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1

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. PMID:21934441

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

2011-01-01

2

Common post-operative complications in children  

PubMed Central

The exact incidence of common post-operative complications in children is not known. Most common one is post-operative nausea and vomiting followed by respiratory complications leading to hypoxia. Cardiac complications are less in children without associated congenital cardiac anomaly. Post-operative shivering, agitation and delirium are seen more often in children anaesthetised with newer inhalational agents like sevoflurane and desflurane. Urinary retention in the post-operative period could be influenced by anaesthetic drugs and regional blocks. The purpose of this article is to review the literature and present to the postgraduate students comprehensive information about the current understanding and practice pattern on various common complications in the post-operative period. Extensive literature was searched with key words of various complications from Pubmed, Google scholar and specific journal, namely paediatric anaesthesia. The relevant articles, review article meta-analysis and editorials were the primary source of information for this article. PMID:23293390

Pawar, Dilip

2012-01-01

3

Predictors of Postoperative Complications After Trimodality Therapy for Esophageal Cancer  

SciTech Connect

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

Wang, Jingya [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wei, Caimiao [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Tucker, Susan L. [Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Myles, Bevan; Palmer, Matthew [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Hofstetter, Wayne L.; Swisher, Stephen G. [Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Ajani, Jaffer A. [Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Cox, James D.; Komaki, Ritsuko; Liao, Zhongxing [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Lin, Steven H., E-mail: SHLin@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

2013-08-01

4

PREVENTING POSTOPERATIVE COMPLICATIONS IN THE ELDERLY  

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. PMID:21295754

Sieber, Frederick E.; Barnett, Sheila Ryan

2011-01-01

5

Prediction factors for breast reconstruction postoperative complications  

PubMed Central

Abstract Breast cancer is a major health problem that requires multiple forms of treatment, including surgery, adjuvant chemotherapy and radiotherapy and more recently, reconstructive surgery. The aim of this study is to determine the factors that can predict the chances of a patient having postoperative complications after breast reconstruction. PMID:24868263

Chiru, MR; Lascar, I

2013-01-01

6

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

ClinicalTrials.gov

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

2014-10-15

7

Hyperprolactinaemia: A cause of severe postoperative complication after reduction mammaplasty.  

PubMed

Abstract Galactorrhoea is a rare complication of wound healing after breast reduction and its association with necrosis of the areolar skin in women with no recent history of breast feeding has to our knowledge never been described. Galactorrhoea is common and there are many differential diagnoses. We report a case of a 46-year-old woman who had bilateral reductions of the breast and developed hyperprolactinaemia and galactorrhoea six weeks postoperatively. Subsequently she developed dry necrosis of both areolas. All radiographic and laboratory findings were within the reference ranges except for of prolactin. PMID:25399958

Mestak, Ondrej; Mestak, Jan; Borsky, Jiri

2014-12-01

8

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

2011-01-01

9

Postoperative abdominal complications after cardiopulmonary bypass  

PubMed Central

Background To summarize the diagnostic and therapeutic experiences on the patients who suffered abdominal complications after cardiovascular surgery with cardiopulmonary bypass(CPB). Methods A total of 2349 consecutive patients submitted to cardiovascular surgery with CPB in our hospital from Jan 2004 to Dec 2010 were involved. The clinical data of any abdominal complication, including its incidence, characters, relative risks, diagnostic measures, medical or surgical management and mortality, was retrospectively analyzed. Results Of all the patients, 33(1.4%) developed abdominal complications postoperatively, including 11(33.3%) cases of paralytic ileus, 9(27.3%) of gastrointestinal haemorrhage, 2(6.1%) of gastroduodenal ulcer perforation, 2(6.1%) of acute calculus cholecystitis, 3(9.1%) of acute acalculus cholecystitis, 4(12.1%) of hepatic dysfunction and 2(6.1%) of ischemia bowel diseases. Of the 33 patients, 26 (78.8%) accepted medical treatment and 7 (21.2%) underwent subsequent surgical intervention. There were 5(15.2%) deaths in this series, which was significantly higher than the overall mortality (2.7%). Positive history of peptic ulcer, advanced ages, bad heart function, preoperative IABP support, prolonged CPB time, low cardiac output and prolonged mechanical ventilation are the risk factors of abdominal complications. Conclusions Abdominal complications after cardiovascular surgery with CPB have a low incidence but a higher mortality. Early detection and prompt appropriate intervention are essential for the outcome of the patients. PMID:23046511

2012-01-01

10

Radial forearm free flap for coverage of postoperative lateral heel wounds after open reduction and internal fixation of the calcaneus  

Microsoft Academic Search

For intraarticular calcaneus fractures, open reduction and internal fixation has become commonplace for the reduction of morbidity of postinjury arthritis. Despite adequate surgical results, there are often associated postoperative wound complications. The purpose of this study was to describe a unique application of the radial forearm free flap for coverage of lateral postoperative heel defects seen after calcaneal fixation. Seven

Jody T Jachna; E. Bruce Toby; Greg A Horton

2003-01-01

11

Wound complications following operative fixation of calcaneal fractures  

Microsoft Academic Search

The aim of our study was to find the incidence of wound complications following operative fixation of fractured calcanea and identify the risk factors contributing to them. We retrospectively reviewed the results of operative treatment of 33 calcaneal fractures in 30 patients over a 4-year period. We report an overall wound complication rate of 18.1%. Wound infection, haematoma, dehiscence and

M Al-Mudhaffar; C. V. R Prasad; A Mofidi

2000-01-01

12

Wound breakdown after middle cranial fossa craniotomy: an unusual complication after rhytidectomy.  

PubMed

Wound complications after middle cranial fossa craniotomy are rare. We describe a patient who underwent a left middle fossa craniotomy for resection of a small internal auditory canal tumor with subsequent development of wound breakdown and infection 1 week postoperatively. Prompting of the patient elicited a history of bilateral rhytidectomies. Wound debridement, hyperbaric oxygen therapy, dermal regeneration template placement, and prolonged antibiotic treatment were performed. Complete secondary intention healing occurred with an acceptable cosmetic outcome. Prior rhytidectomy scars must be identified and incorporated into the surgical planning prior to performing middle fossa craniotomy incisions. PMID:24150991

Moberly, Aaron C; Tweel, Benjamin C; Welling, D Bradley

2014-02-01

13

Do postoperative antibiotics prevent abscess formation in complicated appendicitis?  

PubMed

Recent studies have shown that postoperative antibiotics in nonperforated appendicitis do not reduce infectious complications; however, there is no consensus on patients with complicated appendicitis. The aim of this study is to determine whether postoperative antibiotic administration in complicated appendicitis prevents intra-abdominal abscess formation. We conducted a retrospective chart review of all patients undergoing appendectomy from 2007 to 2012 at our institution. Patients with complicated appendicitis (perforated, gangrenous, or periappendiceal abscess) were identified and data collected including details of postoperative antibiotic administration and rates of postoperative abscess development. Of 444 charts reviewed, 52 patients were included. Forty-four patients received greater than 24 hours and eight patients received 24 hours or less of postoperative antibiotics. In those receiving greater than 24 hours of antibiotics, nine of 44 (20.5%) developed a postoperative abscess, and in those receiving 24 hours or less of antibiotics, two of eight (25.0%) developed a postoperative abscess (P = 1.0000). There is no significant difference in postoperative abscess development among those with complicated appendicitis who received greater than 24 hours of postoperative antibiotics compared with those who did not. Postoperative antibiotics may not provide an appreciable clinical benefit for preventing intra-abdominal abscesses; however, larger sample sizes and prospective studies are needed to confirm these findings. PMID:25197874

Kimbrell, Ashlee R; Novosel, Timothy J; Collins, Jay N; Weireter, Leonard J; Terzian, Hillman W T; Adams, Ryan T; Beydoun, Hind A

2014-09-01

14

Postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate groin incisions.  

PubMed

The focus of this study was to document postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate incisions. Data from 172 consecutive patients with newly diagnosed carcinoma of the vulva were studied. One hundred and one patients primarily treated with modified radical vulvectomy and complete inguinofemoral lymphadenectomy using separate groin incisions (n = 187) were included in this study. One or more complications were documented in 77 of the 101 (76%) patients. Complications after groin dissection were observed in 66% of the patients. The main complications were wound breakdown (17%) and/or infection (39%) of the groin, lymphocyst formation (40%), and lymphedema (28%). In 98 of 187 (52%) groin dissections, one or more complications were documented. The presence of lymph node metastases, postoperative radiation, age older than 65 years, and removal of the vena saphena magna were not significant risk factors for the occurrence of complications. The occurrence of early complications after groin dissection was significantly related to the late-complication lymphedema (P = 0.002). Our results confirm relatively high rates of wound breakdown, infection, lymphocyst formation, and lymphedema even with separate groin incisions. The occurrence of early complications was related to lymphedema. No other risk factors could be identified. PMID:12911732

Gaarenstroom, K N; Kenter, G G; Trimbos, J B; Agous, I; Amant, F; Peters, A A W; Vergote, I

2003-01-01

15

Early post-operative complications in oral implantology.  

PubMed

Hematoma, postoperative bleeding, edema, early infection, dehiscence, emphysema, air embolism, loss of primary stability of the implant, acute sinusitis, postoperative cutaneous or mucosal anesthesia and loss of central visual field are early postoperative complications. The incidence of early post-operative complication during the first days of postoperative follow-up was inquired. Eleven patients were implanted by 27 DPI implants. The patients were followed up the first day, the second day and the tenth day after the one-phase surgical technique. Dehiscence in 2 patients, edema in 10 patients, hematoma in 2 patient and postoperative bleedings in 3 patients were established. Three implants were removed because loss of primary stability. It is indicated that by proper preoperative and intraoperative as well as postoperative approach it is possible to influence early postoperative complications. Even though postoperative complications are sometimes unavoidable, choosing the most appropriate surgical technique and keeping oral cavity hygiene are the most important factors in prevention. It is concluded that only the loss of primary stability is incorrigible and successes of implanto-prosthetic rehabilitation can be properly and fully evaluated only after 5 to 10 years of follow up period. PMID:9951171

Lauc, T; Kobler, P

1998-12-01

16

Risk Factors for Complications after Reconstructive Surgery for Sternal Wound Infection  

PubMed Central

Background Although the utility of flaps for the treatment of sternal wound infections following median sternotomy has been reported for 30 years, there have been few reports on the risk factors for complications after reconstruction. The objective of this investigation was to identify factors related to complications after the reconstruction of sternal wound infections. Methods A retrospective analysis of 74 patients with reconstructive surgery after sternal wound infection over a 5-year period was performed. Clinical data including age, sex, body mass index (BMI), comorbidities, bacterial culture, previous cardiac surgery, wound depth, mortality rate, type of reconstructive procedure, and complication rate were collected. Results The patients' BMI ranged from 15.2 to 33.6 kg/m2 (mean, 23.1±3.74 kg/m2). Wound closure complications after reconstructive surgery were observed in 36.5% of the cases. The mortality rate was 2.7%. Diabetes mellitus significantly affected the rate of wound closure complications (P=0.041). A significant difference in the number of complications was seen between Staphylococcus aureus (S. aureus) and coagulase-negative Staphylococci (P=0.011). There was a correlation between harvesting of the internal thoracic artery and postoperative complications (P=0.048). The complication rates of the pectoralis major flap, rectus abdominis flap, omentum flap, a combination of pectoralis major flap and rectus abdominis flap, and direct closure were 23.3%, 33.3%, 100%, 37.5%, and 35.7%, respectively. Conclusions Diabetes mellitus, S. aureus, harvesting of the internal thoracic artery, and omentum flap were significant factors for complications after reconstruction. The omentum flap volume may be related to the complications associated with the omentum flap transfer in the present study. PMID:24883276

Takaku, Mitsuru; Matsuo, Shinji; Abe, Yoshiro; Harada, Hiroshi; Nagae, Hiroaki; Fujioka, Yusuke; Anraku, Kuniaki; Inagawa, Kiichi; Nakanishi, Hideki

2014-01-01

17

Perioperative complications of cardiac surgery and postoperative care.  

PubMed

The care of the cardiac surgical patient postoperatively is fraught with several complications because of the nature of the surgical procedure itself and the common comorbidities of this patient population. Most complications occurring in the immediate postoperative period are categorized by organ system, and their pathophysiology is presented. Current diagnostic approaches and treatment options are offered. Preventive measures, where appropriate, are also included in the discussion. PMID:24996608

Nearman, Howard; Klick, John C; Eisenberg, Paul; Pesa, Nicholas

2014-07-01

18

Prevention of Postoperative Complications following Pancreatic Surgery  

Microsoft Academic Search

Major pancreatic resection is still accompanied by considerable morbidity and even mortality. Complications which occur after pancreatic surgery are chiefly associated with exocrine pancreatic secretion, hence, the inhibition of exocrine pancreatic secretion perioperatively is a promising concept in the prevention of complications. The hormone somatostatin and its synthetic analogue octreotide have been shown to profoundly inhibit exocrine pancreatic secretion, particularly

M. Büchler; H. Friess

1993-01-01

19

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

PubMed Central

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

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

2014-01-01

20

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

1999-01-01

21

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

2002-01-01

22

Pancreaticoduodenectomy: expected post-operative anatomy and complications.  

PubMed

Pancreaticoduodenectomy is a complex, high-risk surgical procedure performed for tumours of the pancreatic head and other periampullary structures. The rate of perioperative mortality has decreased in the past number of years but perioperative morbidity remains high. This pictorial review illustrates expected findings in early and late post-operative periods, including mimickers of pathology. It aims to familiarize radiologists with the imaging appearances of common and unusual post-operative complications. These are classified into early non-vascular complications such as delayed gastric emptying, post-operative collections, pancreatic fistulae and bilomas; late non-vascular complications, for example, biliary strictures and hepatic abscesses; and vascular complications including haemorrhage and ischaemia. Options for minimally invasive image-guided management of vascular and non-vascular complications are discussed. Familiarity with normal anatomic findings is essential in order to distinguish expected post-operative change from surgical complications or recurrent disease. This review summarizes the normal and abnormal radiological findings following pancreaticoduodenectomy. PMID:25026968

McEvoy, S H; Lavelle, L P; Hoare, S M; O'Neill, A C; Awan, F N; Malone, D E; Ryan, E R; McCann, J W; Heffernan, E J

2014-09-01

23

Postoperative complications associated with caudectomy in brachycephalic dogs with ingrown tails.  

PubMed

Surgical correction of an ingrown tail is indicated to relieve clinical signs of intertriginous dermatitis. The objective of this retrospective study was to identify the type and frequency of complications following caudectomy in dogs with ingrown tails. Medical records of dogs with ingrown tails treated with caudectomy from 2000 to 2010 at the University of Georgia Veterinary Teaching Hospital were reviewed. Data collected included signalment, preoperative infection status, surgical procedures performed, prophylactic antibiotic use, complications noted both during hospitalization and at suture removal, treatments instituted, and owner satisfaction. Seventeen dogs were identified for inclusion. At presentation, 4 of the 17 dogs (23.5%) were receiving antibiotics. Infection was present in 7 of the 17 dogs (41%), and 6 of the 7 cases resolved immediately postoperatively. All dogs received perioperative antimicrobial therapy, and 13 of the 17 dogs (76%) received antibiotics after surgery for an average of 13.5 days ± 5.2 days. Complications occurred in 2 of the 17 cases (12%) immediately after surgery, including decreased rectal sensation with adequate anal tone, failure to posture to defecate, and postoperative draining tracts. Complications were reported in 2 of 15 dogs (13%) at suture removal, including delayed wound healing and wound inflammation, persistent tail chasing behavior, and temporary changes in defecation habits. Caudectomy provided resolution of clinical signs with no long-term complications. PMID:23690492

Knight, Shanna M; Radlinsky, MaryAnn G; Cornell, Karen K; Schmiedt, Chad W

2013-01-01

24

Postoperative Complications after Thoracic Surgery in the Morbidly Obese Patient  

PubMed Central

Little has been recently published about specific postoperative complications following thoracic surgery in the morbidly obese patient. Greater numbers of patients who are obese, morbidly obese, or supermorbidly obese are undergoing surgical procedures. Postoperative complications after thoracic surgery in these patients that can lead to increased morbidity and mortality, prolonged hospital stay, and increased cost of care are considered. Complications include difficulties with mask ventilation and securing the airway, obstructive sleep apnea with risk of oversedation, pulmonary complications related to reduced total lung capacity, reduced functional residual capacity, and reduced vital capacity, risks of aspiration pneumonitis and ventilator-associated pneumonia, cardiomyopathies, and atrial fibrillation, inadequate diabetes management, positioning injuries, increased risk of venous thrombosis, and pulmonary embolism. The type of thoracic surgical procedure may also pose other problems to consider during the postoperative period. Obese patients undergoing thoracic surgery pose a challenge to those caring for them. Those working with these patients must understand how to recognize, prevent, and manage these postoperative complications. PMID:22242020

Cooper, Lebron

2011-01-01

25

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

PubMed Central

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

Ren, Haitao; Li, Yuan

2014-01-01

26

Antibiotic prophylaxis for post-operative wound infection in clean elective breast surgery  

Microsoft Academic Search

Antibiotic prophylaxis has been used to good effect in the prevention of post-operative wound infections in patients undergoing gastrointestinal operations. We have assessed the use of a single dose of intravenous antibiotic (Augmentin 1.2 g), given with induction of anaesthesia as prophylaxis, against post-operative wound infection in women undergoing clean, elective breast surgery. Three hundred and thirty-four patients were recruited.

R. Gupta; D. Sinnett; R. Carpenter; P. E. Preece; G. T. Royle

2000-01-01

27

Pyoderma Gangrenosum in Two Successive Pregnancies Complicating Caesarean Wound  

PubMed Central

Pyoderma gangrenosum (PG) is a rare ulcerative cutaneous disorder with tendency to recur in the injured area. Though most of the time is associated with chronic systemic conditions, it can occur in isolation and can be a diagnostic dilemma. The aetiology is poorly understood. The diagnosis is based on clinical features and excluding other causes of skin ulcers, as it does not have characteristic histopathology or laboratory findings. Lesions can develop after surgery, after trauma or de novo. We are reporting a 32-year-old pregnant lady with two previous instances of pyoderma gangrenosum in the previous pregnancy, who in postoperative period following caesarean section developed the same condition for the third time. She responded well to local wound care, oral Prednisolone, and Dapsone and made a good recovery. Pregnancy being an immunologically altered status can play a role in development of pyoderma gangrenosum and one should always rule out its possibility when there is a delayed wound healing. PMID:24707419

Amin, Sapna Vinit; Bajapai, Neha; Pai, Ashwini; Bharatnur, Sunanda; Hebbar, Shripad

2014-01-01

28

Preoperative insurance status influences postoperative complication rates for gastric bypass.  

PubMed

One hundred morbidly obese patients who had gastric bypass surgery were studied to determine how various demographic and medical variables affected complication rates, weight loss, and reduction in comorbidities associated with obesity. During the follow-up period (range: 12 to 59 months), 42 patients developed at least 1 complication. Twenty-three patients developed postoperative medical complications, 9 developed psychiatric complications, and 24 developed complications related to food ingestion. No significant relationships were observed between outcome and age, sex, age of obesity onset, or associated medical disorders. Striking differences in outcome were noted, however, when patients were contrasted according to their preoperative insurance status. Patients dependent on medical assistance, social security disability, or workman's compensation (publicly funded group) (n = 40) developed significantly more medical and psychiatric complications than did those (n = 60) who had private medical insurance (p less than 0.02). Despite the higher complication rate, both groups had the same average weight loss (44.9 +/- 15.3 kg for the publicly funded group versus 43.1 +/- 12.9 kg for those with private insurance) and similar reductions in percent excess weight (66.0 +/- 18.4% versus 75.7 +/- 23.0%) during the first postoperative year. All patients also had similar reductions in medication requirements for hypertension, diabetes, and degenerative joint disease. Additionally, 45% of the publicly funded insurance group who either received public welfare (n = 26) or disability benefits (n = 14) preoperatively were able to attain either full-time or part-time employment postoperatively which allowed them to decrease their level of support (58% and 21%, respectively). Forty-six percent of women in the private insurance group who were not working outside the home also began part-time or full-time employment postoperatively. All patients who were working preoperatively continued to work. These data suggest that although the risks associated with gastric bypass surgery are greater in patients dependent on public funding, these patients benefit significantly from the surgery. PMID:1830719

Martin, L F; Tan, T L; Holmes, P A; Becker, D A; Horn, J; Mann, L D; Bixler, E O

1991-06-01

29

Exploring the Frontier of Electronic Health Record Surveillance: The Case of Post-Operative Complications  

PubMed Central

Background The aim of this study was to build electronic algorithms using a combination of structured data and natural language processing (NLP) of text notes for potential safety surveillance of nine post-operative complications. Methods Post-operative complications from six medical centers in the Southeastern United States were obtained from the Veterans Affairs Surgical Quality Improvement Program (VASQIP) registry. Development and test datasets were constructed using stratification by facility and date of procedure for patients with and without complication. Algorithms were developed from VASQIP outcome definitions using NLP coded concepts, regular expressions, and structured data. The VASQIP nurse reviewer served as the reference standard for evaluating sensitivity and specificity. The algorithms were designed in the development and evaluated in the test dataset. Results Sensitivity and specificity in the test set were 85% and 92% for acute renal failure, 80% and 93% for sepsis, 56% and 94% for deep vein thrombosis, 80% and 97% for pulmonary embolism, 88% and 89% for acute myocardial infarction, 88% and 92% for cardiac arrest, 80% and 90% for pneumonia, 95% and 80% for urinary tract infection, and 80% and 93% for wound infection, respectively. A third of the complications occurred outside of the hospital setting. Conclusions Computer algorithms on data extracted from the electronic health record produced respectable sensitivity and specificity across a large sample of patients seen in six different medical centers. This study demonstrates the utility of combining natural language processing with structured data for mining the information contained within the electronic health record. PMID:23673394

FitzHenry, Fern; Murff, Harvey J.; Matheny, Michael E.; Gentry, Nancy; Fielstein, Elliot M.; Brown, Steven H; Reeves, Ruth M; Aronsky, Dominik; Elkin, Peter L.; Messina, Vincent P.; Speroff, Theodore

2013-01-01

30

Postoperative Complications Associated With Perioperative Sirolimus Prior to Pediatric Cardiac Retransplantation  

PubMed Central

OBJECTIVES Sirolimus has been used in pediatric cardiac transplantation for the past decade for chronic renal dysfunction, recurrent rejection, and/or coronary allograft vasculopathy. There has been concern regarding the effect of sirolimus on wound healing and other postoperative complications. To date, the pediatric literature on its use is limited and has not specifically addressed its use in the perioperative period following repeat cardiac transplantation. METHODS We compared the patients in our institution who received sirolimus before repeat cardiac transplantation to those in the same era who did not receive sirolimus. RESULTS Of the 5 patients in the study group, 5 (100%) developed pleural effusions vs 1 (17%) in the control group (p=0.013). There was no increase in mortality in the sirolimus group, and there were no significant differences in renal dysfunction, serious bacterial infection, rejection, or postoperative length of stay. CONCLUSIONS In this small data set, there was a statistically significant increase in pleural effusions in patients on sirolimus. Further study is needed to develop an appropriate strategy to avoid postoperative complications in this patient population. PMID:24782689

Goldberg, Jason F.; Jeewa, Aamir; Dreyer, William J.; Adams, Gerald J.; Cabrera, Antonio G.; Price, Jack F.; Heinle, Jeffrey S.; Denfield, Susan W.

