomy is generally safe surgery, but surgeons should be cognizant of potential complications and be prepared to manage them. Postoperative hemorrhage usually responds to local measures or cautery but can be life-threatening. Preoperative screening of coagulation profiles appears unnecessary. Anesthetic risks have declined with modern techniques, but airway risks, aspiration, and pulmonary edema are possible. Nasopharyngeal valving may be altered

David A. Randall; Michael E. Hoffer



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.

Rettinger, Gerhard



Understanding postoperative fatigue.  


Performance characteristics of the central nervous, cardiovascular, respiratory and muscular systems in man postoperatively have received little investigative attention, despite the well known syndrome of postoperative fatigue. The impairmen in perception and psychomotor skills that has been shown to result from caloric restriction, bedrest, sedation and sleep deprivation suggests that a similar deficit may occur after surgical procedures. After a simple elective surgical procedure, maximal oxygen uptake decreases and the adaptability of heart rate to submaximal workloads is impaired. Similar deleterious effects on cardiorespiratory performance have been documented with starvation and bedrest; an understanding of cardiorespiratory performance postoperatively awaits further investigation. Maximal muscular force of contraction is also impaired by caloric restriction and bedrest, suggesting that similar effects may be seen in the postoperative state, although this has not been studied. A better understanding of the syndrome of postoperative fatigue could be achieved by a descriptive analysis of physiologic performance postoperatively. Such descriptive data could form the basis for objective evaluation of therapeutic measures intended to improve performance, such as nutritional supplementation and pharmacologic intervention. The observation that exercise with the patient in the supine position may decrease the impairment in maximal aerobic power otherwise expected in immobilized patients suggests that controlled exercise therapy may be of value in reducing physiologic impairment postoperatively. PMID:351838

Rose, E A; King, T C



The tolerance of skin grafts to postoperative radiation therapy in patients with soft-tissue sarcoma  

SciTech Connect

During the last ten years at the National Cancer Institute, 11 patients have received 12 courses of postoperative adjuvant radiation therapy to skin grafts used for wound closure after the resection of soft-tissue sarcomas. The intervals between grafting and the initiation of radiation ranged between 3 and 20 weeks, and 4 patients received chemotherapy at the same time as their radiation. Ten of the 12 irradiated grafts remained intact after the completion of therapy. One graft had several small persistently ulcerated areas that required no further surgical treatment, and one graft required a musculocutaneous flap for reconstruction of a persistent large ulcer. Acute radiation effects on the grafted skin sometimes developed at slightly lower doses than usually seen with normal skin, but these acute effects necessitated a break in therapy on only five occasions. Concurrent chemotherapy and a relatively short interval between grafting and the initiation of radiation seemed to contribute to more severe radiation reactions. This experience indicates that postoperative adjuvant radiation therapy can be delivered to skin grafted areas without undue fear of complications, especially if the graft is allowed to heal adequately prior to initiating therapy and if chemotherapy is not given in conjunction with radiation.

Lawrence, W.T.; Zabell, A.; McDonald, H.D. (National Cancer Institute, Bethesda, MD (USA))



Management and complications of stomas.  


Stomas are created for a wide range of indications such as temporary protection of a high-risk anastomosis, diversion of sepsis, or permanent relief of obstructed defecation or incontinence. Yet this seemingly benign procedure is associated with an overall complication rate of up to 70%. Therefore, surgeons caring for patients with gastrointestinal diseases must be proficient not only with stoma creation but also with managing postoperative stoma-related complications. This article reviews the common complications associated with ostomy creation and strategies for their management. PMID:23177069

Bafford, Andrea C; Irani, Jennifer L



Liquid Collagen Wound Coverings.  

National Technical Information Service (NTIS)

A stabilized collagen gel is disclosed as are methods of making this collagen gel which is useful as a wound dressing to prevent dehydration of the subject being treated and infection of the wound. The collagen gel of the invention is stabilized by combin...



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



Renal transplant complications.  


Clinical monitoring and appropriate imaging have played an important role to ensure a successful outcome for renal transplant patients. A variety of imaging options now exist, and they are routinely used in these patients. Ultrasound is the most frequent first-line imaging method in the post-operative period and for long-term follow-up. For specific indications, magnetic resonance imaging, computed tomography, and nuclear medicine examinations are often helpful. This article will review the imaging findings of the most commonly encountered complications of renal transplantation. PMID:23793411

Weber, Therese M; Lockhart, Mark E



Complications of pancreatic surgery  

PubMed Central

Pancreatic resection is the only treatment option that can lead to a meaningful prolonged survival in pancreatic cancer and, in some instances, perhaps a potential chance for cure. With the advent of organ and function preserving procedures, its use in the treatment of chronic pancreatitis and other less common benign diseases of the pancreas is increasing. Furthermore, over the past two decades, with technical advances and centralization of care, pancreatic surgery has evolved into a safe procedure with mortality rates of <5%. However, postoperative morbidity rates are still substantial. This article reviews the more common procedure-related complications, their prevention and their treatment.

Ho, Choon-Kiat; Kleeff, Jorg; Friess, Helmut



[Stab wounds in children].  


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



Wound problems in total knee arthroplasty.  