2014-01-01

31

Post-operative spinal epidural hematoma causing American Spinal Injury Association B spinal cord injury in patients with suction wound drains  

PubMed Central

Background Subfascial wound suction drains are commonly used after spinal surgery to decrease the incidence of post-operative hematoma. However, there is a paucity of literature regarding their effectiveness. Objective To report four cases of post-operative spinal epidural hematoma causing massive neurological deficit in patients who had subfascial suction wound drains. Methods During an 8-year period, a retrospective review of 1750 consecutive adult spinal surgery cases was performed to determine the incidence, commonalities, and outcomes of catastrophic neurological deficit caused by post-operative spinal epidural hematoma. Findings Epidural hematoma causing major neurological deficit (American Spinal Injury Association B) was identified in 4 out of 1750 patients (0.23%). All four patients in this series had subfascial wound suction drains placed prophylactically at the conclusion of their initial procedure. Results Three patients developed massive neurological deficits with the drain in place; one patient had the drain removed at 24 hours and subsequently developed neurological symptoms during the following post-operative day. Significant risk factors for the development of hematoma were identified in two of the four patients. Average time to return to the operating room for hematoma evacuation was 6 hours (range 3–12 hours). Neurological status significantly improved in all four patients after hematoma evacuation. Conclusions Post-operative epidural hematoma causing catastrophic neurological deficit is a rare complication after spinal surgery. The presence of suction wound drains does not appear to prevent the occurrence of this devastating complication. PMID:23809591

Chimenti, Peter; Molinari, Robert

2013-01-01

32

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

PubMed Central

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

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

2013-01-01

33

Risk score for postoperative complications in thoracic surgery  

PubMed Central

Background Risk scoring system for thoracic surgery patients have not been widely used, as of recently. We tried to forge a risk scoring system that predicts the risk of postoperative complications in patients undergoing major thoracic surgery. We used a prolonged ICU stay as a representative of postoperative complications and tested various possible risk factors for its relation. Methods Data from all patients who underwent major lung and esophageal cancer surgeries, between 2005 and 2007 in our hospital, were collected retrospectively (n = 858). Multiple logistic regression analysis was performed with various possible risk factors to build the risk scoring system for prolonged ICU stay (> 3 days). Results A total of 9% of patients exhibited more than 3 days of ICU stay. Age, operation name, preoperative lung injury, no epidural analgesia, and predicted post operative forced expiratory volume in 1 second (ppoFEV1) were the risk factors for prolonged ICU stay, by multivariable analysis (P < 0.05). Risk score, p was derived from the formula: logit(p/[1-p]) = -5.39 + 0.06 × age + 1.12 × operation name(2) + 1.52 × operation name(3) + 1.32 × operation name(4) + 1.56 × operation name(5) + 1.30 × preoperative lung injury + 0.72 × no epidural analgesia - 0.02 × ppoFEV1 [Age in years, operation name(2): pneumonectomy, operation name(3): esophageal cancer operation, operation name(4): completion pneumonectomy, operation name(5): extended operation, preoperative lung injury(+), epidural analgesia(-), ppoFEV1 in %]. Conclusions Age, operation name, preoperative lung injury, epidural analgesia, and ppoFEV1 can predict postoperative morbidity in thoracic surgery patients. PMID:23277814

Yang, Mikyung; Kim, Jie Ae; Yu, Jae-Myung

2012-01-01

34

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

PubMed

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 closurenearly 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 antibioticsolder 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. PMID:20941334

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

2010-01-01

35

Preoperative bacterial colonization and its influence on postoperative wound infections in plastic surgery  

Microsoft Academic Search

During two separate periods a total of 654 patients were included in a clinical study relating preoperative bacterial colonization to occurrence of postoperative wound infection in plastic surgery. During the second period one half of the patients were randomized to receive prophylactic azithromycin. Bacteriological samples were collected from the nasal vestibulum during both periods, and additionally from the surgical field

K. Andenæs; E. Lingaas; P. F. Amland; K.-E. Giercksky; F. Åbyholm

1996-01-01

36

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

1995-01-01

37

Prevalence of Nosocomial Wound Infection Among Postoperative Patients and Antibiotics Patterns at Teaching Hospital in Sudan  

PubMed Central

Background: Postoperative nosocomial infections remain a major problem in health care facilities, resulting in extended length of stay, substantial morbidity and mortality, high excess of cost, and less frequent cause of death in the surgical patient. Aims: To determine the prevalence of aerobic nosocomial pathogens among patients with postoperative wound infections at Gadarif state which located in Eastern part of Sudan. Materials and Methods: 109 wound swabs were collected from patients who had developed postoperative wound infection. Conventional technique for isolation of bacteria was applied with analytical profile index (API system) for identification to confirm primary and secondary isolates. Antibiotics susceptibility was applied for all isolated bacteria. Results: Aerobic bacterial isolates were S. aureus (n=55, 55.0%), P. mirabilis (n=35, 35.0%), E. coli (n=5, 5.0%), Ps. aeruginosa (n=3, 3.0%), and Pr. vulgaris (n=2, 2.0%). The prevalence rate of hospital acquired infection were 25.23% Conclusion: The highest prevalence rate of nosocomial postoperative wound infection, in Sudan was due to poor antibiotic selection, for prophylaxis during and after surgery and increased level of contamination in most part of the hospital. PMID:22393545

Ahmed, Mohamed Issa

2012-01-01

38

Prospective assessment of the risk of postoperative pulmonary complications in patients submitted to upper abdominal surgery  

Microsoft Academic Search

Objective: To investigate associations between preoperative variables and postoperative pulmonary complications (PPC) in elective upper abdominal surgery. Design: Prospective clinical trial. Setting: A tertiary university hospital. Patients: 408 patients were prospectively analyzed during the preoperative period and followed up postoperatively for pulmonary complications. Measurements: Patient characteristics, with clinical and physical evaluation, related diseases, smoking habits, and duration of surgery. Preoperative

Eanes Delgado Barros Pereira; Ana Luisa Godoy Fernandes; Meide da Silva Anção; Clóvis de Araújo Peres; Álvaro Nagib Atallah; Sonia Maria Faresin

1999-01-01

39

Role of Muscle Free Flap in the Salvage of Complicated Scalp Wounds and Infected Prosthetic Dura  

PubMed Central

Background The prosthetic dura is an essential element in the protection of the cranial parenchyma and prevention of cerebrospinal fluid leakage. Although prosthetic dura are widely used in neurosurgery, they occasionally provoke infection, which can be a major concern after neurosurgical treatment. However, removal of the prosthetic dura carries a risk of brain parenchyma injury and cerebrospinal fluid leakage. The salvage of infected prosthetic dural material has not been adequately addressed in the literature. In this study, we demonstrate the value of the combination of a meticulous surgical debridement of necrotic tissue and simultaneous muscle free flap for intractable postoperative epidural abscess without removal of the infected prosthetic dura. Methods Between 2010 and 2012, we reviewed the data of 11 patients with persistent infection on the prosthetic dura. The epidural infections each occurred after a neurosurgical procedure, and there was soft tissue necrosis with the disclosure of the underlying prosthetic dura and dead bone around the scalp wound. To salvage the infected prosthetic dura, meticulous debridement and a muscle free flap were performed. Results All 11 patients experienced complete recovery from the complicated wound problem without the need for further surgical intervention. No signs of prosthetic dural infection were observed during the mean follow-up period of 11 months. Conclusions The combination of a meticulous surgical debridement and coverage with a muscle free flap is an effective treatment for salvage of infected prosthetic dura. PMID:24286047

Han, Dae Hee; Park, Myong Chul; Park, Dong Ha; Song, Hyunsuk

2013-01-01

40

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

SciTech Connect

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

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

2013-02-01

41

Wound complications after cleft repair in children with Van der Woude syndrome.  

PubMed

Van der Woude syndrome (VWS; OMIM 119300) is an autosomal-dominant condition associated with clefts of the lip and/or palate and lower lip pits and is caused by mutations in interferon regulatory factor 6 (IRF6). The standard of practice for children born with cleft lip/palate is surgical repair, which requires proper wound healing. We tested the hypothesis that children with VWS are more likely to have wound complications after cleft repair than children with nonsyndromic cleft lip/palate (NSCLP). Furthermore, we hypothesized that children with VWS have more surgical procedures. A retrospective, case-controlled study was performed. Seventeen children with VWS and 68 matched controls with NSCLP were scored for the presence of wound complications after cleft repair, for the severity of complications, and for number of surgeries from age 0 to 10. Of the 17 children with VWS, 8 had wound complications. Of 68 controls, 13 had wound complications (P = 0.02). Of 8 wound complications in the VWS group, 6 were major, whereas of 13 complications in the control group, 9 were major (P = 0.04). Most wound complications were fistulae and occurred in isolated cleft palate and bilateral cleft lip. The mean number of surgeries in the VWS group was 3.0 compared with 2.8 in the control group (P = 0.67). Our studies suggest that children with VWS have an increased risk for wound complications after cleft repair compared with children with NSCLP. Furthermore, these data support a role for IRF6 in wound healing. PMID:20856020

Jones, Jodi L P; Canady, John W; Brookes, James T; Wehby, George L; L'Heureux, Jamie; Schutte, Brian C; Murray, Jeffrey C; Dunnwald, Martine

2010-09-01

42

[Tension pneumopericardium: a rare complication after thoracic stab wound].  

PubMed

The authors report a case involving a patient with thoracic stab wound. The patient developed tension pneumopericardium with acute cardiac tamponade. The clinical and radiological features of tension pneumopericardium and its treatment are discussed. PMID:12494808

Faroudy, M; Marzouk, N; Ababou, A; Lazreq, C; Sbihi, A

2002-11-01

43

Complications of continuous epidural infusions for postoperative analgesia in children  

Microsoft Academic Search

To determine the incidences of side effects and complications associated with the use of epidural analgesia for infants and\\u000a children at the Alberta Children’s Hospital, we reviewed our experience over a two-year period. A database was established\\u000a for recording management, side effects and complications of each epidural, and this is a retrospective review ofthat database.\\u000a Problems were identified as complications

Catherine E. Wood; Gerald V. Goresky; Kimberly A. Klassen; Brian Kuwahara; Stuart G. Neil

1994-01-01

44

The treatment and postoperative complications of Hirschsprung's disease  

Microsoft Academic Search

One hundred and ten patients with Hirschsprung's disease diagnosed and treated from 1981 to 1990 at the Royal Children's Hospital, Melbourne, were studied retrospectively. Eighty (72.7%) were treated by the Boley modification of the Soave procedure, 13 by the original Soave procedure, 13 had a Duhamel operation, and 4 had other procedures. Postoperative mortality was 2.7% (3 patients, 2 of

Kumiko Shono; John M. Hutson

1994-01-01

45

Postoperative Complications of Thyroid Cancer in a Single Center Experience  

PubMed Central

The aim of this study was to investigate the complications following surgical treatment of thyroid cancer and the association between the extent of surgery and complication rates. A total of 2,636 patients who underwent surgery due to thyroid cancer were retrospectively reviewed to identify surgical complications. Complication rates were assessed according to the extent of surgery, which was classified as follows; less-than-total thyroidectomy with central compartment node dissection (CCND) (Group I, n=636), total thyroidectomy with CCND (Group II, n=1,390), total thyroidectomy plus ipsilateral neck dissection (Group III, n=513), and total thyroidectomy plus bilateral neck dissection (Group IV, n=97). The most common surgical complication was symptomatic hypoparathyroidism, of which 28.4% of cases were transient and 0.3% permanent. The other surgical complications included vocal cord palsy (0.7% transient, and 0.2% permanent), hematoma (0.5%), seroma (4.7%), chyle fistula (1.8%), and Horner's syndrome (0.2%). The complication rates increased significantly with increasing the extent of surgery from Group I to Group IV. The more extensive surgery makes more complications, such as hypoparathyroidism, seroma, and others. PMID:20357995

Lee, Yong Sang; Nam, Kee-Hyun; Chung, Woong Youn; Park, Cheong Soo

2010-01-01

46

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

2011-01-01

47

Effect of wound infiltration with bupivacaine or lower dose bupivacaine/magnesium versus placebo for postoperative analgesia after cesarean section  

PubMed Central

Aim: The authors examined the analgesic effect of wound infiltration with bupivacaine or lower dose bupivacaine and magnesium versus normal saline for postoperative analgesia after cesarean section. Materials and Methods: A total of 120 patients, American Society of Anesthesiologists (ASA) I-II were prepared for elective cesarean section. At the end of the surgery, the wound was continuously infiltrated at a rate of 5 ml/h for 24 h post-operatively by one of the following solutions: 0.25% bupivacaine, a mixture of 0.125% bupivacaine and 5% magnesium sulphate or normal saline (0.9%). Total opioid consumption, Visual Analogue Scale (VAS) at rest and movement, incidence of opioid side-effects and signs of wound inflammation were assessed during the period of the study (24 h post-operatively). Three months later, residual pain, surgical wound infection, need for extra-antibiotic therapy and wound healing impairment were assessed. Results: Post-operative pain scores at rest were statistically significant higher in the control group than those in the both wound infiltration groups from 4th h and onwards (P < 0.0001). Meanwhile, post-operative pain was higher in bupivacaine group versus magnesium group (P < 0.0001, P < 0.0001, 0.0012, respectively). There was statistically significant increase in VAS during movement in the control group versus others at 2, 4, 12, 24 h post-operatively (P < 0.0001). However, patients received magnesium plus bupivacaine wound infiltration showed a significant decrease in post-operative pain scores than whom received bupivacaine from 4th h and onward (P < 0.0001, 0.0054, 0.0001, respectively). Morphine consumption was significantly reduced in the magnesium group, (P < 0.0001). Incidence of residual pain was comparable in the three groups. The incidence of sedation and urine retention were noted to be significantly higher in the control group in comparison to other groups, (P <0.0001). The incidence of post-operative nausea and vomiting was reduced in patients received magnesium plus bupivacaine block versus others (P < 0.0001). Conclusion: Continuous wound infiltration with a mixture of bupivacaine and magnesium sulphate after cesarean section showed an effective analgesia and reduced post-operative Patient Controlled Analgesia (PCA) requirements as compared to continuous wound infiltration with local anesthetic only or placebo with fewer incidences of opioid adverse effects.

Eldaba, Ahmad A.; Amr, Yasser M.; Sobhy, Reda A.

2013-01-01

48

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

PubMed Central

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

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

2014-01-01

49

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

2007-01-01

50

Estimated costs of postoperative wound infections. A case-control study of marginal hospital and social security costs.  

PubMed Central

A cohort of 4515 surgical patients in ten selected intervention groups was followed. Three hundred and seventeen developed postoperative wound infections, and 291 of these cases were matched 1:1 to controls by operation, sex and age. In comparison to the controls the cases stayed longer in hospital after the intervention and had more contact after discharge with the social security system. Using data from a national sentinel reference database of the incidence of postoperative wound infections, and using national activity data, we established an empirical cost model based on the estimated marginal costs of hospital resources and social sick pay. It showed that the hospital resources spent on the ten groups, which represent half of the postoperative wound infections in Denmark, amounted to approximately 0.5% of the annual national hospital budget. This stratified model creates a better basis for selecting groups of operations which need priority in terms of preventive measures. PMID:7925666

Poulsen, K. B.; Bremmelgaard, A.; S?rensen, A. I.; Raahave, D.; Petersen, J. V.

1994-01-01

51

Fatal pulmonary embolism complicating a postoperative chylothorax despite adequate thromboprophylaxis.  

PubMed

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

2013-12-01

52

Duration of postoperative intravenous antibiotics in childhood complicated appendicitis: a propensity score-matched comparison study.  

PubMed

Introduction?Postoperative antibiotics complement surgery in managing childhood-complicated appendicitis. However, there is limited evidence to guide clinicians on appropriate duration of therapy. A comparison cohort study was performed to determine whether tailoring duration of inpatient intravenous (IV) antibiotic therapy to patient response, assessed using a set of clinical criteria, leads to shortened hospital length of stay (LOS) without compromising patient outcomes. Patients and Methods Over a 6-month period, 47 children (aged 5-14 years) with complicated appendicitis were treated with postoperative IV antibiotics until each satisfied a set of bedside clinical parameters suggesting resolved intraperitoneal infection (core temperature?Complicated appendicitis was defined as the presence of generalized peritonitis, appendiceal perforation or gangrene, and/or abscess. Postoperative recovery parameters were prospectively recorded and compared with those of 47 historical control patients, matched by propensity scores, who received 5 days minimum of postoperative IV antibiotics. Sample size was determined by a priori power calculation based on reduction in LOS. Severity of postoperative complications was graded using the Clavien-Dindo system. Results?Study group variables were comparable including patient demographics, duration of presenting symptoms, severity of presenting disease, preoperative antibiotics received, length of operation, seniority of primary surgeon, surgical approach taken, and intraoperative findings. The prospective cohort had a significantly shorter median LOS compared with the historical control cohort (5 vs. 6 nights, p?=?0.010) while readmission rates and the incidence and severity of complications were similar, including incidence of postoperative intra-abdominal infections (6 vs. 8 cases, p?=?0.562). Conclusion?Using bedside clinical parameters indicative of resolved intraperitoneal infection to tailor duration of postoperative IV antibiotics for children with complicated appendicitis shortens LOS without apparent compromise to patient outcomes. PMID:23801354

Yu, Tzu-Chieh; Hamill, James K M; Evans, Stephen M; Price, Neil R; Morreau, Philip N; Upadhyay, Vipul A; Ferguson, R Stuart; Best, Emma J; Hill, Andrew G

2014-08-01

53

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

PubMed Central

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

Jacobson, Stefan

2012-01-01

54

Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures  

Microsoft Academic Search

Procedure for prolapsing hemorrhoids (PPH) and stapled transanal rectal resection for obstructed defecation (STARR) carry\\u000a low postoperative pain, but may be followed by unusual and severe postoperative complications. This review deals with the\\u000a pathogenesis, prevention and treatment of adverse events that may occasionally be life threatening. PPH and STARR carry the\\u000a expected morbidity following anorectal surgery, such as bleeding, strictures

M. Pescatori; G. Gagliardi

2008-01-01

55

Managing and caring for a patient with a complicated wound.  

PubMed

The patient discussed in this care study is a 91-year-old woman admitted to hospital from her own home. She presented with reduced mobility, constipation, increased confusion and reduced oral intake. Her history included small vessel disease and a stroke. On admissions she also had a number of grade two pressure ulcers on her buttocks. The surrounding skin appeared macerated and the patient complained of pain when the skin was cleaned after she was incontinent of both urine and faeces. It was expected that the wound would be fast healing, as it was superficial, but the healing rate proved otherwise. This article will focus on incontinence management as well as ways of aiding in healing a pressure ulcer where skin is macerated and the patient has many risk factors. PMID:15564999

Stalick, Liora

56

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. PMID:24049646

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

2012-01-01

57

[Videothoracoscopic treatment of postoperative bleedings and its' complications by thoracic traumas].  

PubMed

35 patients, operated on the thoracic trauma (ISS - 9±3), had videothoracoscopy on the reason of the continued bleeding (n=6), clotted hemothorax (n=27) or pleura empyem (n=2). The best results were obtained in case of the clotted hemothorax thoracoscopic evacuation within 3 days after bleeding. Even the late use of videothoracoscopic procedures for the treatment of postoperative complications shortens the hospital stay in comparison with the traditional methods. The video-assisted thoracoscopic surgery is an accurate and safe method for the postoperative bleeding complications in hemodynamically stable patients. PMID:22968552

Voskresenski?, O V; Abakumov, M M; Daneilian, Sh N

2012-01-01

58

[Pathogenesis of postoperative complications of paraproctitis and measures for their prevention].  

PubMed

The inflammation of Morgagni crypts in the anal canal plays a great part in pathogenesis of acute paraproctitis and anal fistula. Such inflammation is often of diffuse character and in 18--19% of cases results in postoperative complications--acute and chronic cryptitis and subcutaneous microabscesses. Sanitation of Morgagni crypts (cryptotomy and cryptectomy) during radical operations for paraproctitis decreases the number of local postoperative complications and may be considered as one of the prophylactic measures against recurrent abscesses or anal fistulas. PMID:7376345

Nazarov, L U; Akopian, E B; Kanaian, A S

1980-01-01

59

Polypropylene mesh closure of the complicated abdominal wound  

Microsoft Academic Search

Background: Closure of the abdominal wall in the face of fascial necrosis or massive intestinal edema remains a difficult problem with frequent complications. Prior studies have addressed both the utility and the pitfalls of placing polypropylene mesh in this setting.Methods: We performed a retrospective evaluation of our experience with polypropylene mesh in traumatic and nontraumatic difficult abdominal closures. Timing of

Richard F. Fansler; Paul Taheri; Carey Cullinane; Braulio Sabates; Lewis M. Flint

1995-01-01

60

The relationship between pre-operative symptoms, operative findings and postoperative complications in schwannomas.  

PubMed

This study presents a retrospective review of the management of schwannomas in the limbs and examines the relationship between pre-operative clinical examination, operative findings and postoperative neurological complications. Eighteen tumours with a histological diagnosis of schwannoma in 17 patients who underwent surgery between 1998 and 2004 were the basis of this study. Enucleation of the tumour was possible in 14 cases. None of these patients had neurological complications pre-operatively but eight had mild neurological complications postoperatively. The complications consisted of sensory deficit in five cases, motor weakness in one and both in two. Enucleation of the tumours was impossible in four cases. These schwannomas originated in the brachial plexus in three cases and the ulnar nerve in the proximal arm in one case. Tumours with pre-operative symptoms and masses located at a proximal site in the limb were more likely to be impossible to enucleate completely. PMID:16928412

Sawada, T; Sano, M; Ogihara, H; Omura, T; Miura, K; Nagano, A

2006-12-01

61

The impact of prophylactic antibiotics on postoperative infection complication in elective laparoscopic cholecystectomy: a prospective randomized study  

Microsoft Academic Search

BackgroundThe aim of this prospective randomized study was to investigate the necessity and impact of prophylactic antibiotics on postoperative infection complications in elective laparoscopic cholecystectomy.