Wound problems can often be prevented with careful planning. When transverse incisions are used for knee surgery many years prior to any anticipated knee arthroplasty, no major problems are typically encountered with a conventional, anterior longitudinal incision. We recommend lateral incisions (eg, after a previous lateral tibial plateau fracture) be reused for TKA. When confronted with multiple previous incisions, surgeons would best use the most recently healed or the most lateral. We prefer soft tissue reconstruction with expanders or a gastrocnemius flap if there are multiple incisions, if the skin and scar tissue are adherent to underlying tissue, or if wound healing seems questionable. Deep infection must be determined by aspiration. When present, we believe treatment must include irrigation, débridement, polyethylene exchange if acute, and resection arthroplasty if chronic. Poor wound healing is a potentially devastating complication that may result in multiple reconstructive procedures and even amputation. Early recognition followed by expeditious débridement and soft tissue reconstruction should be used for managing wound complications after TKA. PMID:17079990

Vince, Kelly G; Abdeen, Ayesha



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.

Dupps, William J.; Wilson, Steven E.



Conjunctival Complications Related to Ahmed Glaucoma Valve Insertion.  


PURPOSE:: Conjunctival complications may occur after glaucoma drainage device surgery. We analyzed the frequency, risk factors, management and outcomes of Ahmed glaucoma valve (AGV)-related conjunctival complications. METHODS:: Retrospective review of postoperative conjunctival complications in patients undergoing AGV insertion. Only subjects with ?1-year follow-up were included. RESULTS:: The charts of 158 subjects with a median age of 64±16.2 years were reviewed. Median follow-up was 43.5 months (range, 12 to 103 mo). Fifty-three (33.5%) wound dehiscences and 14 (8.9%) device exposures were diagnosed 31.6±35.7 and 996±735 days after procedure, respectively (P<0.001). Ninety-one subjects (57.6%) had no conjunctival complications. This uncomplicated group used 3.3 (±1.1) [95% confidence interval (CI): 3.07, 3.51] hypotensive medications before surgery as compared with 3.8 (±1.1) (95% CI: 3.48, 4.10) and 3.9 (±0.9) (95% CI: 3.36, 4.36) for dehiscence and exposure groups, respectively (P=0.01). The inferonasal quadrant was associated with the highest rate of dehiscences (4/7, 57.1%) (95% CI: 18.4, 90.1), followed by the inferotemporal quadrant (30/65, 46.2%) (95% CI: 33.1, 58.2), the superotemporal (15/61, 24.6%) (95% CI: 12.9, 33.8), and the superonasal (4/25, 16%) (95% CI: 10.9-52.0; P<0.0073). There were no differences in dehiscence and exposure rates between limbal versus fornix-based approaches (P=0.54; 95% CI: 24.8-44.9, 24.4-45.7, 5.9-19.6, 3-45.1, respectively). Forty-eight (90.6%) dehiscent wounds resolved with conservative management and 5 were resutured, whereas all exposed devices were managed surgically. CONCLUSIONS:: Conjunctival dehiscence is usually a benign, common complication after AGV insertion. It does not need repair as long as the tube is well covered. AGV tube or plate exposures are less common, occur later and were promptly repaired as per current practice. Important factors predisposing to these problems include a greater number of preoperative hypotensive medications and the implantation quadrant. PMID:23059483

Geffen, Noa; Buys, Yvonne M; Smith, Michael; Anraku, Ayako; Alasbali, Tariq; Rachmiel, Ronny; Trope, Graham E



The Impact of Psychological Stress on Wound Healing: Methods and Mechanisms  

PubMed Central

Wound healing is a critical process involved in the recovery from injury and surgical procedures. Poor healing increases the risk for wound infections or complications, lengthens hospital stays, magnifies patient discomfort, and slows return to activities of daily living. Converging evidence from different research paradigms suggests that psychological stress and other behavioral factors can affect wound healing. A meta-analytical study using diverse wound-healing models and outcomes found that across studies there was an average correlation of ?0.42 between psychological stress and wound healing.1 This result suggests that the relationship between stress and wound repair is not only statistically significant but also clinically relevant. This review presents data and methods from observational, experimental, and interventional studies corroborating the impact of stress on wound healing. Potential behavioral and physiologic mechanisms explaining the association between stress and impaired wound healing are also discussed.

Gouin, Jean-Philippe; Kiecolt-Glaser, Janice K.



The effects of acupressure on the incidence of postoperative nausea and vomiting in postsurgical patients  

Microsoft Academic Search

Postoperative nausea and vomiting (PONV) is one of the most common postoperative complications. Aside from pharmacological interventions, other complementary healing modalities have been introduced to assist patients in decreasing PONV and improving postoperative outcomes. This study examined acupressure as a potentially holistic and safe complement to the more traditional approach of using drugs to prevent and\\/or relieve nausea and vomiting

Pamela E Windle; Annabelle Borromeo; Herminia Robles; Videlyn Ilacio-Uy



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.



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


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



Postoperative bile leakage: endoscopic management.  

PubMed Central

Bile leakage is an infrequent but serious complication after biliary tract surgery. This non-randomised single centre study evaluated the endoscopic management of this problem in 55 consecutive cases. Treatment consisted of standard sphincterotomy and, if needed, subsequent stone extraction with or without endoprosthesis placement. The aim of all treatments was to facilitate bile flow into the duodenum. The biliary tract and the site of the leakage were visualised during endoscopic retrograde cholangiopancreatography (ERCP) in 98%. There was distal obstruction in 33--caused by retained gall stones in 15 patients and concomitant strictures in 18. Overall, 48 of 55 patients were treated endoscopically. An excellent outcome (clinical and radiological resolution of the bile leak) was achieved in 43 patients (90%). Five patients (10%) had continuing sepsis from which they died. Postoperative bile leakage can be diagnosed safely and effectively by ERCP and subsequent endoscopic management is successful in most cases. Images Figure 1 Figure 2 Figure 3 Figure 4

Davids, P H; Rauws, E A; Tytgat, G N; Huibregtse, K



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.

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



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.

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



Moist wound healing compared with standard care of treatment of primary closed vascular surgical wounds: a prospective randomized controlled study.  


This study was a randomized-controlled trial comparing the standard type of dry dressing, Mepore, with moist wound healing, using a hydrofiber dressing, Aquacel, in primary closed wounds after vascular surgery. The endpoints were patient comfort, cost-effectiveness, infections, wound complications, and length of hospital stay. One hundred and sixty patients were randomized to receive either Mepore or Aquacel dressing. There was no significant difference in patient comfort between the two groups, but a higher cost in the Aquacel group despite significantly fewer changes of dressings in these patients. No difference in the infection rate (13% vs. 11%, p=0.73), length of hospital stay, or wound complications was noted between the two groups. We conclude that although the Aquacel dressing needed significantly fewer changes than the conventional dressing, this did not influence the patient comfort. Moreover, the traditional dressing scheme was significantly less expensive. PMID:17971007

Vogt, Katja C; Uhlyarik, M; Schroeder, Torben V


The wounded worm  

PubMed Central

The ability to heal wounds is an ancient and conserved function of epidermal epithelial layers. The importance of skin wound healing to human life and biology has long been evident, however many of the molecular mechanisms underlying wound repair remain little understood. In the past several years, analysis of the C. elegans innate immune response to fungal infection of the epidermis has led to investigations of the ability of the C. elegans skin to respond to damage. In a recent paper we used live imaging to investigate the cell biological basis of wound repair in the adult C. elegans epidermis. We found that needle or laser injury of the skin triggers a large and sustained increase in epidermal calcium. Epidermal calcium signals appear to specifically promote actin-dependent processes of wound closure. The innate immune and wound closure responses act in parallel to promote survival after injury. Our findings indicate that wounding triggers multiple signals in the C. elegans skin. C. elegans offers a tractable model to dissect how epidermal epithelia activate coordinated responses to repair damage.

Xu, Suhong; Hsiao, Tiffany I.; Chisholm, Andrew D.



Fetal skin wound healing.  


The developing fetus has the ability to heal wounds by regenerating normal epidermis and dermis with restoration of the extracellular matrix (ECM) architecture, strength, and function. In contrast, adult wounds heal with fibrosis and scar. Scar tissue remains weaker than normal skin with an altered ECM composition. Despite extensive investigation, the mechanism of fetal wound healing remains largely unknown. We do know that early in gestation, fetal skin is developing at a rapid pace and the ECM is a loose network facilitating cellular migration. Wounding in this unique environment triggers a complex cascade of tightly controlled events culminating in a scarless wound phenotype of fine reticular collagen and abundant hyaluronic acid. Comparison between postnatal and fetal wound healing has revealed differences in inflammatory response, cellular mediators, cytokines, growth factors, and ECM modulators. Investigation into cell signaling pathways and transcription factors has demonstrated differences in secondary messenger phosphorylation patterns and homeobox gene expression. Further research may reveal novel genes essential to scarless repair that can be manipulated in the adult wound and thus ameliorate scar. PMID:19803418

Buchanan, Edward P; Longaker, Michael T; Lorenz, H Peter



Ascending thoracic aorta: postoperative imaging evaluation.  


Advances in computed tomography (CT) scanners and electrocardiographic gating techniques have resulted in superior image quality of the ascending aorta and increased the use of CT angiography for evaluating the postoperative ascending aorta. Several abnormalities of the ascending aorta and aortic arch often require surgery, and various open techniques may be used to reconstruct the aorta, such as the Wheat procedure, in which both an ascending aortic graft and an aortic valve prosthesis are implanted; the Cabrol and modified Bentall procedures, in which a composite synthetic ascending aorta and aortic valve graft are placed; the Ross procedure, in which the aortic valve and aortic root are replaced with the patient's native pulmonary valve and proximal pulmonary artery; valve-sparing procedures such as the T. David-V technique, which leaves the native aortic valve intact; and more extensive arch repair procedures such as the elephant trunk and arch-first techniques, in which interposition or inclusion grafts are implanted, with or without replacement of the aortic valve. Normal postoperative imaging findings, such as hyperattenuating felt pledgets, prosthetic conduits, and reanastomosis sites, may mimic pathologic processes. Postoperative complications seen at CT angiography that require further intervention include pseudoaneurysms, anastomotic stenoses, dissections, and aneurysms. Radiologists must be familiar with these procedures and their imaging features to identify normal postoperative appearances and complications. PMID:23322828

Prescott-Focht, Julia A; Martinez-Jimenez, Santiago; Hurwitz, Lynne M; Hoang, Jenny K; Christensen, Jared D; Ghoshhajra, Brian B; Abbara, Suhny


Pulmonary Complications in Burn Patients. A Comparative Study of 697 Patients.  

National Technical Information Service (NTIS)

The pulmonary complications of burn patients treated with and without topical burn wound chemotherapy have been reviewed and tabulated. The etiology, pathogenesis, characteristics, clinical course, treatment, and importance of these complications are note...

B. A. Pruitt R. J. Flemma F. C. DiVincenti F. D. Foley A. D. Mason



Negative-pressure wound therapy in the management of diabetic Charcot foot and ankle wounds  

PubMed Central

As the prevalence of diabetes mellitus continues to rise, innovative medical and surgical treatment options have increased dramatically to address diabetic-related foot and ankle complications. Among the most challenging clinical case scenarios is Charcot neuroarthropathy associated with soft tissue loss and/or osteomyelitis. In this review article, the authors present a review of the most common utilizations of negative-pressure wound therapy as an adjunctive therapy or combined with plastic surgery as it relates to the surgical management of diabetic Charcot foot and ankle wounds.