Wen-Tsan Chang; King-Teh Lee; Shih-Chang Chuang; Shen-Nien Wang; Kung-Kai Kuo; Jong-Shyone Chen; Pai-Ching Sheen

2006-01-01

62

Phantom Limb Pain—A Complication of Lower Extremity Wound Management  

Microsoft Academic Search

Amputation is one treatment option for patients with critical limb ischemia, diabetic foot wounds, and occasionally, even venous leg ulcers. Amputation of the whole limb or part of it or the digits can cause complications including pain. Post-amputation pain, and especially phantom limb pain (PLP), is a poorly understood phenomenon. Effective management of established pain is a major challenge. This

Jane F. Hazelgrove; Peter D. Rogers

2002-01-01

63

Effect of Cefazolin Prophylaxis on Postoperative Infectious Complications in Elective Laparoscopic Cholecystectomy: A Prospective Randomized Study  

PubMed Central

Background In patients with symptomatic cholelithiasis, laparoscopic cholecystectomy (LC) is the standard method of treatment. Laparoscopic cholecystectomy has a low rate of postoperative infections probably owing to smaller wounds and minimal tissue damage compared with the open procedure. Objectives This study assessed the effect of cefazolin prophylaxis on postoperative infection in patients undergoing elective laparoscopic cholecystectomy. Additionally, we determined the risk factors of cases with postoperative infection. Patients and Methods A total of 753 patients were enrolled in the study. Among these, 206 were excluded from the study. As a result, 547 patients with symptomatic cholelithiasis who underwent elective laparoscopic cholecystectomy were selected for this prospective study. Patients were randomized consecutively and divided into 2 groups: patients in the cefazolin (CEF) group (n = 278) received 1 g of cefazolin and those in the control group (n = 269) received 10 mL of isotonic sodium chloride solution. Patient characteristics and overall surgical outcomes were compared between the groups. All patients were followed for development of postoperative infections. Results Postoperative infections occurred in 4 patients in the CEF group and in 2 patients in the control group; no significant difference existed in this regard(P = .44). Risk of infection increased in patients with previous cholecystitis and/or endoscopic retrograde cholangiopancreatography (P < 0.001), patients with ruptured gallbladders, and patients for whom a suction drain was used (respectively, P < 0.001 and P < 0.001). Conclusions No correlation existed between cefazolin prophylaxis and postoperative infections in elective laparoscopic cholecystectomy patients. There may be an increased risk of infection in patients with previous cholecystitis or endoscopic retrograde cholangiopancreatography. In addition, there was an increased risk of postoperative infection in patients with gallbladder rupture and suction drain use. PMID:24396577

Turk, Emin; Karagulle, Erdal; Serefhanoglu, Kivanc; Turan, Hale; Moray, Gokhan

2013-01-01

64

Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review  

PubMed Central

Background The aim of this meta-analysis was to analyse the outcomes of major pancreatic surgery among the elderly (?75 and ?80 years of age). Methods A systematic literature search was conducted using Embase, MEDLINE, Cochrane and PubMed databases on all studies published between January 1990 and April 2012 reporting peri-operative outcomes after a pancreaticoduodenectomy (PD) among the elderly. Primary end-points measured were peri-operative mortality and the incidence of post-operative complications. Secondary outcomes considered included the incidence of post-operative pancreatic fistula formation (POPF), delayed gastric emptying (DGE), wound infection, pneumonia, post-operative bleeding and length of hospital stay. Results Eleven trials were included comprising 5186 patients; 7 studies comparing endpoints in patients aged ?75 years vs. younger populations and 4 studies comparing endpoints in patients aged ?80 years vs. younger populations. In both groups, there was a statistically significant increase in the incidence of mortality and post-operative pneumonia in the elderly population. The incidence of post-operative complications was also found to be statistically significant among patients ?80 years of age vs. their younger cohorts. Conclusions There is an increased incidence of post-operative mortality and pneumonia after a PD among all elderly patients ?75 years of age, as well as an increased incidence of post-operative complications among patients ?80 years of age. Additional randomized control trials studying post-PD operative outcomes in elderly vs. younger patients with standardization of comorbidities is therefore necessary to confirm the conclusions presented here. PMID:22954000

Prashant, Sukharamwala; Jonathan, Thoens; Mauricio, Szuchmacher; James, Smith; Peter, DeVito

2012-01-01

65

Variations in Postoperative Complications across Race, Ethnicity and Sex among Older Adults  

PubMed Central

OBJECTIVES To explore differences in the incidence of postoperative complications among three racial/ethnic groups (white, black and Hispanic) before and after taking into account potentially confounding patient and hospital characteristics. DESIGN A cross-sectional study using 2006–2007 administrative patient discharge data from hospitals in four states (CA, PA, NJ, FL), linked to American Hospital Association Annual Survey data, and data from the U.S. Census. Risk-adjusted logistic regression models were used in the analyses. SETTING Six hundred U.S. adult nonfederal acute care hospitals. PARTICIPANTS Five hundred eighty seven thousand three hundred fourteen individuals, ages 65 and over, undergoing general, orthopedic or vascular surgeries (86% white, 6% black and 8% Hispanic). MEASUREMENTS Thirteen frequent postoperative complications. RESULTS When considered without controls, black patients had significantly higher odds than white patients of developing 12 of the 13 complications, by factors (ORs) ranging from 1.09 to 2.69. Hispanic patients had significantly higher odds than white patients on 9 of the 13 complications (ORs range from 1.11 to 1.82) and significantly lower odds than white patients on 2 of the other 4 (ORs = 0.84 in both cases).The fully adjusted models that accounted for hospital and especially patient characteristics substantially diminish the number of complications for which black and Hispanic patients had significantly higher odds than white patients. Many of the significant differences between blacks, Hispanics and white patients that persisted after controls were different for male and female patients. CONCLUSION Older black and Hispanic patients have higher odds than white patients of developing a vast majority of postoperative complications. Differences in postoperative complication risk are largely explained by procedure type and health status, and are frequently conditional on sex. PMID:24006851

Carthon, J. Margo Brooks; Jarrin, Olga; Sloane, Douglas; Kutney-Lee, Ann

2013-01-01

66

Five days of postoperative antimicrobial therapy decreases infectious complications following pancreaticoduodenectomy in patients at risk for bile contamination  

PubMed Central

ObjectivesPancreaticoduodenectomy (PD) is associated with high morbidity, in part as a result of infectious complications increased by preoperative bile contamination. The aim of the present study was to assess the effect on the incidence of infectious complications of short-term antimicrobial therapy (AMT) in high-risk patients. MethodsPatients with a high risk for positive intraoperative bile culture (i.e. those with ampulloma or pancreatic adenocarcinoma with preoperative endoscopic procedures) (high-risk group, n = 99) were compared with low-risk patients (i.e. those with pancreatic adenocarcinoma without preoperative endoscopic procedures) (low-risk group, n = 76). The high-risk group received a 5-day course of perioperative AMT secondarily adapted to the bile antibiogram. The low-risk group received only the usual antimicrobial prophylaxis. ResultsPositive bile cultures were significantly more frequent in high-risk patients (81% versus 12%; P < 0.001). The overall rate of infectious complications was lower in the high-risk group (29% versus 46%; P = 0.018). The statistically significant decrease in the rate of infectious complications reflected reduced rates of urinary tract infections, pulmonary infections and septicaemia. Rates of wound infection (3% versus 5%; P = 0.639) and intra-abdominal abscess (7% versus 7%; P = 0.886) were similar in the high- and low-risk groups, as was the need for curative AMT. ConclusionsThis exploratory study suggests that a postoperative short course of AMT in patients at high risk for biliary contamination reduces the overall rate of infectious complications after PD. The adaptation of perioperative antimicrobial policy to the patient's risk for bile contamination seems promising and should be further evaluated. PMID:23458261

Sourrouille, Isabelle; Gaujoux, Sebastien; Lacave, Guillaume; Bert, Francois; Dokmak, Safi; Belghiti, Jacques; Paugam-Burtz, Catherine; Sauvanet, Alain

2013-01-01

67

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

PubMed

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

2013-01-01

68

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

PubMed

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

2012-11-01

69

Effects of allogeneic leukocytes in blood transfusions during cardiac surgery on inflammatory mediators and postoperative complications  

Microsoft Academic Search

Objective: To investigate whether the higher prevalence of postoperative complications in cardiac surgery after transfusion of leukocyte-containing red blood cells can be related to inflammatory mediators. Design: Analysis of inflammatory markers interleukin-6, interleukin-10, interleukin-12, and procalcitonin in patients participating in a randomized trial comparing leukocyte-depleted with leukocyte-containing, buffy-coat-depleted red blood cells. Setting: Two university-affiliated hospitals in the Netherlands. Subjects: A

Yavuz M. Bilgin; Watering van de L. M. G; Michel I. M. Versteegh; Oers van M. H. J; Anneke Brand

2010-01-01

70

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. PMID:19768118

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

2009-01-01

71

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. PMID:23841040

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

2013-01-01

72

[Ofloxacin in the comprehensive therapy of complicated forms of wound infection].  

PubMed

A 5-year experience with the use of ofloxacin in the complex treatment of complicated wound infections showed that the drug had a broad spectrum of antimicrobial activity, was not toxic and well tolerated by the patients. The side effects were extremely rare. The antimicrobial activity of ofloxacin after its clinical use for 5 years did not practically change. The drug clinical and bacteriological efficacy in different groups of the patients ranged within 85-91 and 74-80 per cent respectively depending on the process severity. The failure of the therapy was as a rule associated with an insufficient surgical treatment of the purulent foci. It was more frequent in the patients with arteriosclerotic and diabetic gangrene of the lower extremities when due to various reasons the initial surgical operations were not radical. The short treatment courses (for not more than 5-7 days) or an early use of the drug tablets instead of the intravenous injections resulted from an insufficient experience with ofloxacin during the first years of its use. Such an unjustified tactics did not provide stable elimination of the pathogen. Our experience with ofloxacin in the treatment of various groups of patients with wound infections demonstrated that it should be considered as a reserve drug for the treatment of cases with complicated wound infections accompanied by infections of the respiratory and uropoietic organs requiring a long-term antibacterial therapy in hospitals and outpatient departments. PMID:8060193

Blatun, L A; Iakovlev, V P; Elagina, L V

1994-01-01

73

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

PubMed Central

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

Espandar, Ladan; Meyer, Jay

2010-01-01

74

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

PubMed Central

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

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

2014-01-01

75

Postoperative Pain Relief Using Wound Infiltration With 0.5% Bupivacaine in Single-Incision Laparoscopic Surgery for an Appendectomy  

PubMed Central

Purpose Recently, single-incision laparoscopic surgery (SILS) has been popular for minimally invasive surgery and cosmetic improvement. However, some papers have reported that SILS for an appendectomy (SILS-A) has had the more postoperative complaints of pain. We investigated postoperative pain relief using wound infiltration with 0.5% bupivacaine in SILS-A and compared the result with that for conventional SILS-A. Methods Between July 2010 and September 2012, 75 patients who underwent SILS-A were enrolled in this study. The patients were randomly assigned to two groups: conventional SILS-A group (C-SILS-A) or wound infiltrated with 0.5% bupivacaine in SILS-A group (W-SILS-A). Forty-five patients were in the C-SILS-A, and 30 patients were in the W-SILS-A. Patients with perforated appendicitis were excluded. The clinical outcomes were compared between the groups by using the verbal numerical rating scale (VNRS). Results Clinical outcomes were similar in both study groups except for the pain score. The W-SILS-A group showed significantly lower numbers of additional pain killers and lower VNRS scores 1, 6, and 12 hours after surgery than the C-SILS-A group. Conclusion W-SILS-A is a technically simple and effective method of reducing early postoperative pain. It may be applicable in SILS-A for pain control system. PMID:24466538

Ahn, So Ra; Lee, Cheol; Park, Won Cheol; Lee, Jeong Kyun

2013-01-01

76

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

PubMed Central

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

de Aquino, Jose Luiz Braga

2014-01-01

77

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. PMID:21896171

2011-01-01

78

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

PubMed

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

Moura, João; Børsheim, Elisabet; Carvalho, Eugenia

2014-01-01

79

Hepatic Steatosis Is a Risk Factor for Postoperative Complications After Major Hepatectomy  

PubMed Central

Objective: To assess the impact of microsteatosis (MiS) and macrosteatosis (MaS) on major hepatectomy. Summary Background Data: While steatosis of a liver graft is an established risk factor in transplantation, its impact on major hepatectomy remains unclear. Methods: Fifty-eight steatotic patients who underwent major hepatectomy were matched 1:1 with patients with normal liver according to age, gender, ASA score, diagnosis, extent of hepatectomy, and need of hepaticojejunostomy. Steatosis was evaluated quantitatively and qualitatively. Primary endpoints were mortality and complications. Results: Pure MaS and MiS were present in only 10 and 3 patients, respectively, while mixed steatosis was noted in 45 patients. Forty-four patients had mild (10%–30%) and 14 moderate/severe (>30%) steatosis. Steatotic patients had significantly higher serum transaminase and bilirubin levels, and lower prothrombin time. Blood loss (P = 0.04) and transfusions (P = 0.03), and ICU stay (P = 0.001) were increased in steatotic patients. Complications were higher in steatotic patients when considered either overall (50% vs. 25%, P = 0.007) or major (27.5% vs. 6.9%, P = 0.001) complications. Patients with pure MaS had increased mortality (MaS: 20% vs. MiS: 6.6% vs. mixed: 0%; P = 0.36) and major complications (MaS: 66% vs. MiS: 50% vs. mixed: 24%; P = 0.59), but not significantly. Preoperative cholestasis was a highly significant risk factor for mortality in patients with hepatic steatosis. Conclusion: Steatosis per se is a risk factor for postoperative complications after major hepatectomy and should be considered in the planning of surgery. Caution must be taken to perform major hepatectomy in steatotic patients with preexisting cholestasis. PMID:17522518

McCormack, Lucas; Petrowsky, Henrik; Jochum, Wolfram; Furrer, Katarzyna; Clavien, Pierre-Alain

2007-01-01

80

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. PMID:22557835

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

2012-01-01

81

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

PubMed Central

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

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

2012-01-01

82

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. PMID:23275327

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

2012-01-01

83

Down syndrome and postoperative complications after paediatric cardiac surgery: a propensity-matched analysis  

PubMed Central

OBJECTIVES The incidence of congenital heart disease is ?50%, mostly related to endocardial cushion defects. The aim of our study was to investigate the postoperative complications that occur after paediatric cardiac surgery. METHODS Our perioperative data were analysed in paediatric patients with Down syndrome undergoing cardiac surgery. We retrospectively analysed the data from 2063 consecutive paediatric patients between January 2003 and December 2008. After excluding the patients who died or had missing data, the analysed database (before propensity matching) contained 129 Down patients and 1667 non-Down patients. After propensity matching, the study population comprised 222 patients and 111 patients had Down syndrome. RESULTS Before propensity matching, the occurrences of low output syndrome (21.2 vs 32.6%, P = 0.003), pulmonary complication (14 vs 28.7%, P < 0.001) and severe infection (11.9 vs 22.5%, P = 0.001) were higher in the Down group. Down patients were more likely to have prolonged mechanical ventilation [median (interquartile range) 22 (9–72) h vs 49 (24–117) h, P = 0.007]. The total intensive care unit length of stay [6.9 (4.2–12.4) days vs 8.3 (5.3–13.2) days, P = 0.04] and the total hospital length of stay [17.3 (13.3–23.2) days vs 18.3 (15.1–23.6) days, P = 0.05] of the Down patients were also longer. Mortality was similar in the two groups before (3.58 vs 3.88%, P = 0.86) and after (5.4 vs 4.5%, P = 1.00) propensity matching. After propensity matching, there was no difference in the occurrence of adverse events. CONCLUSIONS After propensity matching Down syndrome was not associated with increased mortality or complication rate following congenital cardiac surgery. PMID:23832837

Toth, Roland; Szanto, Peter; Prodan, Zsolt; Lex, Daniel J; Sapi, Erzsebet; Szatmari, Andras; Gal, Janos; Szanto, Tamas; Szekely, Andrea

2013-01-01

84

Tissue and Wound Healing Effects of Short Duration Postoperative Oxygen Therapy  

Microsoft Academic Search

The purpose of this study was to determine the effects of 28% oxygen given in the first 36 hours after surgery on tissue oxygen, collagen deposition, and clinical healing outcomes. Twenty-four subjects having cervical spine surgical procedures participated in a randomized, repeated-measures pilot study of tissue and healing effects of postoperative supplemental oxygen. The treatment group (n = 13) received

JoAnne D. Whitney; Stacy Heiner; Brenda I. Mygrant; Connie Wood

2001-01-01

85

Incidence of unintentional intraneural injection and postoperative neurological complications with ultrasound-guided interscalene and supraclavicular nerve blocks.  

PubMed

It is proposed that ultrasound guidance decreases the risk of intraneural injection and associated postoperative neurological complications. However, the incidence of unintentional intraneural injection with ultrasound is unknown. Two hundred and fifty-seven patients were enrolled in a prospective, single-blind observational study. All patients underwent a pre-operative neurological examination before ambulatory shoulder arthroscopy with sedation and ultrasound-guided interscalene or supraclavicular block. Patients were followed up at 1 week and at 4-6 weeks postoperatively. Two blinded anaesthesiologists viewed the same video of the ultrasound image during the block offline to determine intraneural trespass. Intraneural injection occurred in 42 patients (17%; 95% CI 12-22%). No patient suffered from postoperative neurological complications (0%; 95% CI 0-1.6%) at follow-up. PMID:21320084

Liu, S S; YaDeau, J T; Shaw, P M; Wilfred, S; Shetty, T; Gordon, M

2011-03-01

86

May Renal Resistive Index Be an Early Predictive Tool of Postoperative Complications in Major Surgery? Preliminary Results  

PubMed Central

Background. Patients who undergo high-risk surgery represent a large amount of post-operative ICU-admissions. These patients are at high risk of experiencing postoperative complications. Renal Resistive Index was found to be related with renal dysfunction, hypertension, and posttraumatic hemorrhagic shock, probably due to vasoconstriction. We explored whether Renal Resistive Index (RRI), measured after awakening from general anesthesia, could have any relationship with postoperative complications. Methods. In our observational, stratified dual-center trial, we enrolled patients who underwent general anesthesia for high-risk major surgery. After awakening in recovery room (or during awakening period in subjects submitted to cardiac surgery) we measured RRI by echo-color-Doppler method. Primary endpoint was the association of altered RRI (>0.70) and outcome during the first postoperative week. Results. 205 patients were enrolled: 60 (29.3%) showed RRI > 0.70. The total rate of adverse event was 27 (18.6%) in RRI ? 0.7 group and 19 (31.7%) in RRI > 0.7 group (P = 0.042). Significant correlation between RRI > 0.70 and complications resulted in pneumonia (P = 0.016), septic shock (P = 0.003), and acute renal failure (P = 0.001) subgroups. Patients with RRI > 0.7 showed longer ICU stay (P = 0.001) and lasting of mechanical ventilation (P = 0.004). These results were confirmed in cardiothoracic surgery subgroup. RRI > 0.7 duplicates triplicates the risk of complications, both in general (OR 2.03 93 95% CI 1.02–4.02, P = 0.044) and in cardiothoracic (OR 2.62 95% CI 1.11–6.16, P = 0.027) population. Furthermore, we found RRI > 0.70 was associated with a triplicate risk of postoperative septic shock (OR 3.04, CI 95% 1.5–7.01; P = 0.002). PMID:24967414

Meco, Massimo; Ruggieri, Nadia; Cosseta, Daniele; Cirri, Silvia; Zito, Paola Cosma; Gollo, Yari; Raimondi, Ferdinando

2014-01-01

87

Surgical Anatomy, Transperitoneal Approach, and Early Postoperative Complications of a Ventral Lumbar Spine Surgical Model in Lewis Rats  

PubMed Central

Surgical models in animals are used extensively to study small molecules and devices for lumbar intervertebral disc repair, replacement, and fusion. Although the ventral lumbar animal models themselves are well described, critical assessment of morbidity and mortality avoidance when using the models have not been reported. Hypothesizing that technique modifications and the relative prevalence and severity of complications would be correlated, we collected and examined peri- and postoperative data stratified by surgical technique. We here report complications associated with the transperitoneal approach to the lumbar spine in 268 Lewis rats and offer data-driven suggestions regarding complication avoidance through technique modification. Compared with wider exposure, limiting the width of exposure to a maximum of 3 mm resulted in fewer neurologic complications in the lower limbs. In addition, avoiding extracorporeal reflection of the small intestine during the exposure was associated with lower incidence of postoperative gastrointestinal distress and fewer situations requiring euthanasia. These findings underscore the importance of detailed approaches in minimizing postoperative morbidity and attrition in surgical models. PMID:24210017

Damle, Sheela R; Krzyzanowska, Agata; Frawley, Robert J; Cunningham, Matthew E

2013-01-01

88

[Endoscopic collection of v. saphena magna--early complication rates].  

PubMed

Endoscopic harvesting of v. saphena magna for CABG procedures represents a modern method, which in comparison to conventional methods reduces postoperative wound complications. We have analyzed 40 patients, who uderwent CABG procedure with endoscopic harvested venous graft. PMID:20662442

Kurfirst, V; Dusil, I; Rezler, M; Mokrácek, A

2009-11-01

89

Clinical assessment of peripheral perfusion to predict postoperative complications after major abdominal surgery early: a prospective observational study in adults  

PubMed Central

Introduction Altered peripheral perfusion is strongly associated with poor outcome in critically ill patients. We wanted to determine whether repeated assessments of peripheral perfusion during the days following surgery could help to early identify patients that are more likely to develop postoperative complications. Methods Haemodynamic measurements and peripheral perfusion parameters were collected one day prior to surgery, directly after surgery (D0) and on the first (D1), second (D2) and third (D3) postoperative days. Peripheral perfusion assessment consisted of capillary refill time (CRT), peripheral perfusion index (PPI) and forearm-to-fingertip skin temperature gradient (Tskin-diff). Generalized linear mixed models were used to predict severe complications within ten days after surgery based on Clavien-Dindo classification. Results We prospectively followed 137 consecutive patients, from among whom 111 were included in the analysis. Severe complications were observed in 19 patients (17.0%). Postoperatively, peripheral perfusion parameters were significantly altered in patients who subsequently developed severe complications compared to those who did not, and these parameters persisted over time. CRT was altered at D0, and PPI and Tskin-diff were altered on D1 and D2, respectively. Among the different peripheral perfusion parameters, the diagnostic accuracy in predicting severe postoperative complications was highest for CRT on D2 (area under the receiver operating characteristic curve = 0.91 (95% confidence interval (CI) = 0.83 to 0.92)) with a sensitivity of 0.79 (95% CI = 0.54 to 0.94) and a specificity of 0.93 (95% CI = 0.86 to 0.97). Generalized mixed-model analysis demonstrated that abnormal peripheral perfusion on D2 and D3 was an independent predictor of severe postoperative complications (D2 odds ratio (OR) = 8.4, 95% CI = 2.7 to 25.9; D2 OR = 6.4, 95% CI = 2.1 to 19.6). Conclusions In a group of patients assessed following major abdominal surgery, peripheral perfusion alterations were associated with the development of severe complications independently of systemic haemodynamics. Further research is needed to confirm these findings and to explore in more detail the effects of peripheral perfusion–targeted resuscitation following major abdominal surgery. PMID:24894892

2014-01-01

90

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

2011-01-01

91

Multifocal cutaneous mucormycosis complicating polymicrobial wound infections in a tsunami survivor from Sri Lanka.  

PubMed

A man injured in the tsunami of Dec 26, 2004, returned to Sydney for management of his soft-tissue injuries. Despite broad-spectrum antibiotics, surgical wound debridement, and vigilant wound care, his condition worsened. Muscle and fat necrosis developed in a previously debrided thigh wound, and necrotising lesions arose from previous abrasions. Histological analysis showed mucormycosis in three non-contiguous sites, and Apophysomyces elegans was isolated from excised wound tissue. Wound infections, both bacterial and fungal, will undoubtedly add to the morbidity and mortality already recorded in tsunami-affected areas. Other cases [correction] of cutaneous mucormycosis might develop in survivors, but this disease can be difficult to diagnose and even harder to treat, particularly in those remaining in affected regions. PMID:15752532

Andresen, David; Donaldson, Annabelle; Choo, Lennart; Knox, Adrian; Klaassen, Michael; Ursic, Caesar; Vonthethoff, Leon; Krilis, Steven; Konecny, Pamela

92

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

PubMed Central

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

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

2014-01-01

93

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

2005-01-01

94

Impact of Preoperative Physiological Risk Profile on Postoperative Morbidity and Mortality After Emergency Operation of Complicated Peptic Ulcer Disease  

Microsoft Academic Search

Aim  The aim of this study was to evaluate the preoperative physiological risk profile for postoperative morbidity and mortality\\u000a after emergency treatment of complicated peptic ulcer disease (PUD).\\u000a \\u000a \\u000a \\u000a Methods  Operative notes and hospital files of 261 patients—111 female, 150 male; median age 67 years (range 17–100 years)—undergoing\\u000a an emergency operation from 1993 to 2005 were analyzed retrospectively. The physiologic subscore of the

Jan-Hendrik Egberts; Birte Summa; Ulrike Schulz; Clemens Schafmayer; Sebastian Hinz; Juergen Tepel

2007-01-01

95

Effects of hospital and surgeon volumes on operating times, postoperative complications, and length of stay following laparoscopic colectomy  

Microsoft Academic Search

Purpose  A relationship between procedure volume and outcome in colorectal cancer surgery is clearly documented, but there is little\\u000a information on the volume-outcome association in laparoscopic colectomy. We conducted this study to clarify the effects of\\u000a hospital volume and surgeon volume on operating times, postoperative complications, and length of stay following laparoscopic\\u000a colectomy.\\u000a \\u000a \\u000a \\u000a Methods  We conducted a nationwide multicenter survey, targeting surgical

Hideo Yasunaga; Yutaka Matsuyama; Kazuhiko Ohe

2009-01-01

96

High-volume surgeons in regard to reductions in operating time, blood loss, and postoperative complications for total hip arthroplasty  

Microsoft Academic Search

Background  The purpose of this study was to clarify the volume-outcome relations for total hip arthroplasty, with a particular focus\\u000a on outcome variables such as operating time, blood loss, and postoperative complications.\\u000a \\u000a \\u000a \\u000a Methods  Using an Internet-based questionnaire survey, we identified 2965 total hip arthroplasties performed for osteoarthritis, idiopathic\\u000a osteonecrosis of the femoral head, rheumatoid arthritis, or hip fractures in 289 hospitals in

Hideo Yasunaga; Kazuaki Tsuchiya; Yutaka Matsuyama; Kazuhiko Ohe

2009-01-01

97

Impact of Mycophenolate Mofetil on Wound Complications and Lymphoceles after Kidney Transplantation  

Microsoft Academic Search

Background\\/Aims: Despite improved efficacy, modern immunosuppressive agents may show unanticipated side effects. In this study we investigated the possible interactions of mycophenolate mofetil (MMF) with wound healing and lymphocele formation. Methods: We conducted a retrospective single-center analysis in 144 patients receiving a cyclosporine A-based immunosuppression with prednisolone and either MMF (n = 77) or azathioprine (AZA, n = 77). Endpoints