Ramanujam, Crystal L.; Stapleton, John J.; Zgonis, Thomas



[General principles of clinical and therapeutic management in postoperative external enteral fistulas].  


Postoperative enterocutaneous fistulas represent a frequent complication in the emergency or cancerous digestive surgery. As to the high level of mortality and morbidity caused by this type of postoperative complication (4%), efforts are made to establish the principles of therapeutic management, on the purpose of decreasing these indicators and thus lowering the prolonged hospitalisation afferent costs. PMID:20201248

Munteanu, Iulia; Stefan, S; Burcoveanu, C; P?dureanu, S; Bulat, C


Carnosine enhances diabetic wound healing in the db/db mouse model of type 2 diabetes.  


Diabetes mellitus (DM) is a progressive disorder with severe late complications. Normal wound healing involves a series of complex and well-orchestrated molecular events dictated by multiple factors. In diabetes, wound healing is grossly impaired due to defective, and dysregulated cellular and molecular events at all phases of wound healing resulting in chronic wounds that fail to heal. Carnosine, a dipeptide of alanine and histidine and an endogenous antioxidant is documented to accelerate healing of wounds and ulcers. However, not much is known about its role in wound healing in diabetes. Therefore, we studied the effect of carnosine in wound healing in db/db mice, a mice model of Type 2 DM. Six millimeter circular wounds were made in db/db mice and analyzed for wound healing every other day. Carnosine (100 mg/kg) was injected (I.P.) every day and also applied locally. Treatment with carnosine enhanced wound healing significantly, and wound tissue analysis showed increased expression of growth factors and cytokines genes involved in wound healing. In vitro studies with human dermal fibroblasts and microvascular-endothelial cells showed that carnosine increases cell viability in presence of high glucose. These effects, in addition to its known role as an antioxidant and a precursor for histamine synthesis, provide evidence for a possible therapeutic use of carnosine in diabetic wound healing. PMID:22451275

Ansurudeen, Ishrath; Sunkari, Vivekananda Gupta; Grünler, Jacob; Peters, Verena; Schmitt, Claus Peter; Catrina, Sergiu-Bogdan; Brismar, Kerstin; Forsberg, Elisabete Alcantara



Major bleeding during negative pressure wound\\/VAC (R) - therapy for postsurgical deep sternal wound infection - a critical appraisal  

Microsoft Academic Search

Negative-pressure wound therapy, commercially known as vacuum-assisted closure (V.A.C.(R)) therapy, has become one of the most popular (and efficacious) interim (prior to flap reconstruction) or definite methods of managing deep sternal wound infection. Complications such as profuse bleeding, which may occur during negative-pressure therapy but not necessarily due to it, are often attributed to a single factor and reported as

Wingerden van J. J; P. Segers; L. Jekel



Effect of static magnetic field on experimental dermal wound strength  

PubMed Central

Context: An animal model. Aim: We sought to evaluate the effect of static magnetic fields on cutaneous wound healing. Materials and Methods: Male Wistar rats were used. Wounds were created on the backs of all rats. Forty of these animals (M group) had NeFeB magnets placed in contact with the incisions, either parallel (Pa) and perpendicular (Pr) to the incision. The other 40 animals (sham [S] group) had nonmagnetized NeFeB bars placed in the same directions as the implanted animals. Half of the animals in each group were killed and assessed for healing on postoperative day 7 and the other half on postoperative day 14. The following assessments were done: gross healing, mechanical strength, and histopathology. Statistical Analysis Used: Intergroup differences were compared by using the Mann-Whitney U or t test. Values for P less than 0.05 were accepted as significant. Results and Conclusions: There were no differences between the magnetic and sham animals with respect to gross healing parameters. The mechanical strength was different between groups. On postoperative day 14, the MPr14 had significantly higher scores than the other groups. When static, high-power, magnetic fields are placed perpendicular to the wound, increased wound healing occurs in the skin of the experimental model.

Ekici, Yahya; Aydogan, Cem; Balcik, Cenk; Haberal, Nihan; Kirnap, Mahir; Moray, Gokhan; Haberal, Mehmet



Intracranial complications following mastoidectomy.  


Mastoidectomy is a common surgical procedure in otology. However, postoperative complications of various degrees of severity may occur. We present 4 children who underwent mastoidectomy for middle ear and mastoid disease and developed postoperative intracranial complications. One child was operated on for brain abscess 1 week after the initial mastoidectomy. Another child appeared with seizures 5 days after the initial mastoidectomy and a subdural empyema was drained during revision surgery. Large bone defects with exposed middle cranial fossa dura were found at revision surgery in both cases and Proteus vulgaris and methicillin-resistant Staphylococcus aureus were isolated from the mastoid and abscess cavities in these children. A small epidural collection was diagnosed in the third patient 2 days after initial mastoid surgery and was managed with intravenous antibiotics only. The other child was found to have sigmoid sinus thrombosis the day after mastoidectomy that was performed for nonresponsive acute mastoiditis. This child received both intravenous antibiotics and anticoagulants. Timely revision surgery, combinations of third- or fourth-generation cephalosporins with vancomycin or metronidazole and the addition of anticoagulants in cases of sinus thrombosis can lead to full recovery. PMID:15689642