Kai Lopau; Karin Syamken; Peter Rubenwolf; Hubertus Riedmiller; Christoph Wanner

2010-01-01

98

Successful interventional radiological management of postoperative complications of laparoscopic distal pancreatectomy  

PubMed Central

During the past decade, laparoscopic distal pancreatectomy (LDP) has gained increasing acceptance in the surgical community as a viable treatment option for distal pancreatic lesions. However, the possible complication of post-LDP pancreatic leakage remains a challenge, because it may lead to a series of events resulting in intraperitoneal abscess formation, sepsis, pseudoaneurysm formation, and occasional fatal hemorrhage. Dealing with these complications is extremely difficult and not much experience has been reported to date. We report a case involving the aforementioned post-LDP complications successfully managed by interventional radiological techniques while avoiding reoperation. We conclude that these management options are attractive, safe and minimally invasive alternatives to standard protocols. PMID:24363541

Zhu, Yi-Ping; Ni, Jun-Jun; Chen, Ren-Biao; Matro, Erik; Xu, Xiao-Wu; Li, Bin; Hu, Hong-Jie; Mou, Yi-Ping

2013-01-01

99

The Factors Related with Postoperative Complications in Benign Nodular Thyroid Surgery  

Microsoft Academic Search

Thyroid gland is an important endocrine organ because of its functions. Although the morbidity and mortality of thyroid surgery\\u000a have decreased markedly, serious complications may still occur. The aim of this retrospective study was to identify the factors\\u000a influencing the complications in benign nodular thyroid surgery. A total of 332 patients who underwent thyroid surgery between\\u000a April 2004 and May

Aysun Simsek Celik; Hasan Erdem; Deniz Guzey; Fatih Celebi; Atilla Celik; Selim Birol; Rafet Kaplan

2011-01-01

100

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

PubMed Central

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

2014-01-01

101

Meta-analysis of the effectiveness of prophylactic antibiotics in the prevention of postoperative complications after tension-free hernioplasty  

PubMed Central

Background Previous reviews of the effectiveness of antibiotic prophylaxis for elective inguinal hernia repair were not conclusive owing to the limited number of patients enrolled in randomized controlled trials (RCTs). However, since new RCTs involving patients undergoing tention-free hernioplasty have been published in recent years, we performed a new meta-analysis to evaluate the effectiveness of antibiotic prophylaxis in the prevention of postoperative complications after this procedure. Methods We performed a meta-analysis of RCTs studying the use of antibiotic prophylaxis to prevent postoperative complications in patients undergoing tension-free hernioplasty. Results We included 6 RCTs conducted around the world in our analysis. Compared with the control condition, antibiotic prophylaxis was associated with a lower incidence of incision infection (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.26–0.77, p = 0.004). There were no significant differences in risk for incision hematoma (OR 1.57, 95% CI 0.60–4.10, p = 0.35), respiratory infection (OR 1.00, 95% CI 0.17–5.79, p > 0.99) or urinary tract infection (OR 1.81, 95% CI 0.38–8.52, p = 0.45) between the 2 conditions. Conclusion Antibiotic prophylaxis use in patients undergoing tension-free hernioplasty decreases the rate of incision infection by 55%. PMID:22269309

Li, Jian-Fang; Lai, Dan-Dan; Zhang, Xiao-Dong; Zhang, Ai-Min; Sun, Kuan-Xue; Luo, Heng-Gui; Yu, Zhen

2012-01-01

102

Comparison of postoperative complication between Laryngeal Mask Airway and endotracheal tube during low-flow anesthesia with controlled ventilation  

PubMed Central

Objective: To compare the postoperative complications between Laryngeal Mask Airway (LMA) and endotracheal tube (ETT) during low-flow anesthesia with controlled ventilation. Methodology: Eighty adult Patients with ASA class I or II were randomly allocated into two forty-patient groups (ETT or LMA). Cuff pressure was monitored during anesthesia. After high uptake period, fresh gas flow (FGF) was decreased to 1 lit/min and isoflurane set to 1%. Monitoring during anesthesia included non-invasive blood pressure, ECG, ETCO2 and pulse oximetry. System leakage (>100 ml/min), rebreathing and any attempt to increase FGF to overcome the leak were monitored during anesthesia. Later, patients were extubated and transferred to Post Anesthesia Care Unit (PACU). In PACU, the incidence of sore throat, cough, difficulty in swallowing and shivering was monitored for all patients. Results: Leakage was observed in two and three cases in ETT and LMA groups respectively (P>0.05). Postoperative cough, sore throat and difficulty in swallowing were significantly less in LMA than ETT group. No significant difference was observed regarding ETCo2 values between 2 groups. Conclusion: If careful measures regarding insertion techniques, correct LMA position and routine monitoring of LMA cuff pressure are taken, LMA can be used as a safe alternative with lower incidence of post operation complication compared with ETT during low-flow controlled anesthesia with modern anesthetic machines. PMID:24353586

Peirovifar, Ali; Eydi, Mahmood; Mirinejhad, Mir Mousa; Mahmoodpoor, Ata; Mohammadi, Afsaneh; EJ Golzari, Samad

2013-01-01

103

Management of gunshot wounds  

SciTech Connect

Management of Gunshot Wounds provides a review of wound ballistics and a systemic review of gunshot wound management of all major body areas and systems. This volume includes information on pre-hospital care, nursing care, and care of infants, children, and the elderly patient with gunshot wounds. This volume also features information on: lead toxicity; complications of gunshot wounds; socioeconomic aspects of gunshot wounds; the forensic and pathological aspects of gunshot wounds; future directions in the care of gunshot wounds.

Ordog, G.; Drew, R.

1987-01-01

104

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

PubMed Central

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

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

2015-01-01

105

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

2007-01-01

106

[Infections complicating femoral nerve catheter for postoperative analgesia: about two cases].  

PubMed

The process of inserting a perineural catheter on femoral region for a regional anesthesia is quite common amongst hospital practices. The resulting infectious complications, although rare, remain potentially serious. For instance, many cases of severe sepsis were described in medical literature. In this paper, we will be presenting two cases of infections that were under serious investigation and led to major improvements of practice in the related hospitals. At the same time, we will give a reminder of good practices in inserting perineural catheters. PMID:21489744

Delfosse, F; Pronnier, P; Levent, T; Coget, M-L; Blanckaert, K

2011-06-01

107

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

2007-01-01

108

Congenital cardiac surgical complications of the integument, vascular system, vascular-line(s), and wounds: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease.  

PubMed

A complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with, suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval. The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease has set forth a comprehensive list of complications associated with the treatment of patients with congenital cardiac disease, related to cardiac, pulmonary, renal, haematological, infectious, neurological, gastrointestinal, and endocrinal systems, as well as those related to the management of anaesthesia and perfusion, and the transplantation of thoracic organs. The objective of this manuscript is to examine the definitions of operative morbidity as they relate specifically to a collection of loosely related topics that include the following groups of complications: 1) Complications of the Integument, 2) Complications of the Vascular System, 3) Complications of the Vascular-Line(s), 4) Complications of Wounds. These specific definitions and terms will be used to track morbidity associated with surgical and transcatheter interventions and other forms of therapy in a common language across many separate databases. As surgical survival in children with congenital cardiac disease has improved in recent years, focus has necessarily shifted to reducing the morbidity of congenital cardiac malformations and their treatment. A comprehensive list of complications is presented. This list is a component of a systems-based compendium of complications that will standardize terminology and thereby allow the study and quantification of morbidity in patients with congenital cardiac malformations. Clinicians caring for patients with congenital cardiac disease will be able to use this list for databases, initiatives to improve quality, reporting of complications, and comparing strategies of treatment. PMID:19063799

Walters, Henry L; Jeffries, Howard E; Cohen, Gordon A; Klitzner, Thomas

2008-12-01

109

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

SciTech Connect

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

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

2006-03-01

110

Post-operative respiratory complications after palatoplasty in a 19-month-old female with Cornelia de Lange syndrome--a case report.  

PubMed

Cornelia De Lange syndrome is a rare genetically heterogeneous and sporadic syndrome, with an estimated prevalence of 1 in 10,000 to 30,000. The disorder may present many complications during anesthesia due to cardiac, gastrointestinal and airway anomalies. We report a case of an ex premature toddler presenting for repair of a cleft palate. Postoperatively she had respiratory distress, successfully treated by the anesthetic care team Causes for the complication are discussed. PMID:22428500

Ingram, Brooke; Frost, Elizabeth A M

2011-10-01

111

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

PubMed

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

Danielian, Sh N; Godkov, M A; Abakumov, M M; Zubareva, O V; Saprin, A A

2013-01-01

112

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. PMID:23710220

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

2013-01-01

113

Stan scheller: the forerunner of clinical studies on using propolis for poor and chronic nonhealing wounds.  

PubMed

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. PMID:23710220

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

2013-01-01

114

Analysis of factors affecting operating time, postoperative complications, and length of stay for total knee arthroplasty: nationwide web-based survey  

Microsoft Academic Search

Background  This study aimed to clarify the impact of various factors on the operating time, postoperative complications, and length of\\u000a stay (LOS) after total knee arthroplasty (TKA).\\u000a \\u000a \\u000a \\u000a Methods  We identified 3577 TKAs performed in 345 hospitals in Japan from November 2006 to March 2007. We examined the patient characteristics,\\u000a surgical procedure details, hospital and surgeon volumes, and outcome variables (operating time, postoperative

Hideo Yasunaga; Kazuaki Tsuchiya; Yutaka Matsuyama; Kazuhiko Ohe

2009-01-01

115

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

PubMed Central

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

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

2014-01-01

116

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

PubMed Central

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

2014-01-01

117

Evaluation of procalcitonin as a biomarker of diagnosis, severity and postoperative complications in adult patients with acute appendicitis  

PubMed Central

Background: Delay in diagnosis and treatment of acute appendicitis (AA) results in an increased rate of perforation, postoperative morbidity, mortality and hospital length of stay. Several biochemical parameters including white blood cell (WBC) count, C-reactive protein (CRP), interleukin-6 (IL6) and Procalcitonin (PCT) have been used to further improve the clinical diagnosis of AA. The aim of this study was to assess the value of procalcitonin as a predictor of diagnosis and severity of appendicitis in order to improve the clinical decision making, since other studies have been unable to demonstrate a diagnostic value for PCT elevation in acute appendicitis. Methods: One-hundred patients who underwent open appendectomy, including 75 men and 25 women with a mean age of 28 years were included in this study. Procalcitonin values were measured by an immunofluorescent method). Serum PCT>0.5 ng/ml was considered positive. The PCT serum values were measured in four different categories, including ?0.5ng/ml, 0.5-2 ng/ml, 2-10ng/ml and more than 10ng/ml. Results: The sensitivity and specificity of PCT level measurement for acute appendicitis diagnosis were 44% and 100% respectively. The value of PCT increased with the severity of appendicitis and also with the presence of peritonitis and infection, at the site of surgery. Conclusions: Procalcitonin measurement cannot be used as a diagnostic test for adult patients with acute appendicitis and its routine use in such patients is not cost effective and conclusive. Procalcitonin values can be used as a prognostic marker and predictor of infectious complications following surgery and it can help to carry out timely surgical intervention which is highly recommended in patients with PCT values more than 0.5ng/ml.

Vaziri, Mohammad; Ehsanipour, Fahimeh; Pazouki, Abdolreza; Tamannaie, Zeinab; Taghavi, Roohollah; Pishgahroudsari, Mohaddese; Jesmi, Fatemeh; Chaichian, Shahla

2014-01-01

118

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

PubMed Central

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

Pei, Guotian; Zhou, Shijie; Han, Yi

2014-01-01

119

The influence of splenectomy performed simultaneously with gastrectomy on postoperative complications in patients with gastric cancer undergoing surgery with the intention to treat.  

PubMed

Abstract Despite the growing understanding of the pathophysiological processes in the perioperative period and significant advancements in surgical techniques, operative treatment for gastric cancer remains a challenge for surgeons, especially because the primary procedure of total or nearly total gastrectomy must at times be extended by the resection of other organs. The aim of the study was to asses the influence of concomitant splenectomy in patients undergoing curative surgery for gastric cancer on postoperative complications. Material and methods. The study population consisted of 258 patients who underwent surgical treatment for gastric cancer with the intention to treat. The study assessed the influence of extending the surgical intervention by splenectomy on postoperative complications, both general and surgical, including the most severe of these, i.e. oesophago-gastric anastomotic leakage, duodenal stump leakage and peritoneal fluid infections. Results. Among the 258 gastric cancer patients receiving curative surgical treatment, the most common simultaneous intervention was splenectomy: 42/258 (16.3%), which was also accompanied by partial pancreatectomy in 8 cases. The number of surgical postoperative complications, major and minor, was similar in both subgroups: with and without splenectomy. Minor general complications, such as pyrexia with no clinically apparent reason, atelectasis, pneumonia and pleural effusion were statistically significantly more common in the subgroup with splenectomy (p=0.0001). Conclusion. Splenectomy performed concomitantly with gastrectomy for gastric cancer increases the risk of minor general complications. However, it does not increase the risk of severe surgical complications, such as oesophago-intestinal anastomotic leakage and does not increase the risk of death. PMID:25222578

G?uszek, Stanis?aw; Kot, Marta; Kuchinka, Jakub; Matykiewicz, Jaros?aw

2014-07-01

120

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

PubMed Central

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

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

2013-01-01

121

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

2011-01-01

122

Laparoscopic Roux-en-Y Gastric Bypass: Preoperative Determinants of Prolonged Operative Times, Conversion to Open Gastric Bypasses, and Postoperative Complications  

Microsoft Academic Search

Background: We examined our database of 600 consecutive laparoscopic Roux-en-Y gastric bypasses (LRYGBP) to determine predictors\\u000a of prolonged operations, conversion to open operations and postoperative complications. Methods: All were primary bariatric\\u000a operations. Body habitus, gender, and previous surgery were evaluated. Results: Regression analysis showed the following parameters\\u000a to correlate positively with increased operative time: 1) Waist, 2) BMI, 3) Weight,

Michael L. Schwartz; Raymond L. Drew; Marilyn Chazin-Caldie

2003-01-01

123

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

2009-01-01

124

Lessons in the management of post-operative tension pneumocephalus complicating transcranial resection of advanced cutaneous tumours with free flap reconstruction.  

PubMed

Tension pneumocephalus is a rare, but potentially life-threatening complication of transcranial surgery. Whilst commonly described in the field of neurosurgery, little has been published in the context of craniofacial surgery. We describe two cases of post-operative extradural tension pneumocephalus occurring following free myocutaneous latissimus dorsi flap reconstruction of anterior cranial defects following extirpation of advanced recurrent skin carcinomas. These cases illustrate the variation in clinical presentation of this condition, the importance of prompt recognition, urgent radiological investigation and timely decompression, and potential management strategies for minimising the risk of recurrent symptoms. PMID:23485485

Swan, Marc C; Scholz, Anna F M; Pretorius, Pieter M; Johnson, David; Martinez-Devesa, Pablo; Wall, Steven A

2013-12-01

125

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

2006-01-01

126

Does resident involvement impact post-operative complications following primary total knee arthroplasty? An analysis of 24,529 cases.  

PubMed

Little is known about the impact of resident involvement on complication rates following total knee arthroplasty (TKA). The goal of our study was to determine the impact of resident involvement on complications following primary TKA. Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2005-2012) we identified 24,529 patients who underwent primary TKA. Of these, 5960 (24.3%) had a resident involved in a primary TKA. Using a multivariate logistic regression which incorporated propensity score adjustment, no differences were seen in morbidity and mortality following those cases with resident involvement (OR: 1.15, P = 0.129). In the first large scale, comprehensive analysis of resident impact on short-term morbidity and mortality, no increase in complications was observed with resident involvement in primary TKA. PMID:24726182

Haughom, Bryan D; Schairer, William W; Hellman, Michael D; Yi, Paul H; Levine, Brett R

2014-07-01

127

Does preoperative nephrostomy increase the incidence of wound infection after nephrectomy?  

Microsoft Academic Search

Objectives. To determine whether patients with nephrostomy after simple nephrectomy more often had postoperative wound complication than did matched patients without nephrostomy.Methods. The hospital records of patients who underwent retroperitoneal simple nephrectomy were evaluated, and the following data were retrieved: age, indication for nephrectomy and nephrostomy insertion, medical history, urine culture, antibiotic regimen, time elapsed from nephrostomy insertion to nephrectomy,

Alexander Greenstein; Issac Kaver; Juza Chen; Haim Matzkin

1999-01-01

128

Postoperative vascular complications in unrecognised Obstructive Sleep apnoea (POSA) study protocol: an observational cohort study in moderate-to-high risk patients undergoing non-cardiac surgery  

PubMed Central

Introduction Emerging epidemiological data suggest that obstructive sleep apnoea (OSA) is common in the general surgical population. Unfortunately, the majority of these patients are unrecognised and untreated at the time of surgery. There is substantial biological rationale to indicate that patients with unrecognised OSA are at a higher risk of postoperative vascular events. However, the extent of this morbidity is currently unknown. We have initated the postoperative vascular complications in the unrecognised obstructive sleep apnoea (POSA) study to determine the associations between OSA, nocturnal hypoxia and major postoperative vascular events in 1200 moderate-to-high risk patients undergoing major non-cardiac surgery. Methods and analysis The POSA study is an international prospective observational cohort study. Using a type 3 portable sleep monitoring device and ambulatory oximetry, we will quantify the severity of OSA. The primary outcome is a composite of vascular death, myocardial infarction; non-fatal cardiac arrest; stroke; pulmonary embolism; congestive heart failure and new arrhythmia within 30?days of surgery. As of November 2013, we have recruited over 700 patients from nine centres in six countries. The mean age is 68?years, the mean body mass index is 27?kg/m2 and 55% of patients are men. 27.9% of patients have known coronary artery disease, over 76% have diabetes. The majority of patients underwent orthopaedic surgery (28%) and colorectal resection (18.5%). Ethics and dissemination The POSA study has received ethics approval from all study sites before patient recruitment. Informed consent will be obtained from all patients. The POSA study will determine the risk of unrecognised OSA in major non-cardiac surgery. We will publish these findings in peer-reviewed journals. Trial Registration: ClinicalTrials.gov Identifier: NCT01494181 PMID:24413351

Chan, Matthew T V; Wang, Chew-Yin; Seet, Edwin; Tam, Stanley; Lai, Hou-Yee; Walker, Stuart; Short, Timothy G; Halliwell, Richard; Chung, Frances

2014-01-01

129

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

PubMed Central

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

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

2014-01-01

130

To Compare Standard Incision and Comma Shaped Incision and Its Influence on Post-Operative Complications in Surgical Removal of Impacted Third Molars  

PubMed Central

Objectives: To compare standard incision and comma shaped incision and its influence on post operative complications in surgical removal of impacted third molar. Methods: This was a cross–over trial. Twenty subjects with bilateral impacted mandibular third molars were recruited for the study. A standard incision was made on one side of the lower jaw and a comma incision was made on the other side to reflect the mucoperiosteal flap, after which the common steps for removal of impacted third molars were followed. The post– operative parameters were recorded immediately on the post –operative days 1, 3 and 7 respectively. Results: The pain scores which were recorded on days 1, 3 and 7 in the surgical area with comma incisions were found to be significantly lower as compared to the pain scores in the area where standard incisions were made. Similarly, swelling was lesser with comma incisions than with standard incisions. There was a significant difference in mouth opening between the two incisions on day 1, but no significance was seen on days 3 and 7. All these findings showed significant statistical differences. Conclusion: The results of the study showed that the new incision design was preferable over the conventional method, considering the lesser degree of post–operative complications. The cross–over design of the study greatly enhanced its statistical power and validity. PMID:23998110

Kumar B, Saravana; T, Sarumathi; M, Veerabahu; Raman, Uma

2013-01-01

131

Improved perioperative antibiotic use and reduced surgical wound infections through use of computer decision analysis.  

PubMed

A prospective study was performed over a two-year period to determine whether computer-generated reminders of perioperative antibiotic use could improve prescribing habits and reduce postoperative wound infections. During the first year, baseline patterns of antibiotic use and postoperative infection rates were established. During the second year, computer-generated reminders regarding perioperative antibiotic use were placed in the patient's medical record prior to surgery and patterns of antibiotic use and postoperative wound infections monitored. Hospitalized patients undergoing non-emergency surgery from June to November 1985 (3,263 patients), and from June to November 1986 (3,568) were monitored with respect to indications for perioperative antibiotic use, timing of antibiotic use and postoperative infectious complications. Perioperative antibiotic use was considered advisable for 1,621 (50%) patients in the 1985 sample and for 1,830 (51%) patients in the 1986 sample. Among these patients, antibiotics were given within two hours before the surgical incision in 638 (40%) of the 1985 sample and 1,070 (58%) of the 1986 sample (p less than 0.001). Overall, postoperative wound infections were detected in 28 (1.8%) of 1,621 patients in 1985 compared with 16 (0.9%) of 1,830 such patients in 1986 (p less than 0.03). We conclude that computer-generated reminders of perioperative antibiotic use improved prescribing habits with a concurrent decline in postoperative wound infections. PMID:2745959

Larsen, R A; Evans, R S; Burke, J P; Pestotnik, S L; Gardner, R M; Classen, D C

1989-07-01

132

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

PubMed Central

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

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

2012-01-01

133

Wound healing: part II. Clinical applications.  

PubMed

Treatment of all wounds requires adequate wound bed preparation, beginning with irrigation and débridement. Complicated or chronic wounds may also require treatment adjuncts or specialized wound healing products. An extensive body of research and development has introduced novel wound healing therapies and scar management options. In this second of a two-part continuing medical education series on wound healing, the reader is offered an update on current wound healing technologies and recommendations for obtaining optimal outcomes. PMID:24572884

Janis, Jeffrey; Harrison, Bridget

2014-03-01

134

[Infectious complications after esophageal surgery].  

PubMed

The incidence of wound infection, which is an intrasurgical field infection, is lower than the incidence of pneumonia, which is an extrasurgical field infection, after esophageal cancer surgery. Several trials predicting postoperative infectious complications have been reported. One measured the phytohemagglutinin- and concanavalin A-induced proliferation of peripheral blood mononuclear cells in patients; one measured the white blood cell (WBC) count 2 h after surgery and the decrease in WBC count on first postoperative day; and another showed that the decrease in serum IgG2 level can predict the occurrence of methicillin-resistant Staphylococcus aureus (MRSA) infections. Useful strategies for managing infectious complications have also been reported. Applying mupirocin calcium hydrate ointment to the nasal cavity decreases the incidence of MRSA infections. Autologous blood collection reduces the need for allogeneic transfusion in patients undergoing resection of esophageal cancer, and avoidance of allogeneic transfusion may reduce the risk of postoperative infection. The total exposure to preoperative chemoradiotherapy should be limited to 40 Gy or less to prevent postoperative pneumonia. PMID:12599924

Ozawa, Soji; Kitagawa, Yuko; Okamoto, Nobuhiko; Shimizu, Yoshimasa; Kitajima, Masaki

2002-12-01

135

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.

1989-07-01

136

Wound closure after split-thickness skin grafting is accelerated with the use of continuous direct anodal microcurrent applied to silver nylon wound contact dressings.  

PubMed

Wound healing after graft closure of excised burn wounds is a critical factor in the recovery process after thermal injury. Processes that speed time to stable wound closure should lead to improved outcomes, shorter lengths of hospital stays, and decreased complications. A randomized clinical trial to test the ability of continuous direct anodal microcurrent application to silver nylon wound contact dressings was designed. Time for wound closure after split-thickness skin grafting was observed. Thirty patients with full-thickness thermal burns were randomized into two groups. The control group received postoperative dressing care using moistened silver nylon fabric covered with gauze after tangential burn wound excision and split-thickness skin grafting. The study group received an identical protocol with the addition of continuous direct anodal microcurrent application. Time to 95% wound closure was measured using digital photography. The digital photographs were evaluated by a burn surgeon blinded to the patient's randomization. An independent t-test was used to analyze the data. The study group experienced a 36% reduction in time to wound closure (mean of 4.6 days) as compared to the control group (mean of 7.2 days). This was statistically significant at a P value of <.05. The use of continuous direct anodal microcurrent decreased time to wound closure after split-thickness skin grafting. PMID:17667128

Huckfeldt, Roger; Flick, A Bart; Mikkelson, Debbie; Lowe, Cindy; Finley, Phillip J

2007-01-01

137

The nutritional risk is a independent factor for postoperative morbidity in surgery for colorectal cancer  

PubMed Central

Purpose The authors evaluate the prevalence of malnutrition and its effect on the postoperative morbidity of patients after surgery for colorectal cancer. Methods Three hundred fifty-two patients were enrolled prospectively. Nutritional risk screening 2002 (NRS 2002) score was calculated through interview with patient on admission. Clinical characteristics, tumor status and surgical procedure were recorded. Results The prevalence of patients at nutritional risk was 28.1 per cent according to the NRS 2002. The rate of postoperative complication was 27%. There was a significant difference in postoperative complication rates between patients at nutritional risk and those not at risk (37.4% vs. 22.9%, P = 0.006). Nutritional risk was identified as an independent predictor of postoperative complications (odds ratio, 3.05; P = 0.045). Nutritional risk increased the rate of anastomotic leakage (P = 0.027) and wound infection (P = 0.01). Conclusion NRS may be a prognostic factor for postoperative complication after surgery for colorectal cancer. A large scaled prospective study is needed to confirm whether supplementing nutritional deficits reduces postoperative complication rates. PMID:24783180

Kwag, Seung-Jin; Kim, Jun-Gi; Kang, Won-Kyung; Lee, Jin-Kwon

2014-01-01

138

A prospective study of wound infections after laparotomy in obstetrics and gynaecology department.  

PubMed

Postoperative wound infection is of great importance to both surgeon and patient. All surgeons know that postoperative wound infection means morbidity, anxiety, longer hospitalization, higher cost; not to forget the embarrassment to the surgeons. However, it is still a common surgical complication despite other advances in modern medicine. This study was conducted to find out the incidence of postoperative wound infection and to survey the risk factors for wound infection in obstetrics and gynaecology department of Nepal medical college teaching hospital (NMCTH). A prospective study of all the cases with infected wound after laparotomy and lower segment cesarean section done in NMCTH in obstetrics and gynaecology department was carried out in this study from Chaitra 2068 to Falgun 2069. The frequency of wound infection was 5.87%. Most of the wound infection after lower segment cesarean section occurred in emergency cases (16 out of 19). Seventy percent of patients had preoperative hospital stay range of 0-2 days whereas the range was 3-18 days for the rest 30%. The range of blood loss was 150-300 ml in nearly 75.7 % of patients. Duration of operation was 1-2 hours in 89.2% cases. Only 48.6% of wound infection was identified within 8th postoperative day. Number of infected cases getting prophylactic antibiotic was 25 (67.6%). BMI was >25 in 62.2% of patients. Type of skin incision was pfannenstiel in 94.6%. Skin was closed subcuticularly with vicryl no. 1 in 81.1%. Staphylococcus aureus was isolated in swab culture in 24.3%. Resuturing was required in 18.9% of cases. PMID:24579531

Suwal, A; Shrivastava, V R; Giri, A

2012-12-01

139

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

PubMed Central

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

Payne, Caroline; Edwards, Daren

2014-01-01

140

miRNA in Diabetic Wound Healing  

Cancer.gov

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

141

[Complications associated with inguinal orchiectomy and scrotal orchiectomy].  

PubMed

Inguinal excision of testis is technically an elementary surgical procedure. According to the indication (e.g., malignant tumors, infarction, inflammation), an inguinal or alternatively a transcrotal approach is possible. Despite its straightforwardness, surgery of the scrotum includes remarkable risks and complications such as postoperative hemorrhage, hematoma formation, infections, and disturbances of wound healing followed by insufficient unfavorable cosmetic results. Nerve injury may be accompanied by temporary or persistent paresthesias which have been documented in our patients undergoing orchiectomy. PMID:24744108

Anheuser, P; Kranz, J; Will, J; Dieckmann, K P

2014-05-01

142

[Complications of arterial reconstructions below the knee for chronic vascular occlusion (author's transl)].  

PubMed

From 1967 to 1976 49 reconstructions were undertaken in the area distal of the art. poplitea: 30 femoral-crural bypasses, 12 TEA und 7 orthogradic desobliterations. Complications until clinical demission were reviewed. There were in 8 cases postop. thrombosis which led to 4 amputations. 6 patients suffered from wound infection with one consecutive amputation. 4 hemmorages had to be stopped surgically. THE OVER ALL RATE OF COMPLICATIONS WAS 36,7% WITH A PRIMARY MORTALity of 4%. PMID:1086013

Brieler, H S; Müller-Wiefel, H; Bernhard, A

1976-08-01

143

Arthrodesis of the wrist-complications and their management.  

PubMed

This report confirms the concept previously established in the literature tha arthrodesis of the wrist is a technically demanding procedure witha significant incidence of postoperative complications. A series of 31 patients is presented in whom wrist arthrodesis was performed using three separate types of operative techniques, with emphasis on postoperative morbidity and complications. Major complications included: pseudarthrosis (six patients), deep wound infection (one patient), neuroma (one patient), fracture of healed fusion (two patients), and impingement of Steinmann pin on metacarpophalangeal joint (one patient). Minor complications occurred in 13 patients, with transient nerve palsy (four patients) and superficial skin necrosis (five patients) accounting for the majority. A technique is described for treating pseudarthrosis following fusion, which has been used successfully in four patients. In each case, an autogenous bone graft was taken from the ipsilateral proximal ulna, thus obviating the need for a second iliac bone graft. PMID:7016972

Clendenin, M B; Green, D P

1981-05-01

144

[Errors in wound management].  

PubMed

Chronic ulcers have adverse effects on the patient quality of life and productivity, thus posing financial burden upon the healthcare system. Chronic wound healing is a complex process resulting from the interaction of the patient general health status, wound related factors, medical personnel skill and competence, and therapy related products. In clinical practice, considerable improvement has been made in the treatment of chronic wounds, which is evident in the reduced rate of the severe forms of chronic wounds in outpatient clinics. However, in spite of all the modern approaches, efforts invested by medical personnel and agents available for wound care, numerous problems are still encountered in daily practice. Most frequently, the problems arise from inappropriate education, of young personnel in particular, absence of multidisciplinary approach, and inadequate communication among the personnel directly involved in wound treatment. To perceive them more clearly, the potential problems or complications in the management of chronic wounds can be classified into the following groups: problems mostly related to the use of wound coverage and other etiology related specificities of wound treatment; problems related to incompatibility of the agents used in wound treatment; and problems arising from failure to ensure aseptic and antiseptic performance conditions. PMID:25326993

Filipovi?, Marinko; Novinscak, Tomislav

2014-10-01

145

Negative Pressure Wound Therapy  

PubMed Central

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

2006-01-01

146

Effect of the knee position during wound closure after total knee arthroplasty on early knee function recovery  

PubMed Central

Objective This study investigated the effect of the knee position during wound closure on early knee function recovery after total knee arthroplasty (TKA). Methods This study included 80 primary total knee arthroplasties due to osteoarthritis. The patients were randomized according to the type of wound closure: extension group for full extension and flexion group for 90° flexion. The incision of articular capsule was marked for precise wound alignment. In the flexion group, the knee was kept in high flexion for 1 to 2 min after wound closure. The two groups were treated with the same postoperative rehabilitation exercises. The range of motion (ROM), visual analogue scale (VAS) score of anterior knee pain, Knee Society Score (KSS) and postoperative complications were assessed at 6 weeks, 3 months and 6 months, postoperatively. Results At 6 weeks and 3 months postoperatively, the ROM in flexion group was 98.95?±?10.33° and 110.05?±?4.93° respectively, with 87.62?±?8.92° and 95.62?±?6.51° in extension group, respectively; The VAS score of anterior knee pain in flexion group was 2.02?±?1.38 and 2.21?±?0.87, respectively, with 2.57?±?1.07 and 2.87?±?0.83 in extension group, respectively. The ROM and VAS pain score of the two groups were significantly different at these two time points, with no significant difference at 6 months postoperatively. The two groups were not significantly different in KSS, and no apparent complication was observed at three time points. Conclusion Marking the articular capsule incision, wound closure in flexion and high flexion after wound closure can effectively decrease anterior knee pain after TKA and promote the early recovery of ROM. PMID:25149657

2014-01-01

147

Wound modulation after filtration surgery.  

PubMed

Filtration surgery is the standard invasive procedure for the management of intraocular pressure in advanced glaucoma. The key to a successful outcome is to modulate the normal wound healing cascade that leads to closure of the newly created aqueous outflow pathway. Antifibrotic agents such as mitomycin C and 5-fluorouracil have been increasingly used to modulate the wound healing process and increase surgical success. Although these agents have proven efficacy, they also increase the risk of complications. Efforts have centered on the identification of novel agents and techniques that can influence wound modulation without these complications. We detail new agents and methods under investigation to control wound healing after filtration surgery. PMID:23068975

Seibold, Leonard K; Sherwood, Mark B; Kahook, Malik Y

2012-11-01

148

Wound closure and wound management  

PubMed Central

Wound closure and infection control are the primary goal of wound management. A variety of disinfectants and antimicrobial agents are widely available today and routinely achieve infection control. On the contrary, wound closure still remains a challenging goal. Cell adhesion, migration and contraction play significant roles in creating contractile force of patent wound margins and in contributing to wound closure. Modulations of these cellular behaviors have been investigated in the context of wound contraction; however, therapeutic strategy to achieve wound closure has not been established. Recently, we have reported that a previously unknown cytoskeleton molecule, wound inducible transcript-3.0 (wit3.0) also known as fibroblast growth factor receptor 1 oncogene partner 2 (FGFR1OP2), can significantly modulate fibroblast-driven wound closure in vitro and in vivo. The dynamic role of cytoskeleton in different experimental models may provide a novel platform for designing the therapeutic target of wound management. PMID:20448469

Lin, Audrey; Hokugo, Akishige

2010-01-01

149

Cervical cystic hygroma: pre-, intra-, and post-operative morbidity and mortality in Zaria, Nigeria.  

PubMed

The management of extensive cystic hygromas in the cervical region (CCH) presents difficult challenges. A retrospective study of 41 children with CCH treated over 24 years in Nigeria was carried out; there were 28 boys and 13 girls with an age range of 3 days to 10 years (median 6.5 months). Thirty-three (80%) presented with 34 life-threatening complications including infection in 11 (27%), rapid increase in cyst size in 10 (24%), respiratory obstruction in 7 (17%), and intracystic hemorrhage in 6 (15%). Complete excision was possible in only 14 of 34 (41%) patients, and injuries to neighboring structures occurred in 6 (18%) (facial nerve 2, recurrent laryngeal nerve 1, internal jugular vein 1, parotid duct 1, pharynx 1). Postoperatively, 8 (24%) patients developed 9 complications. Wound infections occurred in 5 incompletely-excised cysts and 2 patients had respiratory obstruction. One patient with a wound infection developed edema of the tongue lasting several days and drainage was prolonged (> 6 weeks) in 1. Five patients died, 3 from respiratory obstruction and 1 each from wound and chest infection. Four patients (12%) developed a recurrence within 5 years of surgery. The pre-, intra-, and post-operative morbidity were high in this series. Although complete excision is the ideal treatment for CCH, this need not be pursued if neighboring structures are liable to injury. When cysts are incompletely excised, antibiotic prophylaxis is necessary as the incidence of wound infection is high. PMID:11527161

Ameh, E A; Nmadu, P T

2001-07-01

150

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. PMID:22279118

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

2012-01-01

151

Renal surgery for kidney cancer in Germany 2005-2006: length of stay, risk of postoperative complications and in-hospital death  

PubMed Central

Background Representative statistics of surgical care among patients with kidney cancer are scant. With the introduction of the diagnosis related group system in Germany, it is now possible to provide nationwide statistics on surgical care. We studied in-hospital mortality risk in relation to comorbidity and complications, length of hospital stay in relation to surgical approach and comorbidity, and risk of complications in relation to surgical approach among kidney cancer patients undergoing nephrectomy. Methods We analyzed the nationwide hospitalization file of the years 2005 and 2006 including 23,753 hospitalizations with a diagnosis of renal cancer and partial or complete nephrectomy and classified comorbidity (Charlson comorbidity index) and complications. Length of stay, risk of in-hospital complications and in-hospital death were analyzed by linear regression and log-linear regression (relative risks (RR) and 95% confidence intervals (95% CI)). Results The overall in-hospital mortality was 1.4%. Per one unit increase of the Charlson comorbidity index, the adjusted risk of in-hospital mortality increased by 53% (95% CI 47-59%). The risks of bleeding or acute posthaemorrhagic anemia, respiratory, urological and gastrointestinal complications and infections ranged between 1.1% and 2.7% with the exception of bleeding or acute posthaemorrhagic anemia with 18.4%. Complications were associated with an increased adjusted in-hospital mortality risk. Highest adjusted mortality risk ratios were observed for gastrointestinal (RR?=?3.61, 95% CI 2.32-5.63) and urological complications (RR?=?3.62, 95% CI 2.62-5.00). The risk of haemorrhage or acute posthaemorrhagic anemia was lower for total laparoscopic nephrectomies than total open nephrectomies. The adjusted risk of gastrointestinal complications was lower for partial open compared to total open nephrectomy (adjusted RR?=?0.66, 95% CI 0.45-0.97). Total laparoscopic nephrectomy was associated with shorter length of stay (?3.3 days; 95% CI 2.9-3.7 days) compared to total open nephrectomy. The estimated age-adjusted increase of length of stay per one unit increase of the Charlson comorbidity index was 1.3 days (95% CI 1.2-1.4 days). Conclusions In this representative population-based analysis, we found that the surgical approach is associated with the risk of complications and length of hospital stay. Furthermore, in the era of ageing populations, renal cancer patients with comorbidities should be counseled about their increased in-hospital mortality risk. PMID:25217295

2014-01-01

152

Postoperative morbidity of lymph node excision for cutaneous melanoma-sentinel lymphonodectomy versus complete regional lymph node dissection.  

PubMed

For patients with melanoma metastasis to a sentinel lymph node, subsequent complete regional lymph node dissection (CLND) is currently regarded to be the surgical standard. This approach, however, has not been confirmed by controlled studies, so that surgical morbidity is of primary importance. Using clinical examination and a questionnaire, we determined morbidity in 315 patients with axillary or inguinal lymph node excision on whom 275 sentinel lymphonodectomies (SLNEs) and 90 CLNDs were performed. The overall incidence of at least one complication following SLNE was 13.8%. The short-term complication rate was 11.3% (allergic reaction to blue dye 0%, wound breakdown 0%, haematoma 2.5%, wound infection 3.6%, seroma 6.9%). The incidence of long-term complications was 4.1% (persistent tattoo 0.4%, functional deficit 0.4%, nerve dysfunction/pain 0.7% or swelling 2.5%). All complications were mild. Significantly, the complication rate was not higher for patients aged 70 years or older. After CLND, the overall complication rate was significantly higher (65.5%, P<0.000001). The incidence of short-term complications was 50% (haematoma 0%, wound breakdown 6.7%, wound infection 24.7% or seroma 34.8%). The incidence of long-term complications was also 50% (nerve dysfunction/pain 8.9%, functional deficit 16.8%, swelling 37.1%). Overall, inguinal lymph node excision was burdened by a higher complication rate (P=0.015). Age and sex did not influence postoperative morbidity. No deaths linked to either procedure were noted. Complication rates after SLNE are low and most complications are minor and short-lasting. In contrast, CLND has been demonstrated to be a major and potentially morbid surgical procedure. This highlights the importance of testing the therapeutic value that CLND adds to the sentinel lymph node procedure. PMID:18227703

Kretschmer, Lutz; Thoms, Kai-Martin; Peeters, Sabine; Haenssle, Holger; Bertsch, Hans-Peter; Emmert, Steffen

2008-02-01

153

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

PubMed

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

2009-09-01

154

Ultraviolet light and hyperpigmentation in healing wounds  

SciTech Connect

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

Wiemer, D.R.; Spira, M.

1983-10-01

155

Postoperative Spinal Wound Infections and Postprocedural Diskitis  

PubMed Central

Background/Objective: Postprocedural infections are a significant cause of morbidity after spinal interventions. Methods: Literature review. An extensive literature review was conducted on postprocedural spinal infections. Relevant articles were reviewed in detail and additional case images were included. Results: Clinical findings, laboratory markers, and imaging modalities play important roles in the detection of postprocedural spinal infections. Treatment may range from biopsy and antibiotics to multiple operations with complex strategies for soft tissue management. Conclusions: Early detection and aggressive treatment are paramount in managing postprocedural spinal infections and limiting their long-term sequelae. PMID:18092559

Chaudhary, Saad B; Vives, Michael J; Basra, Sushil K; Reiter, Mitchell F

2007-01-01

156

[Retrospective appreciation of results of treatment and early and late radiologic mucositis and other postradiological complications in patients with parotid gland cancer irradiated postoperatively].  

PubMed

We describe results and complications of combined (surgery and radiotherapy) treatment of parotid gland cancer. 86 patients, 31 women and 55 men, have been treated between the years 1984-1997 in Cancer Center--Institute in Warsaw. Mean age of patients was 56.6 years and ranged from 15 to 84 years. Surgical treatment was microscopically radical in 16 patients, macroscopically radical in 59 patients and debulking was performed on 11 patients. 5-year overall survival has been estimated as 58.2%. Distant metastases were observed in 23.3% of patients, local recurrences were observed in 12.8% of patients. Late serious postirradiation skin reaction (grade IV EORTC) was observed 6 months after completion of radiotherapy in 1 patient, and symptoms subsided completely during next 18 months. Late mucosal postirradiation complications (grade I and II EORTC) after 6 to 8 months after radiotherapy were described in 22.9% of patients and after 24-26 months in 15.9% of patients. There were no serious--grade III and IV EORTC--mucosal complications. Observed xerostomia was minimal due to compensation of saliva production by contralateral major salivary glands and did not worsen patients quality of life. Early middle ear postradiological inflammation occurred in 18.6% of patients, late reaction in the middle ear (6 to 8 months after completion of radiotherapy) was observed in 19% of all patients. In the group of 57 patients who survived 2 years after radiotherapy 1 developed temporo-mandibular joint fibrosis. Late postradiological changes in petrosal bone were detected in 2 patients (1 in Rtg imaging and 1 in CT imaging)-they were painful and primarily suspected as recurrence. None of the patients had clinically overt temporal lobe complications. Our patients survival results were a little worse than reported in the literature. Observed tolerance of combined treatment was very good. PMID:15307475

Laskus, Zofia; Kawecki, Andrzej

2004-01-01

157

Pulmonary complications after esophagectomy  

Microsoft Academic Search

Background. Pulmonary complications are common in patients who have undergone esophagectomy. There are no good predictive variables for these complications. In addition, the role that preoperative treatment with chemotherapy and radiation may play in postoperative complications remains unclear.Methods. We performed a retrospective review of all patients who underwent esophagectomy by a single surgeon at our institution over a 6-year period.

Christopher E Avendano; Patrick A Flume; Gerard A Silvestri; Lydia B King; Carolyn E Reed

2002-01-01

158

Wound healing.  

PubMed

Wound healing is a dynamic biologic process of repairing insults to the integumentary system. It is commonly divided into three phases: inflammatory, proliferative, and maturation. Each phase has unique cellular and substance constituents without which it cannot progress normally. A large variety of factors may influence any part of wound healing, including local factors such as bacteria, oxygen tension, and bleeding, and systemic factors such as the mental and physical health of the patient. There are also extrinsic factors that can be influenced by the caretakers of the wound to enhance wound healing. Areas of intervention include using antiseptic technique when one is dealing with the wound, using good surgical technique, choosing the appropriate wounding method and repair for the individual patient, and using antibiotics and special wound dressings. Modern science and technology are giving us new insights into wound healing and leading us to exciting new ways of influencing it, including the topical use of growth factors, artificial skins, cultured epithelium with and without dermal components, and electrical stimulation. The future of wound healing holds a better understanding of the complexities of the physiologic events that occur and a translation of that into a biologically active and interactive wound care. PMID:7794680

Waldorf, H; Fewkes, J

1995-01-01

159

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. PMID:21149356

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

2011-01-01

160

Clinical results of laparoscopic appendectomy in patients with complicated and uncomplicated appendicitis  

PubMed Central

Acute appendicitis is the most common surgical emergency. The aim of this study was to evaluate the clinical results of laparoscopic appendectomy (LA) for the treatment of uncomplicated and complicated appendicitis. A retrospective analysis was performed who had undergone laparoscopic appendectomy for complicated appendicitis between January 2010 to October 2013. The diagnosis of acute appendicitis was established with physical examination, laboratory tests, and ultrasound examination. The patients were analysed for age, sex, conversion rate,operation time, postoperative infectious complications and length of hospital stay. A total of 452 patients were operated with LA. There were 362 (80.1%) uncomplicated (Group I) and 90 (19.1%) complicated Group (II) appendicitis.The intraabdominal abscess rate was 14.35% in Group I and 19.5% in Group II. The wound infection and rate of incisional hernia were also higher in Group II. The postoperative complications including intraabdominal abscess, wound infection and incisional hernia after LA in complicated appendicitis found high. LA should be performed very carefully in complicated appendicitis. PMID:25419386

Bat, Orhan; Kaya, Hakan; Çelik, Hamit Kafkas; ?ahbaz, Nuri Alper

2014-01-01

161

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

1993-01-01

162

Negative pressure wound therapy for management of the surgical incision in orthopaedic surgery  

PubMed Central

Objectives The period of post-operative treatment before surgical wounds are completely closed remains a key window, during which one can apply new technologies that can minimise complications. One such technology is the use of negative pressure wound therapy to manage and accelerate healing of the closed incisional wound (incisional NPWT). Methods We undertook a literature review of this emerging indication to identify evidence within orthopaedic surgery and other surgical disciplines. Literature that supports our current understanding of the mechanisms of action was also reviewed in detail. Results A total of 33 publications were identified, including nine clinical study reports from orthopaedic surgery; four from cardiothoracic surgery and 12 from studies in abdominal, plastic and vascular disciplines. Most papers (26 of 33) had been published within the past three years. Thus far two randomised controlled trials – one in orthopaedic and one in cardiothoracic surgery – show evidence of reduced incidence of wound healing complications after between three and five days of post-operative NPWT of two- and four-fold, respectively. Investigations show that reduction in haematoma and seroma, accelerated wound healing and increased clearance of oedema are significant mechanisms of action. Conclusions There is a rapidly emerging literature on the effect of NPWT on the closed incision. Initiated and confirmed first with a randomised controlled trial in orthopaedic trauma surgery, studies in abdominal, plastic and vascular surgery with high rates of complications have been reported recently. The evidence from single-use NPWT devices is accumulating. There are no large randomised studies yet in reconstructive joint replacement. Cite this article: Bone Joint Res 2013;2:276–84. PMID:24352756

Karlakki, S.; Brem, M.; Giannini, S.; Khanduja, V.; Stannard, J.; Martin, R.

2013-01-01

163

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

PubMed

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

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

2014-07-01

164

Postoperative liver insufficiency: Prevention and management  

Microsoft Academic Search

Postoperative hepatic insufficiency is a rare cause of liver failure. Consequences of this usually predictable complication can be limited by appropriate preventive measures and careful postoperative management. This report reviews the current experimental and clinical literature with regard to postoperative hepatic insufficiency.

H. Bismuth; D. Houssin; G. Mazmanian

1983-01-01

165

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. PMID:20220265

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

2010-01-01

166

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

PubMed

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

2013-11-01

167

A Real World, Observational Registry of Chronic Wounds and Ulcers  

ClinicalTrials.gov

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

2014-10-29

168

[Radical surgical treatment of patients with complicated forms of acute paraproctitis].  

PubMed

The authors discuss the results of surgical treatment of 412 patients with complicated forms of acute paraproctitis. They found that one-stage radical surgical treatment may be performed in most patients. With strict observance of indications for each type of operative measures, careful surgical techniques, and effective treatment of the purulent operative wound, not only may the period of treatment be shortened but, which is most important, the incidence of postoperative complications may be considerably reduced and the best end results of the management of this most serious group of patients be achieved. But the authors also do not exclude the tactics of two-stage treatment. PMID:7897941

Koplatadze, A M; Bondarev, Iu A; Nosov, V A

1994-12-01

169

Fulminant Clostridium difficile colitis: a complication of perioperative antibiotic prophylaxis.  