Migirov, Lela; Eyal, Ana; Kronenberg, Jona


Silver Sol Improves Wound Healing: Case Studies In the Use of Silver Sol in Closing Wounds (Including MRSA), Preventing Infection, Inflammation and Activating Stem Cells  

Microsoft Academic Search

Wound healing is a complex and fragile process, which can be complicated by infection and inflammation. In this study, multiple cases are reviewed pictorially for the purpose of recording improved wound healing using the antimicrobial Silver Sol gel. The daily use of Silver Sol gel results in reduced infection (including MRSA), which leads to less inflammation. By reducing the inflammation

Gordon Pedersen; Keith Moeller


Sternum wound contraction and distension during negative pressure wound therapy when using a rigid disc to prevent heart and lung rupture  

PubMed Central

Background There are increasing reports of deaths and serious complications associated with the use of negative pressure wound therapy (NPWT), of which right ventricular heart rupture is the most devastating. The use of a rigid barrier has been suggested to offer protection against this lethal complication by preventing the heart from being drawn up against the sharp edges of the sternum. The aim of the present study was to determine whether a rigid barrier can be safely inserted over the heart with regard to the sternum wound edge movement. Methods Sternotomy wounds were created in eight pigs. The wounds were treated with NPWT at -40, -70, -120 and -170 mmHg in the presence and absence of a rigid barrier between the heart and the edges of the sternum. Wound contraction upon NPWT application, and wound distension under mechanical traction to draw apart the edges of the sternotomy were evaluated. Results Wound contraction resulting from NPWT was similar with and without the rigid barrier. When mechanical traction was applied to a NPWT treated sternum wound, the sternal edges were pulled apart. Wound distension upon traction was similar in the presence and absence of a the rigid barrier during NPWT. Conclusions A rigid barrier can safely be inserted between the heart and the edges of the sternum to protect the heart and lungs from rupture during NPWT. The sternum wound edge is stabilized equally well with as without the rigid barrier during NPWT.



Optimizing postoperative sexual function after radical prostatectomy  

PubMed Central

Erectile dysfunction (ED) is one of the complications associated with pelvic surgery. The significance of ED as a complication following pelvic surgery, especially radical prostatectomy (RP), lies in the negative impact that it has on patients’ sexual and overall life. In the literature, rates of ED following RP range from 25% to 100%. Such variety is associated with pelvic dissection and conservation of neurovascular structures. Another important factor impacting on postoperative ED is the preoperative erectile function of the patient. Advances in the knowledge of pelvic anatomy and pathological mechanisms led to a refinement of pelvic surgical techniques, with attention to the main structures that if damaged compromise erectile function. These improvements resulted in lower postoperative ED rates and better erectile recovery, especially in patients undergoing RP. Furthermore, surgery alone is not sufficient to prevent this complication, and thus, several medical strategies have been tested with the aim of maximizing erectile function recovery. Indeed it seems that prevention of postoperative ED must be addressed by a multimodal approach. The aim of this review is to give a picture of recent knowledge, novel techniques and therapeutic approaches in order to reach the best combination of treatments to reduce the rate of ED after pelvic surgery.

Tutolo, Manuela; Briganti, Alberto; Suardi, Nazareno; Gallina, Andrea; Abdollah, Firas; Capitanio, Umberto; Bianchi, Marco; Passoni, Niccolo; Nini, Alessandro; Fossati, Nicola; Rigatti, Patrizio



Optimizing postoperative sexual function after radical prostatectomy.  


Erectile dysfunction (ED) is one of the complications associated with pelvic surgery. The significance of ED as a complication following pelvic surgery, especially radical prostatectomy (RP), lies in the negative impact that it has on patients' sexual and overall life. In the literature, rates of ED following RP range from 25% to 100%. Such variety is associated with pelvic dissection and conservation of neurovascular structures. Another important factor impacting on postoperative ED is the preoperative erectile function of the patient. Advances in the knowledge of pelvic anatomy and pathological mechanisms led to a refinement of pelvic surgical techniques, with attention to the main structures that if damaged compromise erectile function. These improvements resulted in lower postoperative ED rates and better erectile recovery, especially in patients undergoing RP. Furthermore, surgery alone is not sufficient to prevent this complication, and thus, several medical strategies have been tested with the aim of maximizing erectile function recovery. Indeed it seems that prevention of postoperative ED must be addressed by a multimodal approach. The aim of this review is to give a picture of recent knowledge, novel techniques and therapeutic approaches in order to reach the best combination of treatments to reduce the rate of ED after pelvic surgery. PMID:23205061

Tutolo, Manuela; Briganti, Alberto; Suardi, Nazareno; Gallina, Andrea; Abdollah, Firas; Capitanio, Umberto; Bianchi, Marco; Passoni, Niccolò; Nini, Alessandro; Fossati, Nicola; Rigatti, Patrizio; Montorsi, Francesco