PubMed

Antibiotic prophylaxis for maxillofacial surgical wounds remains common practice. Surgeons must weigh the risks (e.g., 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

2013-11-01

170

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

Microsoft Academic Search

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

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

1999-01-01

171

Complications from micronutrient deficiency following bariatric surgery.  

PubMed

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

Wilson, Helen O; Datta, Dev Bn

2014-11-01

172

Ultrasound assessment of the efficacy of wound drains.  

PubMed

We report the use of ultrasound in the assessment of the efficacy of wound drains in preventing wound haematoma. 171 patients with proximal femoral fractures who underwent AO dynamic hip screw or hemiarthroplasty were randomized as to whether or not they should receive wound drainage. Patients then underwent ultrasound examination on the 5th postoperative day to localize and quantify any wound haematomas. Results show that drains are effective in preventing wound collections, but only while in situ; following the removal of drains the size of resulting wound collections is the same whether the wound has been drained or not (Student's t-test; t = 0.19, NS). This study questions current theories on the mechanisms by which wound drainage is thought to influence wound healing. PMID:7520078

Varley, G W; Milner, S; Turner, G M; Crisp, A J; Szypryt, E P

1994-04-01

173

Postoperative infections after oesophageal resections: the role of blood transfusions  

Microsoft Academic Search

BACKGROUND: Perioperative blood transfusion carries numerous potential risks concerning the transmission of infective diseases and immunodepression that can facilitate the occurrence of postoperative infectious complications. Explanation of connections between perioperative blood transfusion and postoperative septic complication worldwide is not well documented. Many studies have described a correlation between perioperative blood transfusions and postoperative infections. On the contrary, other studies indicate

Francesca Rovera; Gianlorenzo Dionigi; Luigi Boni; Andrea Imperatori; Alessandra Tabacchi; Giulio Carcano; Mario Diurni; Renzo Dionigi

2006-01-01

174

Telemedicine and wound care.  

PubMed

Although wound care has been practiced for centuries, telewound care is a relatively new concept. Currently, only a few pilot programs are in existence. Telewound care has yet to achieve the popularity and recognition of its other telemedicine predecessors amongst members of the health care industry and public alike. The tremendous potential of incorporating the technology of telemedicine into wound care needs to be realized. Wound care is a representation of the care of chronic and debilitating conditions that require long-term specialized care. We have seen the positive effects of improved living conditions and advances in health care globally. The result: people are now living longer. Every day a small piece is added to the pie: the percentage of world's elderly and those with chronic medical conditions that would require medical attention is rising. With the escalating costs of health care, and the push of the industry towards outpatient care, this is a part of the health care crisis that is demanding our immediate attention. We have seen positive outcomes in the care of other chronic medial conditions using telemedicine such as home telecare programs. In addition, the effectiveness of several programs using available advances in technology such as the field of radiology has been established. Wound care can build on success created in these fields to create an effective and useful method of care. The aim of this chapter is to recognize the impact of this problem, to introduce several pilot programs in several different aspects of wound care and to build on current resources in order to achieve a novel method of wound care. The goal would be to create a technologically advanced, cost-effective and user-friendly program, and be able to bridge the gap between the sick and available specialized care. Both store-and-forward technology and televideo have a role to play in telewound care, the latter greater in the role of home telecare and teleconsultation, and the former in post-operative patients and the follow-up of chronic wounds. Either way, both have been underutilized and underdeveloped. With the advances in the field of telecommunications in connecting people across distances at a fraction of the time and costs, improved outcomes reported in other fields of telemedicine and positive legislative changes, there is an enormous potential in this field. We now have the ability, knowledge and resources to develop telewound care programs, which can provide high quality patient care in a more concise and cost-effective way. It is certainly a welcoming relief to a field that has traditionally been known to pose an emotional, physical and financial drain to all those involved. PMID:18305332

Ong, Cheri A

2008-01-01

175

Management of choledochal cysts and their complications.  

PubMed

Choledochal cysts are increasingly reported in adults. The presence of cyst-related complications alters its presentation and complicates the management. We reviewed our experience to find the clinical presentation, complications, and the management of choledochal cysts. The records of 132 patients with choledochal cysts presented to us between 2003 and 2010 maintained as a prospective database were analyzed for demography, clinical presentation, radiological investigation, management, and outcome. There were 12 children and 120 adults. Based on preoperative cholangiogram, 93 (71%) patients had Type I and 39 (29%) Type IVA cysts. The overall incidence of complicated choledochal cyst was 4 of 12 (33%) in children and 85 of 120 (71%) in adults. The most common complication was cystolithiasis (49%) followed by cholangitis (32%), acute pancreatitis (10%), hepatolithiasis (7%), malignancy (3%), portal hypertension (2%), and chronic pancreatitis (2%). Acute pancreatitis and cholangitis were managed conservatively. Endoscopic stenting was performed in patients with cholangitis and those requiring staged treatment as a result of portal hypertension. Overall 114 patients underwent cyst excision with Roux-en-y hepaticojejunostomy. The overall morbidity was 17.5 per cent (wound infection 13% and bilioenteric anastomotic leak 7%). There was one postoperative death resulting from cardiac failure. Three patients developed anastomotic stricture and underwent redo hepaticojejunostomy. Choledochal cysts in adults are often associated with complications. Complications are more common in adults compared with children. Acute pancreatitis, cholangitis and portal hypertension are managed conservatively and then followed up by definitive surgery. Cyst excision with Roux-en-Y hepaticojejunostomy is necessary to prevent the recurrence of complications. PMID:22524764

Saluja, Sundeep Singh; Nayeem, Mohammed; Sharma, Barjesh Chander; Bora, Giriraj; Mishra, Pramod Kumar

2012-03-01

176

Deep sternal wound infection after cardiac surgery  

PubMed Central

Background Deep sternal wound infection (DSWI) is a serious postoperative complication of cardiac surgery. In this study we investigated the incidence of DSWI and effect of re-exploration for bleeding on DSWI mortality. Methods We reviewed 73,700 cases registered in the Japan Adult Cardiovascular Surgery Database (JACVSD) during the period from 2004 to 2009 and divided them into five groups: 26,597 of isolated coronary artery bypass graft (CABG) cases, 23,136 valvular surgery cases, 17,441 thoracic aortic surgery cases, 4,726 valvular surgery plus CABG cases, and 1,800 thoracic aortic surgery plus CABG cases. We calculated the overall incidence of postoperative DSWI, incidence of postoperative DSWI according to operative procedure, 30-day mortality and operative mortality of postoperative DSWI cases according to operative procedure, 30-day mortality and operative mortality of postoperative DSWI according to whether re-exploration for bleeding, and the intervals between the operation and deaths according to whether re-exploration for bleeding were investigated. Operative mortality is defined as in-hospital or 30-day mortality. Risk factors for DSWI were also examined. Results The overall incidence of postoperative DSWI was 1.8%. The incidence of postoperative DSWI was 1.8% after isolated CABG, 1.3% after valve surgery, 2.8% after valve surgery plus CABG, 1.9% after thoracic aortic surgery, and 3.4% after thoracic aortic surgery plus CABG. The 30-day and operative mortality in patients with DSWI was higher after more complicated operative procedures. The incidence of re-exploration for bleeding in DSWI cases was 11.1%. The overall 30-day/operative mortality after DSWI with re-exploration for bleeding was 23.0%/48.0%, and it was significantly higher than in the absence of re-exploration for bleeding (8.1%/22.0%). The difference between the intervals between the operation and death according to whether re-exploration for bleeding had been performed was not significant. Age and cardiogenic shock were significant risk factors related to re-exploration for bleeding, and diabetes control was a significant risk factor related to DSWI for all surgical groups. Previous CABG was a significant risk factor related to both re-exploration for bleeding and DSWI for all surgical groups. Conclusions The incidence of DSWI after cardiac surgery according to the data entered in the JACVSD registry during the period from 2004 to 2009 was 1.8%, and more complicated procedures were followed by higher incidence and mortality. When re-exploration for bleeding was performed, mortality was significantly higher than when it was not performed. Prevention of DSWI and establishment of an effective appropriate treatment for DSWI may improve the outcome of cardiac surgery. PMID:23688324

2013-01-01

177

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. PMID:23533931

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

2013-01-01

178

Wound management following orbital exenteration surgery.  

PubMed

Exenteration of the orbital contents is a rare but mutilating surgical procedure which can have a profound effect on a patient's life. As a specialist nurse working within the oculoplastics team at Manchester Royal Eye Hospital, the author has taken a particular interest in the wound management of post-operative exenteration patients. Using evidence-based practice relating to cavity wound healing as a cornerstone, he has developed guidelines for the post-operative wound management of these patients both for nurses and other allied professionals. Several surgical approaches to the exenteration of the orbital contents are outlined. The implications for wound healing and other elements of the post operative care for these patients are also explored. Selected dressing products which may be used in patients having undergone orbital exenteration surgery ar reviewed, and practice recommendations and guidelines proposed. PMID:19374038

Cooper, John

179

Dressings and Products in Pediatric Wound Care  

PubMed Central

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

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

2014-01-01

180

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

2006-01-01

181

Importance of pre- and postoperative physiotherapy in pediatric cardiac surgery  

Microsoft Academic Search

Lung complications during postoperative of pediatric heart surgery are frequently highlighting atelectasis and pneumonia. Physiotherapy has an important role in the treatment of these complications. We reviewed and update the physiotherapy performance in the preoperative and in the postoperative lung complication of pediatric cardiac surgery. We noted efficacy of physiotherapy treatment through different specific techniques and the need for development

Simone CAVENAGHI; Silvia Cristina; Garcia de MOURA; Thalis Henrique da SILVA; Talita Daniela; Lais Helena; Carvalho MARINO; Neuseli Marino LAMARI

182

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

183

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

2008-01-01

184

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

185

Heterotopic Ossification in Wartime Wounds.  

National Technical Information Service (NTIS)

Heterotopic ossification (HO) refers to the formation of mature lamellar bone in nonosseous tissue. In the setting of high-energy wartime extremity wounds, HO is expected to complicate up to 64% of patients, has a predilection for the residual limbs of am...

B. K. Potter, J. A. Forsberg

2010-01-01

186

Adrenal gunshot wound: Laparoscopic approach. Report of a case?  

PubMed Central

INTRODUCTION Although there is no debate that patients with peritonitis or hemodynamic instability should undergo urgent laparotomy after penetrating abdominal injury, it is also clear that certain stable patients may be managed without operation. Controversy persists regarding use of laparoscopy. PRESENTATION OF CASE We report a case of gunshot wounds with bullet in left adrenal gland and perirenal subcapsular hematoma. The patients had no signs of peritonitis but in the observation period we noted a significative blood loss, so we performed an exploratory laparoscopy. DISCUSSION We found the bullet in adrenal parenchyma. The postoperative period was regular and the patient was discharged without any local or general complication. CONCLUSION Although the data are still controversial, the importance of the laparoscopic approach is rapidly increasing also in case of penetrating trauma of the abdomen. This technique assumes both a diagnostic and therapeutic role by reducing the number of negative laparotomies. PMID:24441440

Agrusa, Antonino; Romano, Giorgio; De Vita, Giovanni; Frazzetta, Giuseppe; Chianetta, Daniela; Di Buono, Giuseppe; Gulotta, Gaspare

2013-01-01

187

Postoperative Fatigue: A Review  

Microsoft Academic Search

Background  Postoperative fatigue (POF) significantly impacts well-being after major surgery. However, this topic has received little\\u000a emphasis.\\u000a \\u000a \\u000a \\u000a Methods  We conducted a comprehensive search on major databases with a focus on studies relevant to assessment and etiology of POF.\\u000a \\u000a \\u000a \\u000a Results  POF has been measured by a number of different and inadequate instruments. It has a complicated etiology, with a number of\\u000a biological and psychological

Kamran Zargar-Shoshtari; Andrew G. Hill

2009-01-01

188

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

189

Prevention and Management of Nonhealing Perineal Wounds  

PubMed Central

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

Kamrava, Allen; Mahmoud, Najjia N.

2013-01-01

190

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. PMID:19293328

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

2009-01-01

191

Characterization of a preclinical model of chronic ischemic wound.  

PubMed

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. PMID:19293328

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

2009-05-13

192

Wound Healing Essentials: Let There Be Oxygen  

PubMed Central

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

Sen, Chandan K.

2009-01-01

193

[Construction and operation of the wound care technology platform].  

PubMed

Chronic wounds are a major healthcare problem costing billions of dollars a year over the world. However, it is regrettable that a large number of chronic wounds are still treated simply by conventional dressing change in local clinics, lacking of definite diagnosis and personalized care. This situation results in a low wound healing rate, unsatisfied life quality of the patients, and higher medical cost for the prolonged promiscuous care. We should not only emphasize the importance of wound care in clinical practice, but also emphasize the importance of establishing wound care centers. With the experience of our practice in wound care center, the construction of wound care technology platform is strongly suggested. This platform could act as an education base to train more professional wound care doctors, nurses, and care workers, as well as resolve many technical difficulties involved in the treatment of many complicated chronic wounds. PMID:22097298

Hu, Da-hai; Zhou, Qin; Han, Jun-tao

2011-08-01

194

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

NASA Astrophysics Data System (ADS)

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

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

2011-03-01

195

Wound closure and wound monitoring in total hip arthroplasty. An overview.  

PubMed

Wound closure in primary and revision total hip arthroplasty is an essential and crucial step of the procedure. A recently published meta-analysis comparing metallic staples and sutures with stitches in hip procedures revealed that the risk of infection was four times greater when staples were used. This statement created concern among orthopaedic surgeons. The aim of this overview is to address the problem of THA wound closure and wound monitoring. Further well designed, randomised, controlled trials comparing staples vs traditional stitches and eventually vs skin adhesive are necessary in order to draw conclusions in elective THA, revision surgery and hip fractures. Orthopaedic surgeons need to have more evidence in order to be able to justify their method of wound closure. Monitoring of the wound by the surgeon in the postoperative period is recommended. PMID:22983895

Mondini, Andrea; Bianchi, Luca; Zagra, Luigi

2012-01-01

196

Postoperative Pain Management and Proinflammatory Cytokines: Animal and Human Studies  

Microsoft Academic Search

The postoperative period is associated with neuroendocrine, metabolic, and immune alterations, which are the combined result of tissue damage, anesthesia, postoperative pain, and psychological stress. Limited evidence indicates that pain management in the postoperative period can affect the outcome of the surgery, reducing cardiac, pulmonary, and metabolic complications. Recent evidence indicates that pain and immune factors, especially proinflammatory cytokines, mutually

Yehuda Shavit; Keren Fridel; Benzion Beilin

2006-01-01

197

Treatment effects of dexmedetomidine and ketamine on postoperative analgesia after cleft palate repair.  

PubMed

Primary cleft palate repair may result in significant pain in the immediate postoperative period, which can lead to vigorous crying resulting in wound dehiscence and pulmonary complications. Effective pain control with opioids is the mainstay but administration on the floor has to be countered with the complications associated with their use, chiefly respiratory depression and sedation. We retrospectively examined the efficacies of intraoperative administration of intravenous (IV) dexmedetomidine (DEX) and ketamine (KET) to prevent early postoperative pain in children undergoing primary cleft palate repair and compared the results against relevant literature. The Texas Children's Hospital anesthesia database was queried to identify children undergoing a palatal surgery from December 2011 to December 2012. Inclusion criteria permitted completed primary palatal surgery without major complications and intraoperative administration of DEX or KET. The control group (CTRL) received no additional drug. A comprehensive literature review was performed. A total of 71 pediatric patients underwent palatal surgery during the study period with 46 patients qualifying for analysis. Although results were not significant, consistent trends were observed with regards to lower opioid requirements during the first 24 hours for both medications compared with the CTRL. KET also had shorter time to discharge. The literature review resulted in several studies supporting decreased postoperative pain end points for both DEX and KET. In our sample, DEX and KET reduced postoperative opioid requirements. KET seems to have the added benefit of a shorter hospital stay. These finding are supported in the literature. With further investigation, the addition of these drugs may serve to provide improved pain relief without over sedation in patients undergoing cleft palate repair. PMID:25045418

Kayyal, Talal A; Wolfswinkel, Erik M; Weathers, William M; Capehart, Samantha J; Monson, Laura A; Buchanan, Edward P; Glover, Chris D

2014-06-01

198

Does a continuous local anaesthetic pain treatment after immediate tissue expander reconstruction in breast carcinoma patients more efficiently reduce acute postoperative pain - a prospective randomised study  

PubMed Central

Background Immediate breast reconstruction with an expander is a reasonable option for properly selected patients. After reconstruction, patients have severe postoperative pain, which responds poorly to opioids. Our aim was to evaluate if continuous wound infusion of a local anaesthetic into the surgical wound reduces postoperative pain, consumption of opioids and incidence of chronic pain compared to standard intravenous piritramide after primary breast reconstruction in breast carcinoma patients. Methods Altogether, 60 patients were enrolled in our study; one half in the group with wound infusion of a local anaesthetic, and the other half in the standard (piritramide) group. Parameters measured included: pain intensity (visual analogue scale), drug requirements, alertness, hospitalisation, side-effects and late complications. A p-value of?wound infusion of a local anaesthetic significantly reduces acute pain and enables reduced opioid consumption, resulting in less postoperative sedation and reduced need for antiemetic drugs. Wound infusion of a local anaesthetic reduces chronic pain. PMID:24433317

2014-01-01

199

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. PMID:24083051

Kivelev, Juri; Hernesniemi, Juha

2013-01-01

200

Staphylococcus aureus and repeat bacteremia in febrile patients as early signs of sternal wound infection after cardiac surgery  

PubMed Central

Background Sternal wound infection is a devastating complication of cardiothoracic surgery that carries high postoperative morbidity and mortality rates. We explored whether our current program of extensive bacteriological examination including repeat blood cultures may contribute to the early diagnosis of sternal wound infection. Methods We retrospectively analyzed 112 patients who were subjected to our bacteriological examination protocol including within 90 days after cardiothoracic surgery. Univariate and multivariate analyses were made in order to identify risk factors for sternal infection. Results The median patient age was 75 years, and 65 patients were male. In 35 cases (31.2%) the blood cultures showed the presence of bacterial infection with the following frequencies: Staphylococcus aureus, 18 cases; Coagulase-negative Staphylococcus, 7 cases; other organisms, 10 cases. Eleven patients presented repeat bacteremia on at least 2 different occasions. Twenty patients (17.8%) presented sternal wound infections. There was no difference in operative mortality between the patients with and without sternal wound infection. Univariate and multivariate analyses demonstrated that bilateral mammary artery use (OR, 13.68, 95% CI, 1.09-167.36, p?=?0.043), positive blood culture for Staphylococcus aureus (OR, 19.51, 95% CI, 4.46-104.33, p?wound infection. Conclusion Repeat blood cultures in febrile patients appear to be useful for the early detection of Staphylococcus aureus and repeat bacteremia, and these were associated with sternal wound infection. Bilateral internal mammary artery use was another risk factor of sternal wound infection in febrile patients. These factors may identify patients suitable for expeditious radiological examination and aggressive treatments. PMID:24885820

2014-01-01

201

Microcurrent skin patches for postoperative pain control in total knee arthroplasty: a pilot study  

PubMed Central

Pain control following painful orthopaedic procedures such as total knee arthroplasty (TKA) is an ongoing challenge, as current pain management techniques often result in under-medication and/or complications. In a study designed to test the effect of the micro-current skin patch (MCT) on pain relief in patients following TKA, we followed 24 patients, randomly divided into two groups, one group receiving MCT plus tramadol hydrochloride (tramadol) for pain relief and a control group receiving only tramadol, for 10 days postoperatively. Tramadol was given intramuscularly in increment doses of 100 mg, as needed, for the duration of the study period. Pain was assessed daily using a visual analogue score (VAS). Other parameters, including the effect of MCT on the dose of tramadol needed for pain relief, the degree of wound healing measured at the end of the follow-up period, category of the wound 10 days postoperatively (1, 2 or 3) and total drain fluid volume, were also assessed. During the 10-day postoperative period there was a progressive decrease in pain in patients of both groups, however the patients of the MCT group showed a consistently lower VAS throughout the observation period, most markedly on those follow-up days with the highest pain scores in patients of the control group. This effect was monitored on the basis of the average dose of tramadol administered per day: 200.0±7.0 mg/day in the control group and 63.3±15.8 mg/day in the MCT group. Wound healing was better with the application of the MCT patch: grade 1 wounds were observed in 50% of the patients of the MCT group as compared to 8.3% in control group. The total drain volume was lower in patients of the MCT group compared to the controls (1020.8±211.6 and 1170.8±243.5 ml, respectively). None of the patients indicated that they wished to discontinue MCT therapy. This pilot study shows that MCT therapy led to better pain control with a markedly lower need for tramadol as compared to the control group. This better pain control was accompanied by a better healing of the wound and a lower drain volume. PMID:16896874

El-Husseini, T.; El-Kawy, S.; El-Sebai, M.

2006-01-01

202

Microcurrent skin patches for postoperative pain control in total knee arthroplasty: a pilot study.  

PubMed

Pain control following painful orthopaedic procedures such as total knee arthroplasty (TKA) is an ongoing challenge, as current pain management techniques often result in under-medication and/or complications. In a study designed to test the effect of the micro-current skin patch (MCT) on pain relief in patients following TKA, we followed 24 patients, randomly divided into two groups, one group receiving MCT plus tramadol hydrochloride (tramadol) for pain relief and a control group receiving only tramadol, for 10 days postoperatively. Tramadol was given intramuscularly in increment doses of 100 mg, as needed, for the duration of the study period. Pain was assessed daily using a visual analogue score (VAS). Other parameters, including the effect of MCT on the dose of tramadol needed for pain relief, the degree of wound healing measured at the end of the follow-up period, category of the wound 10 days postoperatively (1, 2 or 3) and total drain fluid volume, were also assessed. During the 10-day postoperative period there was a progressive decrease in pain in patients of both groups, however the patients of the MCT group showed a consistently lower VAS throughout the observation period, most markedly on those follow-up days with the highest pain scores in patients of the control group. This effect was monitored on the basis of the average dose of tramadol administered per day: 200.0+/-7.0 mg/day in the control group and 63.3+/-15.8 mg/day in the MCT group. Wound healing was better with the application of the MCT patch: grade 1 wounds were observed in 50% of the patients of the MCT group as compared to 8.3% in control group. The total drain volume was lower in patients of the MCT group compared to the controls (1020.8+/-211.6 and 1170.8+/-243.5 ml, respectively). None of the patients indicated that they wished to discontinue MCT therapy. This pilot study shows that MCT therapy led to better pain control with a markedly lower need for tramadol as compared to the control group. This better pain control was accompanied by a better healing of the wound and a lower drain volume. PMID:16896874

El-Husseini, T; El-Kawy, S; Shalaby, H; El-Sebai, M

2007-04-01

203

Electrical stimulation to accelerate wound healing  

PubMed Central

Background There are several applications of electrical stimulation described in medical literature to accelerate wound healing and improve cutaneous perfusion. This is a simple technique that could be incorporated as an adjunctive therapy in plastic surgery. The objective of this review was to evaluate the results of randomized clinical trials that use electrical stimulation for wound healing. Method We identified 21 randomized clinical trials that used electrical stimulation for wound healing. We did not include five studies with treatment groups with less than eight subjects. Results Electrical stimulation was associated with faster wound area reduction or a higher proportion of wounds that healed in 14 out of 16 wound randomized clinical trials. The type of electrical stimulation, waveform, and duration of therapy vary in the literature. Conclusion Electrical stimulation has been shown to accelerate wound healing and increase cutaneous perfusion in human studies. Electrical stimulation is an adjunctive therapy that is underutilized in plastic surgery and could improve flap and graft survival, accelerate postoperative recovery, and decrease necrosis following foot reconstruction. PMID:24049559

Thakral, Gaurav; LaFontaine, Javier; Najafi, Bijan; Talal, Talal K.; Kim, Paul; Lavery, Lawrence A.

2013-01-01

204

Postoperative intracranial haemorrhage: a review.  

PubMed

Postoperative haemorrhage (POH) is one of the most serious complications of any cranial neurosurgical procedure and is associated with significant morbidity and mortality. The relative paucity of work investigating this postoperative complication prompted us to undertake a review of the literature, focussing on demographic, clinical, and surgical risk factors. A literature search was undertaken using Ovid MEDLINE (1950-2009) using keywords including craniectomy, craniotomy, neurosurgery, intracranial, reoperation, repeat craniotomy, postoperative, haemorrhage, haematoma, and bleeding. The rates of POH following intracranial procedures reported in the literature vary greatly, and meaningful comparison is difficult. We defined postoperative haemorrhage as that following craniotomy, which is clinically significant and requires surgical evacuation. Risk factors include pre-existing medical comorbidities including hypertension, coagulopathies and haematological abnormalities, intraoperative hypertension and blood loss, certain lesion pathologies including tumours, chronic subdural haematomas, and deficiencies in haemostasis. We conclude by providing recommendations for clinical practice based on the literature reviewed to aid clinicians in the detection and avoidance of POH. PMID:21246389

Seifman, Marc A; Lewis, Phillip M; Rosenfeld, Jeffrey V; Hwang, Peter Y K

2011-10-01

205

Midline Submental Orotracheal Intubation in Maxillofacial Injuries: A Substitute to Tracheostomy Where Postoperative Mechanical Ventilation is not Required  

PubMed Central

Background: Maxillofacial fractures present unique airway problems to the anaesthesiologist. Nasotracheal intubation is contraindicated due to associated Lefort I, II or III fractures. The requirement for intraoperative maxillomandibular fixation (MMF) to re-establish dental occlusion in such cases precludes orotracheal intubation. Tracheostomy has a high complication rate and in many patients, an alternative to the oral airway is not required beyond the perioperative period. Hernandez1 in 1986 first described “The submental route for endotracheal intubation”. Later some workers faced difficult tube passage, bleeding, and sublingual gland involvement with this approach. They modified this to strict midline submental intubation and there were no operative or postoperative complications in their cases.67&8. Therefore we used mid line approach for submental orotracheal intubation in this study to demonstrate its feasibility and reliability and that it can be used as an excellent substitute to short term tracheostomy. Patients & Methods: We used midline submental intubation in 25 cases selected out of 310 consecutively treated patients with maxillofacial trauma over a 3 year period. After induction orotracheal intubation was done with spiral re-inforced tube. A 1.5-2.0 cm skin incision was made in the submental region in the midline 2.0 cm behind the symphysis and endotracheal tube was taken out through this incision in all the cases. At the end of the surgery the procedure was reversed, the submental wound was stitched; all the patients could be extubated & none of them required post-operative mechanical ventilation. Conclusion: There were no significant operative or postoperative complications. Postoperative submental scarring was acceptable[6]. We conclude that midline submental intubation is a simple and useful technique with low morbidity. It can be chosen in selected cases of maxillofacial trauma and is an excellent substitute to tracheostomy where postoperative mechanical ventilation is not required. PMID:21547178

Agrawal, Malti; Kang, L. S.

2010-01-01

206

Perioperative Complications in Abdominal Sacrocolpopexy, Sacrospinous Ligament Fixation and Prolift Procedures  

PubMed Central

Background: Pelvic organ prolapse is an important problem for women. To overcome this issue, different operational technics are in use, such as abdominal sacrocolpopexy, sacrospinous fixation, and the total Prolift procedure. Aims: This study assessed perioperative complications in abdominal sacrocolpopexy, sacrospinous fixation, and the total Prolift procedure. Study Design: Retrospective comparative study. Methods: Perioperative complications were defined as any complication occurring during surgery or the first 6 weeks postoperatively. Forty-five patients underwent abdominal procedures, 60 patients underwent sacrospinous fixation, and 43 patients underwent the total Prolift procedure. Results: In the abdominal group, one bladder injury, four hemorrhages, and three wound dehiscences occurred. In the sacrospinous group, one rectal injury and one postoperative vault infection occurred. In the Prolift group, one bladder injury and one hemorrhage occurred. Minor complications were more frequent in the abdominal group than the others. The operating time and hospital stay of the abdominal group were significantly longer than the others. The Pro-lift procedure had less operating time and hospital stay than other procedures. Conclusion: The total Prolift may be a novel alternative for apical prolapse with low perioperative morbidities and complications.

Demirci, Fuat; Demirci, Oya; Dolgun, Zehra Nihal; Karakoc, Birgul; Demirci, Elif; Somunk?ran, Asl?; Iyibozkurt, Cem; Karaalp, Erhan

2014-01-01

207

A novel treatment in X-linked agammaglobulinaemia - hyperbaric oxygen therapy in refractory chronic wounds.  

PubMed

Chronic wounds are a rare complication of X-linked agammaglobulinaemia (XLA). Fastidious organisms such as helicobacter bills have been reported in XLA with chronic wounds but sterile chronic wounds also occur. Hyperbaric Oxygen Therapy has been used in chronic wounds but has not previously been reported in primary antibody deficiencies. We present a case of a chronic wound in a patient with XLA refractory to antimicrobial therapy that made a remarkable recovery following Hyperbaric Oxygen Therapy. PMID:25091287

Steele, C L; Cridge, C; Edgar, J D M

2014-10-01

208

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

E-print Network

that the majority of GzmB was secreted by mast cells and localized in the wound edges and granulation tissues granulation tissue phenotype as indicated by increased cells with proliferative activity, vascularization by chronic inflammation and excessive protease activity. While once thought to function primarily as a pro

Ollivier-Gooch, Carl

209

Postoperative Immunosuppression After Open and Laparoscopic Liver Resection: Assessment of Cellular Immune Function and Monocytic HLA-DR Expression  

PubMed Central

Background and Objectives: Major abdominal procedures are strongly associated with postoperative immunosuppression and subsequent increased patient morbidity. It is believed that laparoscopic surgery causes less depletion of the systemic immune function because of the reduced tissue trauma. Various cytokines and monocytic HLA-DR expression have been successfully implemented to assess postoperative immune function. The aim of our study was to show the difference in immunologic profiles after minimally invasive versus conventional liver resection. Methods: Ten animals underwent either laparoscopic or conventional open left lateral liver resection. Flow cytometric characteristics of HLA-DR expression on monocytes and lipopolysaccharide-stimulated cellular secretion of tumor necrosis factor ?, interferon ?, interleukin 6, and interleukin 8 were measured and analyzed in ex vivo whole blood samples. Intraoperative and postoperative clinical outcome parameters were also documented and evaluated. Results: All animals survived the procedures. Postoperative complications were fever (n = 3), wound infections (n = 2), and biloma (n = 1). Open surgery showed a morbidity rate of 80% compared with 40% after laparoscopic surgery. Laparoscopic liver resection showed no postoperative immunoparalysis. Major histocompatibility complex class II expression in this group was elevated, whereas the open surgery group showed decreased major histocompatibility complex class II expression on postoperative day 1. Postoperative secretion of tumor necrosis factor ?, interleukin 6, and interferon ? was lower in the open surgery group. Elevated transaminase levels after laparoscopy might have resulted from an ischemia/reperfusion injury caused by the capnoperitoneum. Conclusion: Major immunoparalysis depression was not observed in either group. Laparoscopic surgery shows a tendency to improve immunologic recovery after liver resection. PMID:24398205

Haacke, Nadine; Meisel, Christian; Unterwalder, Nadine; Fikatas, Panagiotis; Schmidt, Sven C.

2013-01-01

210

O efeito do índice de massa corporal sobre as complicações no pós-operatório de cirurgia de revascularização do miocárdio em idosos The effect of the body mass index on postoperative complications of coronary artery bypass grafting in elderly  

Microsoft Academic Search

Objectives: To evaluate the effect of BMI (body mass index) in the postoperative period of elderly patients undergoing CABG. Methods: Cross-sectional retrospective study, carried out in academic hospital, with all patients (n=290), aged or above 60 years, undergone CABG, from August 2006 to July 2007. The patients were divided into tertiles of BMI (<22, 22-27,> 27kg \\/m²). The variables included

Cíntia REIS; Sandra Mari BARBIERO; Luciane RIBAS

211

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

2012-03-19

212

[Gunshot wounds, firearms and wound ballistics].  

PubMed

In the Netherlands the majority of gunshot wounds are caused by hand guns with a low firing velocity, such as pistols and revolvers, in which the severity of the injuries caused is primarily determined by whether or not vital structures are hit. With these sorts of wounds the removal of debris as equally the bullet is not usually necessary. For firearms with a high firing velocity the wounds are more severe due to the greater quantity of kinetic energy transferred to the tissues. As a result of this, cavitations and damage due to secondary projectiles can occur. The extensive removal of debris can be necessary in such cases. The severity of the wounds caused by a shotgun depends mainly on the distance from the shooter. For shotgun wounds incurred at a short distance it is necessary to ascertain whether the plastic pellet has ended up in the wound. PMID:12138671

Verleisdonk, E J M M

2002-07-01

213

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. PMID:20351978

Vadivelu, Nalini; Mitra, Sukanya; Narayan, Deepak

2010-01-01

214

Recent advances in postoperative pain management.  

PubMed

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. PMID:20351978

Vadivelu, Nalini; Mitra, Sukanya; Narayan, Deepak

2010-03-01

215

The Effect of Preemptive Analgesia in Postoperative Pain Relief-A Prospective Double-Blind Randomized Study  

Microsoft Academic Search

Objective. To analyze the effect of infiltration of local anesthetics on postoperative pain relief. Design. Prospective randomized double-blind trial. Setting. University Teaching Hospital in Barbados, West Indies. Patients. Patients undergoing total abdominal hysterectomy. Interventions. Patients were randomly allocated into one of four groups according to the wound infiltration: 1) preoperative and postoperative 0.9% saline; 2) preoperative saline and postoperative local

Seetharaman Hariharan; Harley Moseley; Areti Kumar; Senthilkumar Raju

2009-01-01

216

Extremity trauma, dressings, and wound infection: should every acute limb wound have a silver lining?  

PubMed

The manner in which high-energy transfer limb injuries are dressed can alter the wound environment through manipulation of the bacterial burden, thus minimizing tissue degradation and influencing healing potential. Infection is the principal complication of such wounds, and antiseptic soaked gauze is accepted in early coverage of extremity wounds despite a lack of evidence to support this practice. There has been resurgence in the use of silver in acute wounds, through dressings manipulated to deliver sustained elemental silver to the wound interface. In vitro and in vivo experimentation of silver dressings are characterized however by methodological compromise, primarily through lack of similarity of models to the physiology of the healing wound. Results from in vitro studies caution against the use of silver because of evidence of cytotoxicity, but this is not reproduced in in vivo or clinical experimentation, leading to ambiguity. Review of silver dressing application in burns and chronic wound studies fails to support its use over other dressing systems. Similarly, evidence for the use of silver in acute limb wounds is lacking. This article provides a comprehensive overview of the use of silver dressings in acute wound care and highlights in particular the paucity of evidence regarding its routine use in extremity injury. PMID:23008343

Eardley, William G P; Watts, Sarah A; Clasper, Jon C

2012-09-01

217

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

PubMed Central

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

Hutan, Martin; Bartko, Christian; Slysko, Roman; Sekac, Jaroslav; Prochotsky, Augustin; Majesky, Ivan; Skultety, Jan

2014-01-01

218

A Systematic Review of Complications and Failures Associated with Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation  

PubMed Central

Background Patellofemoral instability affects activities of daily living and hinders athletic participation. Over the past 2 decades more attention has been paid to medial patellofemoral ligament reconstruction (MPFL) for treatment of recurrent patellar dislocations/subluxations. Numerous techniques have been reported; however, there is no consensus regarding optimal reconstruction. Purpose This study sought to report on the various techniques for MPFL reconstruction described in the literature and to assess the rate of complications associated with the procedure. Study Design Meta-analysis. Methods A systematic review of the literature was performed in early October 2010 using keywords “medial patellofemoral ligament,” “MPFL”, “reconstruction,” “complication(s),” and “failure(s)”. Articles meeting the inclusion criteria were reviewed. Graft choice, surgical technique, outcome measures, and complications were recorded and organized in a database. Descriptive statistical analysis was performed on the data collected. Results Twenty-five articles were identified and reviewed. A total of 164 complications occurred in 629 knees (26.1%). These adverse events ranged from minor to major including patella fracture, failures, clinical instability on post-operative examination, loss of knee flexion, wound complications, and pain. Twenty-six patients returned to the operating room for additional procedures. Conclusions Medial patellofemoral ligament reconstruction has a high rate of success for patients with patellofemoral instability; however, the complication rate of 26.1% associated with this procedure is not trivial. This study quantified complications and documented the variety of complications reported in outcomes-based literature. PMID:22679297

Shah, Jay N.; Howard, Jennifer S.; Flanigan, David C.; Brophy, Robert H.; Carey, James L.; Lattermann, Christian

2013-01-01

219

Ethics of treating postoperative pain.  

PubMed

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

2012-02-01

220

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

NASA Astrophysics Data System (ADS)

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

Fujiwara, Hisao

1989-09-01

221

Salvage of a complicated penis replantation using bipedicled scrotal flap following a prolonged ischaemia time.  

PubMed

Microsurgical replantation is the standard method to treat penile amputation. The loss of variable area of skin is a common complication following penile replantation due to prolonged ischaemia time, postoperative venous congestion, oedema and wound infection. There is limited literature available on the management of complications following replantation. A skin graft is commonly used to resurface the denuded areas after skin necrosis. However, this simple and rapid approach has some inherent disadvantages, including paresthesia, contracture, mismatched skin colour and disfiguring donor site. In this report, we present the salvage of a replanted penis by a bipedicled scrotal flap in which the skin fragment was necrosed due to prolonged ischaemia time. Cosmetic and functional outcomes in the 1-year follow-up period were satisfactory. PMID:20189899

Ching, Wei-Cheng; Liao, Han-Tsung; Ulusal, Betul Gozel; Chen, Chien-Tzung; Lin, Chih-Hung

2010-08-01

222

Evaluation of electrical stimulation for ischemic wound therapy: a feasibility study using the lapine wound model  

Microsoft Academic Search

Chronic wounds are a major secondary complication for many people with impaired mobility. Electrical stimulation (ES) has\\u000a been recommended as a adjunctive therapy, however optimal treatment paradigms have not been established. Our group seeks to\\u000a determine the basic mechanisms underlying ES wound therapy, an area where understanding is currently limited. A feasibility\\u000a study was carried out to develop the Ahn\\/Mustoe

Kimberly A. Morris; Michael F. McGee; John J. Jasper; Kath M. Bogie

2009-01-01

223

Use of negative pressure wound therapy in the treatment of neonatal and pediatric wounds: a retrospective examination of clinical outcomes.  

PubMed

The clinical effectiveness of negative pressure wound therapy for the management of acute and chronic wounds is well documented in the adult population but information regarding its use in the pediatric population is limited. A retrospective, descriptive study was conducted to examine the clinical outcomes of using negative pressure wound therapy in the treatment of pediatric wounds. The medical records of 24 consecutive pediatric patients receiving negative pressure wound therapy were reviewed. Demographic data, wound etiology, time to closure, closure method, duration of negative pressure wound therapy, complications, dressing change frequency, dressing type used, and pressure settings were analyzed. All categorical variables in the dataset were summarized using frequency (count and percentages) and all continuous variables were summarized using median (minimum, maximum). The 24 pediatric patients (mean age 8.5 years [range 14 days to 18 years old]) had 24 wounds - 12 (50%) were infected at baseline. Sixteen patients had hypoalbuminemia and six had exposed hardware and bone in their wounds. Twenty-two wounds reached full closure in a median time of 10 days (range 2 to 45) following negative pressure wound therapy and flap closure (11), split-thickness skin graft (three), secondary (four), and primary (four) closure. Pressures used in this population ranged from 50 to 125 mm Hg and most wounds were covered with reticulated polyurethane foam. One patient developed a fistula during the course of negative pressure wound therapy. When coupled with appropriate systemic antibiotics, surgical debridement, and medical and nutritional optimization, in this population negative pressure wound therapy resulted in rapid granulation tissue and 92% successful wound closure. Future neonatal and pediatric negative pressure wound therapy usage registries and prospective studies are needed to provide a strong evidence base from which treatment decisions can be made in the management of these challenging cases, especially pertaining to the safety and efficacy of pressure settings, dressings, and interposing contact layer selection. PMID:17586874

Baharestani, Mona Mylene

2007-06-01

224

Enhancement of lysine acetylation accelerates wound repair  

PubMed Central

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

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

2013-01-01

225

Human amniotic membrane: a versatile wound dressing.  

PubMed Central

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

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

1978-01-01

226

CCMR: Wound Dressing Tool and Wound Analysis  

NSDL National Science Digital Library

The goal of our project is to develop a Wound Dressing Tool (WDT) that in addition to extracting overabundant chemicals like the VAC system does, can also allow for variable rates of mass transfer as well as a way for clinicians to monitor the fluid chemical composition of the wound bed during the healing and treatment processes.

Men, Shannon

2005-08-17

227

Wound Healing and Care  

MedlinePLUS

... there's a risk that a wound might pull apart if it gets too wet. Avoid picking or ... Tetanus Dealing With Cuts and Wounds Dealing With Falls Sports and Exercise Safety Contact Us Print Additional ...

228

Wound care centers  

MedlinePLUS

... multiple types of dressings as your wound heals. Hyperbaric oxygen therapy Depending on the type of wound, your doctor may recommend hyperbaric oxygen therapy . Oxygen is important for healing. During this treatment, ...

229

Postoperative MRI of the shoulder.  

PubMed

Magnetic resonance imaging (MRI) evaluation of the postoperative shoulder presents technical and diagnostic challenges related to imaging artifacts from hardware and micrometallic shavings, postsurgical scarring, and morphological alterations. Improved visualization of postoperative shoulder anatomy and pathology can be obtained with the use of metal artifact reduction techniques as well as MR arthrography. In this article we review the MR techniques that are designed to address these technical and diagnostic challenges, and we discuss the definitions and indications, normal MRI appearance, and complications of routine surgical procedures for treatment of injuries to the rotator cuff, labral ligamentous complex, and biceps tendon. J. Magn. Reson. Imaging 2014;40:1280-1297. © 2014 Wiley Periodicals, Inc. PMID:24753010

Beltran, Luis S; Bencardino, Jenny T; Steinbach, Lynne S

2014-12-01

230

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

PubMed

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

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

2014-10-01

231

[New directions of research related to chronic wound healing].  

PubMed

Optimal nutrition, immunological state and psychological condition play an important role in the process of chronic wound healing. Infections caused by pathogens resistant to commonly used antibiotics additionally complicate and disturb regeneration of wounds. As part of the treatment, modern wound dressings are used, for example designed on the basis of alginates, dextranomers, hydrogels, hydrofiber, polyurethanes foams, hydrocolloids and liquids for wound debridement such us 0.9% NaCl, the PWE liquid, Ringer's liquid, octenidine. Owing to their features, treatment in accordance with TIME concept could be realized, because they provide moisture wound bed, protection against contamination, gas exchange, protection of wound edges and infection control. Repairing process in chronic wounds is dependent on blood flow in tissues, which may be insufficient. The result is a permanent hypoxia. Natural occurring antioxidants are becoming more crucial in chronic wound treatment. They decrease oxygen radical concentration, increase angiogenesis, reduce inflammatory response, stimulate fibroblasts and keratinocytes proliferation, possess antibacterial properties against chemotherapeutic resistant strains. There are a lot of antioxidants in honey, papaya fruit (Carrica papaia L.), transgenic flax (Linum usitatissimum), and in orange oil (Citrus sinensis), stem of acanthus (Acanthus ebracteatus), leafs of tea (Camellia sinensis). Application of biologically active, natural derived compounds is nowadays a direction of intense in vitro and in vivo research focused on the chronic wound treatment. Results suggest beneficial influence of antioxidant on wound repairing process. Clinical research are needed to state effective influence of natural compound in the chronic wound treatment. PMID:24377187

Rusak, Agnieszka; Rybak, Zbigniew

2013-01-01

232

The Wound Microbiome: Modern Approaches to Examining the Role of Microorganisms in Impaired Chronic Wound Healing  

PubMed Central

Significance: Bacterial burden is believed to play a significant role in impaired wound healing of chronic wounds and the development of infection-related complications. The standard of care in the clinic relies upon cultivation-dependent methods to identify microorganisms. These assays are biased toward microorganisms that thrive in isolation under laboratory conditions. Recent Advances: Significant advances in genomic technologies have enabled less-biased, culture-independent approaches to characterize microbial communities, or microbiomes. The aggregate sequencing and analysis of 16S ribosomal RNA genes has demonstrated that cultures under-represent true microbial diversity and load. Critical Issues: Despite recent advances that enable culture-independent analyses of microbiomes, those organisms that are important in impaired healing remain ambiguous. Inconsistent findings across various studies highlight the need to characterize microbiomes of chronic wounds with homogenous etiology to determine differences in microbiomes that may be driven by the wound environment and that may affect wound outcomes. Rigorous analyses of wound microbiomes in light of the three dimensions of bioburden (microbial diversity, microbial load, and pathogenic organisms), clinical metadata, and wound outcomes will be a significant step forward in our quest to understand the role of microorganisms in impaired healing. Future Directions: Longitudinal studies employing serial sampling are needed to appreciate the role of the dynamic microbial community in chronic wound healing. The value of clinical metadata needs to be examined as potential biomarkers of problematic microbiota and wound outcomes. Lastly, better characterization and understanding of wound microbiomes will open avenues for improved diagnostic and therapeutic tools for the nonhealing wound. PMID:25032070

Misic, Ana M.; Gardner, Sue E.; Grice, Elizabeth A.

2014-01-01

233

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

PubMed

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

Topaz, Moris

2012-05-01

234

Comparison in Terms of Postoperative Morbidity and Hospital Stay between Open Cholecystectomy and Laparoscopic Cholecystectomy  

Microsoft Academic Search

Type of study: Comparative. Aim: To compare the postoperative morbidity in terms of post- operative pain, gait disturbances, wound and respiratory infections along with length of hospital stay in patients undergoing laparoscopic cholecystectomy with those undergoing open surgery for symptomatic gallstone disease to compare the effectivity of minimally invasive surgery with open surgery in reducing postoperative morbidity and thus length

Faryal Gul Afridi; Javeria Iqbal; Jehangir Akbar; Zahoor Khan; M Zarin; Samiullah Wazir

2008-01-01

235

Postoperative infections in craniofacial reconstructive procedures.  

PubMed

The rate of, and possible risk factors for, postoperative craniofacial infection is unclear. To investigate this problem, we reviewed 349 cases of craniofacial skeletal procedures performed from 1996 to 1999 at our institution. Infection rate was determined and correlated with the use of implants, operative site, and cause of deformity. The inclusion criteria consisted of all procedures requiring autologous or prosthetic implantation in craniofacial skeletal sites, as well as all procedures involving bone or cartilage resection, osteotomies, debridement, reduction and/or fixation. Procedures that did not involve bone or cartilage surgery were excluded. The criteria for diagnosis of infection included clinical confirmation and one or more of 1) intravenous or oral antibiotic treatment outside of the prophylactic surgical regimen; 2) surgical intervention for drainage, irrigation, and or debridement; and 3) microbiological confirmation. Among the 280 surgical cases that fit the inclusion criteria and had complete records, there were 23 cases of postoperative infection (8.2%). The most common site for postoperative infection was the mandible (infection rate = 16.7%). Multiple logistic regression analysis revealed gunshot wound to be the most significant predictor of postoperative infection. Additionally, porous polyethylene implantation through a transoral route was correlated with a significant risk of postoperative infection. PMID:11482621

Fialkov, J A; Holy, C; Forrest, C R; Phillips, J H; Antonyshyn, O M

2001-07-01

236

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

PubMed Central

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

Ireton, Jordan E.; Unger, Jacob G.

2013-01-01

237

Management of open wounds: lessons from orthopedic oncology.  