Endogenous Opioids in Wound-Site Neutrophils of Sternotomy Patients  

PubMed Central

Background Postoperative pain management is a critical aspect of patient care. The inflammatory state of the post-sternotomy surgical wound sensitizes nerve endings, causing pain. Unrelieved or improperly managed pain compromises wound healing. Peripheral opioid receptors play a major role in analgesia, particularly under inflammatory conditions where both opioid receptor expression and efficacy are increased. Leukocytic opioid peptides include ?-endorphin (END), met-enkephalin (ENK), and dynorphin-A (DYN), with END and ENK being predominant. Methodology/Principal Findings This work represents the first study of inflammatory cells collected from post-sternotomy wounds of patients undergoing cardiac surgery including coronary artery bypass grafting (CABG). Wound fluid (WF) and cells were collected from sternal wounds using a JP Blake drain at 24, 48, and 72 hours post sternum closure. Anti-CD15 staining and flow cytometry revealed that polymorphonuclear neutrophils (PMN) are the predominant cells present in wound fluid collected post-surgery. Compared to peripheral blood (PB) derived PMN, significant increases in CD177+/CD66b+ PMN were observed suggesting activation of wound-site PMN. Such activation was associated with higher levels of opioid peptide expression in PMN derived from WF. Indeed, increased level of opioid peptides in sternal wound environment was noted 72 h post-surgery. We demonstrate that WF contains factors that can significantly induce POMC transcription in human PMNs. IL-10 and IL-4 were abundant in WF and both cytokines significantly induced POMC gene expression suggesting that WF factors such as IL-10 and IL-4 contribute towards increased opioid peptide expression in wound-site PMN. Conclusions/Significance This approach provided a unique opportunity to study the cross-talk between inflammation and opioid peptides in PMN at a sternotomy wound-site. Wound-site PMN exhibited induction of END and ENK. In addition, sternal wound fluid significantly induced END expression in PMN. Taken together, these data constitute first clinical evidence that human wound-site PMNs are direct contributors of opioids at the sternal wound-site.

Awad, Hamdy; Abas, Motaz; Elgharably, Haytham; Tripathi, Ravi; Theofilos, Tykie; Bhandary, Sujatha; Sai-Sudhakar, Chittoor; Sen, Chandan K.; Roy, Sashwati



Effect of submucosal and intramuscular dexamethasone on postoperative sequelae after third molar surgery: comparative study.  


We compared the effects of dexamethasone sodium phosphate given submucosally and intramuscularly on postoperative complications after removal of impacted lower third molars in a preliminary randomised prospective clinical trial. Thirty patients, each of whom required removal of a single impacted mandibular third molar under local anaesthesia, were randomly allocated to one of 3 groups of 10 each. The 2 experimental groups were given dexamethasone 4 mg submucosally or intramuscularly, and the control group had no steroid. Facial swelling and maximal interincisal distance were measured by an independent examiner at baseline (preoperatively), and at 1, 3, and 7 days postoperatively. Pain was measured by counting the number of rescue analgesic tablets taken, and from the patients' response to a visual analogue scale (VAS). The mean age of the 16 men and 14 women was 27 years (range 20-48). Both dexamethasone groups showed significant reductions in swelling (p<0.001) and in pain (p<0.05) compared with the control group at all intervals. Submucosal dexamethasone resulted in significantly less trismus than controls on day 1 postoperatively (p=0.04), but there were no significant differences among the groups at the other times. The effects of the two routes of dexamethasone were comparable for all variables. There were no cases of alveolar osteitis or wound infection. Dexamethasone 4 mg given submucosally is an effective way of minimising swelling, trismus, and pain after removal of impacted lower third molars, and is comparable with the intramuscular route. It offers a simple, safe, painless, non-invasive, and cost-effective treatment in moderate and severe cases. PMID:21035237

Majid, Omer Waleed; Mahmood, Waseem Khalid



Complicated Grief  


... type of psychological counseling (psychotherapy) called complicated grief therapy. It's similar to psychotherapy techniques used for post-traumatic stress disorder (PTSD). You may explore such topics as grief ...


Spectroscopy of Burn Wounds.  

National Technical Information Service (NTIS)

This research seeks to develop non-invasive techniques for evaluating burn depth based upon non-contacting visible and near-infrared spectroscopic measurement of the wounds. In previous years, we demonstrated that features of the optical reflection spectr...

J. B. Callis M. A. Afromowitz



Spectroscopy of Burn Wounds.  

National Technical Information Service (NTIS)

This research seeks to develop non-invasive burn depth evaluation from non-contacting visible and near-infrared spectroscopic measurements. In previous years, we demonstrated that features of the optical reflection spectra of burn wounds can be correlated...

M. A. Afromowitz J. D. Callis



Etiology of contaminated wounds  

SciTech Connect

The US Department of Energy reports of events that occurred in the chemical processing 200 Areas of the Hanford Site during the period from 1972 through 1986 were reviewed to identify the causes of contaminated wounds. Contaminated wounds were reported in 19 events involving 20 workers. The causal agents (high risk operations) and the root causes were characterized. Emergency actions taken and their efficacy were noted. The 19 wound events were compared with 17 events with the potential for inhalation. It was found that the wound events involve a single worker and frequently result in an internal contamination and its resulting dose. Inhalation events involve groups of workers and rarely resulted in detectable internal contamination. The difference is attributed to anticipation of an inhalation event and use of respiratory protection and continuous air monitors to mitigate its effects.

Sudmann, R.H.



Etiology of contaminated wounds  

SciTech Connect

The US Department of Energy reports of events that occurred in the chemical processing 200 Areas of the Hanford Site during the period from 1972 through 1986 were reviewed to identify the causes of contaminated wounds. Contaminated wounds were reported in 19 events involving 20 workers. The causal agents (high risk operations) and the root causes were characterized. Emergency actions taken and their efficacy were noted. The 19 wound events were compared with 17 events with the potential for inhalation. It was found that the wound events involve a single worker and frequently result in an internal contamination and its resulting dose. Inhalation events involve groups of workers and rarely resulted in detectable internal contamination. The difference is attributed to anticipation of an inhalation event and use of respiratory protection and continuous air monitors to mitigate its effects.

Sudmann, R.H.



Management of radiation wounds  

SciTech Connect

Radiation wounds caused by newer high-voltage radiotherapy techniques are very difficult to manage. Recent developments in flap design and transfer aid the surgeon in successfully treating these difficult problems.

Reinisch, J.F.; Puckett, C.L.



Thiolated Carboxymethyl-Hyaluronic-Acid-Based Biomaterials Enhance Wound Healing in Rats, Dogs, and Horses  

PubMed Central

The progression of wound healing is a complicated but well-known process involving many factors, yet there are few products on the market that enhance and accelerate wound healing. This is particularly problematic in veterinary medicine where multiple species must be treated and large animals heal slower, oftentimes with complicating factors such as the development of exuberant granulation tissue. In this study a crosslinked-hyaluronic-acid (HA-) based biomaterial was used to treat wounds on multiple species: rats, dogs, and horses. The base molecule, thiolated carboxymethyl HA, was first found to increase keratinocyte proliferation in vitro. Crosslinked gels and films were then both found to enhance the rate of wound healing in rats and resulted in thicker epidermis than untreated controls. Crosslinked films were used to treat wounds on forelimbs of dogs and horses. Although wounds healed slower compared to rats, the films again enhanced wound healing compared to untreated controls, both in terms of wound closure and quality of tissue. This study indicates that these crosslinked HA-based biomaterials enhance wound healing across multiple species and therefore may prove particularly useful in veterinary medicine. Reduced wound closure times and better quality of healed tissue would decrease risk of infection and pain associated with open wounds.

Yang, Guanghui; Prestwich, Glenn D.; Mann, Brenda K.



Complications of hysteroscopy: a prospective, multicenter study  

Microsoft Academic Search

Objective: To estimate the incidence of complications of diagnostic and operative hysteroscopic procedures in the Netherlands and describe their nature.Methods: Data on complications were recorded by 82 hospitals in 1997. Participating hospitals had a 100% response rate. Any unexpected events that required intraoperative or postoperative intervention were defined as complications in two groups: approach (entry-related) and technique-related (caused by surgical

Frank Willem Jansen; CORLA B. VREDEVOOGD; Karin Van Ulzen; Jo Hermans; J. Baptist Trimbos; TRUDY C. M. TRIMBOS-KEMPER



Diagnosis, Prevention and Management of Postoperative Pulmonary Edema  

PubMed Central

Postoperative pulmonary edema is a well-known postoperative complication caused as a result of numerous etiological factors which can be easily detected by a careful surveillance during postoperative period. However, there are no preoperative and intraoperative criteria which can successfully establish the possibilities for development of postoperative pulmonary edema. The aims were to review the possible etiologic and diagnostic challenges in timely detection of postoperative pulmonary edema and to discuss the various management strategies for prevention of this postoperative complication so as to decrease morbidity and mortality. The various search engines for preparation of this manuscript were used which included Entrez (including Pubmed and Pubmed Central),,,,, Scopus, Science Direct,, and Manual search was carried out and various text books and journals of anesthesia and critical care medicine were also searched. From the information gathered, it was observed that postoperative cardiogenic pulmonary edema in patients with serious cardiovascular diseases is most common followed by noncardiogenic pulmonary edema which can be due to fluid overload in the postoperative period or it can be negative pressure pulmonary edema (NPPE). NPPE is an important clinical entity in immediate post-extubation period and occurs due to acute upper airway obstruction and creation of acute negative intrathoracic pressure. NPPE carries a good prognosis if promptly diagnosed and appropriately treated with or without mechanical ventilation.

Bajwa, SJ Singh; Kulshrestha, A



Disorders of wound healing  

Microsoft Academic Search

The healing wound offers a variety of potential end results. The surgeon's responsibility is to define what he wants and then\\u000a arrange to get it. History has proved that technical improvements can eliminate disorders such as dehiscence and incisional\\u000a hernias. Technical improvements should diminish the frequency of failed tendon repairs.\\u000a \\u000a When the author first became interested in wound healing and

Thomas K. Kunt



Wound Healing Disorders: Chronic Wounds and Keloids  

Microsoft Academic Search

\\u000a The normal wound healing response can be divided into (1) inflammatory, (2) proliferative, and (3) tissue remodeling (i.e.,\\u000a fibroplasia and maturation) phases that involve complex interactions between various cutaneous-derived and inflammatory cells,\\u000a cytokines, and the extracellular matrix (ECM) [1–6]. Numerous studies continue to uncover the genetic, epigenetic (i.e., microRNA),\\u000a cellular (including stem cells), molecular, and biochemical mechanisms underlying this process

Michael J. Murphy


Combat Wound Initiative program.  


The Combat Wound Initiative (CWI) program is a collaborative, multidisciplinary, and interservice public-private partnership that provides personalized, state-of-the-art, and complex wound care via targeted clinical and translational research. The CWI uses a bench-to-bedside approach to translational research, including the rapid development of a human extracorporeal shock wave therapy (ESWT) study in complex wounds after establishing the potential efficacy, biologic mechanisms, and safety of this treatment modality in a murine model. Additional clinical trials include the prospective use of clinical data, serum and wound biomarkers, and wound gene expression profiles to predict wound healing/failure and additional clinical patient outcomes following combat-related trauma. These clinical research data are analyzed using machine-based learning algorithms to develop predictive treatment models to guide clinical decision-making. Future CWI directions include additional clinical trials and study centers and the refinement and deployment of our genetically driven, personalized medicine initiative to provide patient-specific care across multiple medical disciplines, with an emphasis on combat casualty care. PMID:23634474

Stojadinovic, Alexander; Elster, Eric; Potter, Benjamin K; Davis, Thomas A; Tadaki, Doug K; Brown, Trevor S; Ahlers, Stephen; Attinger, Christopher E; Andersen, Romney C; Burris, David; Centeno, Jose; Champion, Hunter; Crumbley, David R; Denobile, John; Duga, Michael; Dunne, James R; Eberhardt, John; Ennis, William J; Forsberg, Jonathan A; Hawksworth, Jason; Helling, Thomas S; Lazarus, Gerald S; Milner, Stephen M; Mullick, Florabel G; Owner, Christopher R; Pasquina, Paul F; Patel, Chirag R; Peoples, George E; Nissan, Aviram; Ring, Michael; Sandberg, Glenn D; Schaden, Wolfgang; Schultz, Gregory S; Scofield, Tom; Shawen, Scott B; Sheppard, Forest R; Stannard, James P; Weina, Peter J; Zenilman, Jonathan M



Arginine metabolism in wounds  

SciTech Connect

Arginine metabolism in wounds was investigated in the rat in 1) lambda-carrageenan-wounded skeletal muscle, 2) Schilling chambers, and 3) subcutaneous polyvinyl alcohol sponges. All showed decreased arginine and elevated ornithine contents and high arginase activity. Arginase could be brought to the wound by macrophages, which were found to contain arginase activity. However, arginase was expressed by macrophages only after cell lysis and no arginase was released by viable macrophages in vitro. Thus the extracellular arginase of wounds may derive from dead macrophages within the injured tissue. Wound and peritoneal macrophages exhibited arginase deiminase activity as demonstrated by the conversion of (guanido-/sup 14/C)arginine to radiolabeled citrulline during culture, the inhibition of this reaction by formamidinium acetate, and the lack of prokaryotic contamination of the cultures. These findings and the known metabolic fates of the products of arginase and arginine deiminase in the cellular populations of the wound suggest the possibility of cooperativity among cells for the production of substrates for collagen synthesis.

Albina, J.E.; Mills, C.D.; Barbul, A.; Thirkill, C.E.; Henry, W.L. Jr.; Mastrofrancesco, B.; Caldwell, M.D.



Single cell wound repair  

PubMed Central

Cell wounding is a common event in the life of many cell types, and the capacity of the cell to repair day-to-day wear-and-tear injuries, as well as traumatic ones, is fundamental for maintaining tissue integrity. Cell wounding is most frequent in tissues exposed to high levels of stress. Survival of such plasma membrane disruptions requires rapid resealing to prevent the loss of cytosolic components, to block Ca2+ influx and to avoid cell death. In addition to patching the torn membrane, plasma membrane and cortical cytoskeleton remodeling are required to restore cell function. Although a general understanding of the cell wound repair process is in place, the underlying mechanisms of each step of this response are not yet known. We have developed a model to study single cell wound repair using the early Drosophila embryo. Our system combines genetics and live imaging tools, allowing us to dissect in vivo the dynamics of the single cell wound response. We have shown that cell wound repair in Drosophila requires the coordinated activities of plasma membrane and cytoskeleton components. Furthermore, we identified an unexpected role for E-cadherin as a link between the contractile actomyosin ring and the newly formed plasma membrane plug.

Abreu-Blanco, Maria Teresa; Verboon, Jeffrey M



Surgical wound sepsis  

PubMed Central

With the help of a surgical nurse and using data-processing techniques, a prospective clinical study was conducted to determine the wound infection rate in two hospitals in Calgary. The overall sepsis rate was 5.2% and the clean wound rate 3.5%. The latter is the more meaningful figure as it allows for comparison between hospitals, specialties and individuals and is a good guide for hospital morbidity reviews. The groundwork for succeeding wound infection is laid in the operating theatre, and it is believed that wound infection would be reduced more by attention to Halsted's principles than by more rigid aseptic techniques. It is estimated that wound sepsis costs the Province of Alberta 1.5 million dollars per year for hospitalization alone. This amounts to roughly $1 per person per year. The annual cost of a prospective study such as the present one is approximately $7000. This is equivalent to the cost of hospitalizing 24 patients with infected wounds for one week (at $300 per week). One dividend of a prospective study is an associated reduction in infection rate. This reduction more than pays for the cost of the program.

Cruse, P. J. E.



In vitro electrical-stimulated wound-healing chip for studying electric field-assisted wound-healing process  

PubMed Central

The wound-healing assay is an easy and economical way to quantify cell migration under diverse stimuli. Traditional assays such as scratch assays and barrier assays are widely and commonly used, but neither of them can represent the complicated condition when a wound occurs. It has been suggested that wound-healing is related to electric fields, which were found to regulate wound re-epithelialization. As a wound occurs, the disruption of epithelial barrier short-circuits the trans-epithelial potential and then a lateral endogenous electric field is created. This field has been proved invitro as an important cue for guiding the migration of fibroblasts, macrophages, and keratinocytes, a phenomenon termed electrotaxis or galvanotaxis. In this paper, we report a microfluidic electrical-stimulated wound-healing chip (ESWHC) integrating electric field with a modified barrier assay. This chip was used to study the migration of fibroblasts under different conditions such as serum, electric field, and wound-healing-promoting drugs. We successfully demonstrate the feasibility of ESWHC to effectively and quantitatively study cell migration during wound-healing process, and therefore this chip could be useful in drug discovery and drug safety tests.

Sun, Yung