PubMed

The management of complex wounds remains a challenge, and although there have been many promising advances, patients often undergo a morbid and lengthy process to obtain sufficient, satisfactory healing. Sarcoma patients are especially vulnerable to soft tissue wound-healing complications. These patients are often treated with neoadjuvant radiation and/or chemotherapy and have compromised local vascularity to healing tissue. The advent and refinement of wound vacuum-assisted closure technology have been shown to have a tremendous impact. This article reviews the benefits of some novel technologies currently undergoing investigation in orthopedic oncology that will likely have applications in wound management from other causes. PMID:24267211

Siegel, Herrick J

2014-01-01

238

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. PMID:22686656

2012-01-01

239

Systematic review of the use of honey as a wound dressing  

Microsoft Academic Search

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

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

2001-01-01

240

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

PubMed

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

Brubaker, Aleah L; Kovacs, Elizabeth J

2013-10-01

241

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

PubMed Central

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 following 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 (3–4 month) and aged (18–20 month) BALB/c mice received three dorsal, subcutaneous injections of G-CSF (250 ng/50 ?l/injection) or saline control (50 ?l/injection) 30 minutes after wound infection. Mice were sacrificed at days 3 and 7 post 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 affect 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 post-operative wound infection or chronic, non-healing wounds in elderly patients. PMID:23856924

Brubaker, Aleah L.; Kovacs, Elizabeth J.

2013-01-01

242

Postoperative assessment of the patient after transsphenoidal pituitary surgery  

Microsoft Academic Search

While most transsphenoidal pituitary surgery is accomplished without complication, monitoring is required postoperatively\\u000a for a set of disorders that are specific to this surgery. Postoperative assessments are tailored to the early and later postoperative\\u000a periods. In the early period, which spans the first few weeks after surgery, both monitoring of anterior and posterior pituitary\\u000a function and managing neurosurgical issues are

John C. Ausiello; Jeffrey N. Bruce; Pamela U. Freda

2008-01-01

243

Postoperative Pneumonia after Major Lung Resection  

Microsoft Academic Search

Background: Postoperative pneumonia (POP) is a life-threatening complication of lung resection. The incidence, causative bacteria, predisposing factors, and outcome are poorly understood. Design: Prospective observational study. Methods: A prospective study of all patients undergoing major lung resections for noninfectious disease was performed over a 6-mo period. Culture of intraoperative bronchial aspirates was systemati- cally performed. All patients with suspicion of

Olivier Schussler; Marco Alifano; Herve Dermine; Salvatore Strano; Anne Casetta; Sergio Sepulveda; Aziz Chafik; Sophie Coignard; Antoine Rabbat; Jean-Francois Regnard

2006-01-01

244

Octreotide in the Management of Postoperative Chylothorax  

Microsoft Academic Search

Chylothorax (KT) may be a complication of thoracic surgery. Its management is not well established and may comprise dietary interventions and surgery. The effectiveness of somatostatin and its analogues has been reported, although their mechanism(s) of action is unclear. We report our experience with octreotide in a series of patients with postoperative chylothorax. Eight patients with KT were treated with

L. Rosti; F. De Battisti; G. Butera; S. Cirri; M. Chessa; A. Delogu; M. Drago; A. Giamberti; G. Pomè; M. Carminati; A. Frigiola

2005-01-01

245

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

PubMed Central

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

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

2005-01-01

246

Complications of shoulder instability surgery.  

PubMed

Complications of shoulder instability surgery may results from errors made during the preoperative, intraoperative, or postoperative periods. Some complications are preventable whereas the risk of others can be reduced. A few complications remain unpreventable. Two sources of error in the preoperative period that can lead to complications are an incorrect diagnosis and failure to address a patient's expectations of treatment. These errors and their subsequent complications are preventable. Preventing complications during the intraoperative period begins with proper patient positioning and a thorough knowledge of shoulder anatomy. Understanding the indications and limitations of the various stabilization procedures, as well as applying proper surgical technique, is essential to avoid a surgical misadventure. Complications recognized in the postoperative period include recurrent instability, limitation of motion, inability to return to the previous level of sport, problems related to hardware, pain, development of osteoarthritis, and neurovascular injuries. Infection and hematoma formation may also occur; both need to be recognized and treated early to maximize outcome. A protocol for treating each complication that may occur often is helpful. Knowledge of the complications that can arise is paramount to preventing their occurrence. This knowledge comes through experience, study, and continued research. PMID:8582009

Wall, M S; Warren, R F

1995-10-01

247

Treatment of complications of parotid gland surgery  

PubMed Central

Summary Although several reports in the literature have documented the surgical technique, and the oncological outcome achieved with parotidectomy, only a few articles have described the complications of parotid gland surgery and their management. Several complications have been reported in parotid surgery. We re-classified the complications of parotidectomy in intra-operative and post-operative (early and late). The commonest complications after parotidectomy are temporary or permanent facial palsy and Frey’s syndrome. PMID:16450773

Marchese-Ragona, R; De Filippis, C; Marioni, G; Staffieri, A

2005-01-01

248

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

PubMed Central

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

2014-01-01

249

Pregnancy Complications  

MedlinePLUS

... Emergency Preparedness and Response Pregnant Women and Flu Pregnancy Complications On this Page Before Pregnancy During Pregnancy ... to decrease the risk of pregnancy complications. Before Pregnancy Make sure to talk to your doctor about ...

250

Scalp Wound Closure with K wires: An alternative easier method to scalp wound closure.  

PubMed

Scalp defects and lacerations present a reconstructive challenge to plastic surgeons. Many methods have been described from the use of skin grafting to rotation flaps. Here we present a method of closure of a contaminated scalp wound with the use of Kirschner wires. In our case, closure of scalp laceration was made possible with the use of 1.4 Kirschner wires and cable tie/ zip tie fasteners. The duration to closure of wound was 10 days. In reconstructing the scalp defect, this method was found to adhere to principles of scalp reconstruction. There were no post operative complications found from the procedure. On initial application on the edge of the wound, tension applied caused the K wires to cut through the wound edge. On replacement of K wires 1cm away from wound edge the procedure was not plagued by any further complication. In conclusion we find scalp closure with Kirschner wires are a simple and effective method for scalp wound closure. PMID:23770963

Ramesh, S; Ajik, S

2012-12-01

251

Wound currents and wound healing in the newt, Notophthalmus viridescens  

Microsoft Academic Search

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

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

1990-01-01

252

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

2001-01-01

253

Developing a toolbox for analysis of warrior wound biopsies: vibrational spectroscopy  

NASA Astrophysics Data System (ADS)

The management of modern traumatic war wounds remains a significant challenge for clinicians. This is a reflection of the extensive osseous and soft-tissue damage caused by blasts and high-energy projectiles. The ensuing inflammatory response ultimately dictates the pace of wound healing and tissue regeneration. Consequently, the eventual timing of wound closure or definitive coverage is often subjectively based. Some wounds require an extended period of time to close or fail to remain closed, despite the use and application of novel wound-specific treatment modalities. Aside from impaired wound healing, additional wound complications include wound infection, biofilm formation, and heterotopic ossification (the pathological mineralization of soft tissues). An understanding of the molecular environment of acute wounds throughout the debridement process can provide valuable insight into the mechanisms associated with the eventual wound outcome. The analysis of Raman spectra of ex vivo wound biopsy tissue obtained from serial traumatic wound debridements reveals a decreased 1665 cm-1/1445 cm-1 band area ratio in impaired healing wounds, indicative of an impaired remodeling process, in addition to a decreased 1240 cm-1/1270cm-1. The examination of debrided tissue exhibits mineralization during the early development of heterotopic ossification. Finally, preliminary results suggest that Fourier transform infrared (FT-IR) images of wound effluent may be able to provide early microbiological information about the wound.

Crane, Nicole J.; O'Brien, Frederick P.; Forsberg, Jonathan A.; Potter, Benjamin K.; Elster, Eric A.

2011-03-01

254

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

PubMed Central

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

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

2014-01-01

255

Designing Hydrogel Adhesives for Corneal Wound Repair  

PubMed Central

Today, corneal wounds are repaired using nylon sutures. Yet there are a number of complications associated with suturing the cornea, and thus there is interest in an adhesive to replace or supplement sutures in the repair of corneal wounds. We are designing and evaluating corneal adhesives prepared from dendrimers – single molecular weight, highly branched polymers. We have explored two strategies to form these ocular adhesives. The first involves a photocrosslinking reaction and the second uses a peptide ligation reactions to couple the individual dendrimers together to from the adhesive. These adhesives were successfully used to repair corneal perforations, close the flap produced in a LASIK procedure, and secure a corneal transplant. PMID:17889330

Grinstaff, Mark W.

2013-01-01

256

Risks and complications in rhinoplasty  

PubMed Central

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

Rettinger, Gerhard

2008-01-01

257

Thyroid surgery in octogenarians is associated with higher complication rates  

PubMed Central

Objectives To determine whether thyroid surgery in patients ?80 is associated with higher complication rates. Background The incidence of thyroid nodules increases with age and little information is available regarding the risks of thyroid surgery in elderly patients. Methods Out of 3568 patients undergoing thyroid surgery between July 2001 and October 2007 at a single institution, the records of 90 consecutive patients ?80 years were retrospectively reviewed and compared to a cohort of 242 randomly selected patients aged 18–79, who underwent thyroid surgery during the same time period, using SAS statistical software. Clinical variables included age group, sex, medical co-morbidities, pre-operative diagnosis, substernal component, previous surgery, final pathology, length of stay (LOS), postoperative complications and mortality. Results Preoperative indications for surgery included benign disease in 51.1% vs. 40.9%, suspected malignancy in 18.9% vs. 26% and suspected follicular neoplasms including indeterminate/microfollicular cytology in 30% vs. 33.1% in the octogenarian patient group (?80 yrs old) vs. the younger patient cohort (p=NS). Octogenarians had a 21.1% rate of significant malignancy on final pathology vs. 28.1% in the younger cohort (p=NS). The overall complication rate in the octogenarian group was 23.3% vs. 9.1% in the younger cohort (p=.0006). Male sex and lung disease were independent risk factors for perioperative complications. Complications unique to octogenarians included heart failure, atrial fibrillation, pneumonia, tracheotomy, urosepsis, blood transfusion, wound infection and ischemic colitis. There was no mortality in either group. Conclusions Patients ?80 years of age can undergo successful thyroid surgery but with significantly higher morbidity. Earlier surgical intervention may be advised in those who are at high risk for disease progression whereas follow-up strategies without surgery may be advised for others. PMID:19744461

Mekel, Michal; Stephen, Antonia E.; Gaz, Randall D.; Muzikansky, Alona; Hodin, Richard A.; Parangi, Sareh

2013-01-01

258

Bio-Conjugated Polycaprolactone Membranes: A Novel Wound Dressing  

PubMed Central

Background The combination of polycaprolactone and hyaluronic acid creates an ideal environment for wound healing. Hyaluronic acid maintains a moist wound environment and accelerates the in-growth of granulation tissue. Polycaprolactone has excellent mechanical strength, limits inflammation and is biocompatible. This study evaluates the safety and efficacy of bio-conjugated polycaprolactone membranes (BPM) as a wound dressing. Methods 16 New Zealand white rabbits were sedated and local anaesthesia was administered. Two 3.0×3.0 cm full-thickness wounds were created on the dorsum of each rabbit, between the lowest rib and the pelvic bone. The wounds were dressed with either BPM (n=12) or Mepitel (n=12) (control), a polyamide-silicon wound dressing. These were evaluated macroscopically on the 7th, 14th, 21st, and 28th postoperative days for granulation, re-epithelialization, infection, and wound size, and histologically for epidermal and dermal regeneration. Results Both groups showed a comparable extent of granulation and re-epithelialization. No signs of infection were observed. There was no significant difference (P>0.05) in wound size between the two groups. BPM (n=6): 8.33 cm2, 4.90 cm2, 3.12 cm2, 1.84 cm2; Mepitel (n=6): 10.29 cm2, 5.53 cm2, 3.63 cm2, 2.02 cm2; at the 7th, 14th, 21st, and 28th postoperative days. The extents of epidermal and dermal regeneration were comparable between the two groups. Conclusions BPM is comparable to Mepitel as a safe and efficacious wound dressing.

Cai, Elijah Zhengyang; Teo, Erin Yiling; Jing, Lim; Koh, Yun Pei; Qian, Tan Si; Wen, Feng; Lee, James Wai Kit; Hing, Eileen Chor Hoong; Yap, Yan Lin; Lee, Hanjing; Lee, Chuen Neng; Teoh, Swee-Hin; Lim, Jane

2014-01-01

259

Telemedicine for wound management  

PubMed Central

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

Chittoria, Ravi K.

2012-01-01

260

Acute postoperative diverticulitis  

Microsoft Academic Search

Acute diverticulitis following surgery is a severe condition reported previously only after heart surgery. Four cases of diverticulitis in the early postoperative period are presented, three of them after non-cardiac procedures (tracheostomy, inguinal hernia repair and laminectomy). Advanced age, administration of morphine, treatment with steroids, postoperative constipation and intestinal mucosal ischaemia are discussed as possible aetiological factors leading to diverticular

J. M. Badia-Pèrez; J. Valverde-Sintas; G. Franch-Arcas; J. Pla-Comos; A. Sitges-Serra

1989-01-01

261

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))

1986-03-01

262

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

PubMed

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

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

2014-01-01

263

Understanding methods of wound debridement.  

PubMed

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

Atkin, Leanne

264

Release of ischaemia prior to wound closure in total knee arthroplasty: a better method?  

PubMed Central

We included 46 total knee arthroplasties (43 patients) in a prospective, randomised study, dividing them into two groups: group A (23 knees, 21 patients) in which the ischaemia was released prior to wound closure allowing control of bleeding and group B (23 knees, 22 patients) releasing the tourniquet after suturing and bandaging. We compared the haemoglobin before surgery and at 24 and 48 h postoperatively, the total blood loss and the transfusions that were needed. Student's t-test was used to analyse the data. The results we obtained were as follows: preoperative haemoglobin in group A was 14.21 g/dl and group B 14.28 g/dl; haemoglobin at 24/48 h for group A was 10.04/10.1 g/dl and group B 10.28/10.3 g/dl; total blood loss was 743.2 cc for group A and 692.5 cc for group B; the mean number of blood units transfused were 2 in group A and 1.8 in group B. No statistical differences were found in the data analysed, but one of the complications in group B was major blood loss right after surgery that needed reintervention. We assume that this could have been avoided if the tourniquet had been released beforehand. We conclude that releasing ischaemia prior to wound closure does not demonstrate a statistical difference, but like other authors, we found clinical advantages suggesting the need of further study of this situation. PMID:17503044

Ponce, V. V.; Gil, F.

2007-01-01

265

Sharp wound debridement in local anaesthesia using EMLA cream: 6 years' experience in 1084 patients.  

PubMed

Sharp debridement is the most efficient method for clearing the woundbed in the exudation and granulation phase of wound healing. At our clinic the anaesthetic lidocaine-prilocaine cream, EMLA, has been used as an analgesic for sharp debridement since 1994. A review of patients' records was conducted, including ulcer size, dose of cream used, analgesic efficacy and complications. During a 6-year period a total of 1084 patients were treated for leg ulcers, decubitus ulcers, abscess revisions, anal and coccyx fistulae, postoperative wounds, diabetic ulcers and burns. Doses ranging from 3 to 150 g cream were applied for 45-60 min. In all patients except three the analgesia was adequate for debridement. We observed no allergic reactions, no clinical symptoms of local anaesthetic toxicity or methaemoglobinaemia. In 12 patients (1.1%) a burning sensation was reported directly after the application of EMLA cream to the ulcer, which, however, subsided within 15-20 min. In our experience, sharp debridement in percutaneous analgesia with EMLA is efficient, economical, safe, and tolerable for the patient. PMID:12972901

Blanke, Walter; Hallern, Bernd V

2003-09-01

266

Complications of carotid endarterectomy and their prevention  

Microsoft Academic Search

Mortality and morbidity associated with carotid endarterectomy may be minimized by proper selection of patients and proper operative and postoperative management. Complications include cardiac and airway problems related to anesthesia, infection, hematoma, nerve pareses, parotitis, arterial disruption, false aneurysms, and carotid-cavernous fistula. The most serious complication is the occurrence of neurologic deficits as a result of cerebral emboli or ischemia.

Jesse E. Thompson

1979-01-01

267

Unusual complications of preperitoneal mesh implantation in the treatment of inguinal hernia.  

PubMed

More and more prosthetic materials are being used in the treatment of inguinal hernia. This report deals with some unusual but devastating complications, occurring after preperitoneal mesh implantation. A 56-year old male patient underwent a Stoppa-repair for a bilateral inguinal hernia. Two years postoperatively, a localized abdominal wall abscess was treated with antibiotics and drainage. A barium enema and a CT-scan of the abdomen were performed to rule out an enteric fistula; the CT-scan unexpectedly revealed a tumoral mass involving the sigmoid colon, and an explorative laparotomy was done. Peroperatively, part of the mesh was found to penetrate the bowel wall and a sigmoidectomy with removal of the mesh was performed. Two years later, ingrowth of the urinary bladder by the remains of the mesh was the unfortunate peroperative finding when the patient was operated on for an inflammatory mass, involving the bladder wall. The patient needed two more interventions for persisting wound fistulas. All the remains of the mesh have been removed and all fistulas have been widely excised. Nowadays, the patient is recovering well with complete healing of all wounds. Although infection of prostheses used in the treatment of hernias has been described, late and serious complications related to mesh implantation, such as perforation of the colon and the bladder, have seldom been reported. PMID:14653040

Lauwers, P; Bracke, B; Hubens, G; Vaneerdeweg, W

2003-10-01

268

Histological evaluation of wound healing performance of electrospun poly(vinyl alcohol)/sodium alginate as wound dressing in vivo.  

PubMed

Poly(vinyl alcohol)/sodium alginate nanofibrous mats were produced by electrospinning method at optimum process parameters. Evaluation of alginate-based electrospun nanofibrous mats as a wound dressing material and their comparison to commercially available wound dressings produced with conventional methods were carried out in vivo. Tissue specimens were examined histopathologically on 4th, 6th, 15th, 21st postoperative days. In contrast to other dressings it was observed that nanofibrous mat could survive on the wound crust in early stages of healing. In terms of epithelization, epidermis characteristics, vascularization and formation of hair follicles, nanofibrous mat showed the best healing performance. This could be explained with presence of nanofibrous mat acting as an artificial skin on the wound region until new tissue regenerated. PMID:24642979

Co?kun, Gökçe; Karaca, Esra; Ozyurtlu, Mustafa; Ozbek, Serhat; Yermezler, Aysun; Cavu?o?lu, Ilkin

2014-01-01

269

The relative roles of aggressive wound care versus revascularization in salvage of the threatened lower extremity in the renal failure diabetic patient.  

PubMed

Current literature indicates poor survival and limb salvage rates in renal failure diabetic patients who present with ulcerated or gangrenous lower extremities. Even in those limbs that were successfully revascularized, the amputation rate was as high as 37 percent. This has led some to advocate immediate amputation when treating the threatened limb of a renal failure diabetic patient. The authors reviewed all renal failure diabetic patients in their wound registry to determine whether such pessimism was warranted. The authors then analyzed the relative roles of revascularization and aggressive wound care on long-term limb salvage. Forty-five consecutive renal failure diabetic patients with 71 wounds in 54 limbs were identified. Twenty-seven patients had chronic renal insufficiency, 15 patients had end-stage renal disease, and three patients received kidney transplants. The revascularization procedures (46 percent of all limbs) included angioplasty, femoral-popliteal, femoral-distal, and popliteal-distal bypasses. Forty-three amputations in combination with 67 soft-tissue repairs (delayed primary wound closure, skin grafts, local flaps, pedicled flaps, and free flaps) were necessary to close the defects. After a mean follow-up of over 3 years, the data indicate that 79 percent of wounds healed, 89 percent of all limbs were salvaged, and 49 percent of patients survived. Revascularization improved the threatened limb's salvage rate from negligible to a level similar to that of the adequately vascularized limb. Fifteen out of 71 wounds did not heal because of the patient's early postoperative death, ischemia not amenable to revascularization, or noncompliance. Six below-knee amputations were performed (one despite a patent bypass and five in adequately vascularized patients). The average time for wounds to heal in the revascularized patients was 79 days versus 71 days in adequately vascularized patients. There was an overall 43 percent complication rate. Of the patients who were alive after the 3-year follow-up, 73 percent were independently ambulating, whereas 27 percent were bound to wheelchair or bed. Eighty-two percent of patients were very satisfied with the salvage attempt, 18 percent were moderately satisfied, and all patients said they would go through the process again. The authors believe that salvaging the threatened extremity in the renal failure diabetic patient is justified whether or not the limb requires revascularization. Revascularization improved the limb salvage rate, patient survival, and days for wounds to heal to a level comparable to that of the adequately vascularized limb. The key to subsequently achieving high salvage rates is the quality of perioperative wound care (e.g., serial debridements, antibiotics, dressings) and the timing and selection of appropriate soft-tissue coverage. PMID:11964979

Attinger, Christopher E; Ducic, Ivica; Neville, Richard F; Abbruzzese, Mark R; Gomes, Mario; Sidawy, Anton N

2002-04-01

270

Ambulatory surgical hemorrhoidectomy—A solution to postoperative urinary retention?  

Microsoft Academic Search

PURPOSE: The most frequent complication of surgical hemorrhoidectomy is urinary retention. This study evaluates the incidence of urinary retention in a series of patients undergoing surgical hemorrhoidectomy in an ambulatory setting. METHODS: The records of all patients undergoing anorectal surgical operative procedures during the calendar year 1990 were reviewed, with particular emphasis on urinary retention and other postoperative complications. RESULTS:

Stuart D. Hoff; H. Randolph Bailey; Donald R. Butts; Ernest Max; Kenneth W. Smith; Luis F. Zamora; Gary B. Skakun

1994-01-01

271

Immunomodulation after Blood Transfusion – Impact on Incidence of Postoperative Infection  

Microsoft Academic Search

Summary Objective: Overview of complications and side effects related to perioperative transfusion of allogeneic blood components. Data Sources: Present literature based on electronical search (PubMed). Results: Transfusion of blood components is one of the most common therapeutic methods used in medicine. However, transfusion of allogeneic blood components may be associated with certain postoperative complications. Recent data indicate that some of

P. Hobisch-Hagen

2002-01-01

272

VLAP: results immediately post-op  

NASA Astrophysics Data System (ADS)

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

Cowles, Robert S.

1996-05-01

273

Hemoglobin A1c predicts healing rate in diabetic wounds.  

PubMed

Lower-extremity wounds are a major complication of diabetes. Hemoglobin A1c (HbA1c) reflects glycemia over 2-3 months and is the standard measure used to monitor glycemia in diabetic patients, but results from studies have not shown a consistent association of HbA1c with wound healing. We hypothesized that elevated HbA1c would be most associated with poor wound healing. To test this hypothesis, we conducted a retrospective cohort study of 183 diabetic individuals treated at the Johns Hopkins Wound Center. Our primary outcome was wound-area healing rate (cm(2) per day). Calibrated tracings of digital images were used to measure wound area. We estimated coefficients for healing rate using a multiple linear regression model controlling for clustering of wounds within individuals and other common clinic variables. The study population was 45% female and 41% African American, with a mean age of 61 years. Mean HbA1c was 8.0%, and there were 2.3 wounds per individual (310 wounds total). Of all measures assessed, only HbA1c was significantly associated with wound-area healing rate. In particular, for each 1.0% point increase in HbA1c, the daily wound-area healing rate decreased by 0.028 cm(2) per day (95% confidence interval: 0.003, 0.0054, P = 0.027). Our results suggest that glycemia, as assessed by HbA1c, may be an important biomarker in predicting wound-healing rate in diabetic patients.JID JOURNAL CLUB ARTICLE: For questions, answers, and open discussion about this article, please go to http://www.nature.com/jid/journalclub. PMID:21697890

Christman, Andrea L; Selvin, Elizabeth; Margolis, David J; Lazarus, Gerald S; Garza, Luis A

2011-10-01

274

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. PMID:22548859

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

2013-01-01

275

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

PubMed

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

2008-01-01

276

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. PMID:23162219

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

2012-01-01

277

[Basic of wound healing in thoracic surgery].  

PubMed

Wound condition changes from moment to moment. It is important to understand what is happening on the wound to evaluate and treat it. Wound can be classified into low contaminated wound, contaminated wound, colonized wound, critical colonized wound and infected wound by status of bacteria on the wound. Moreover, it can be classified into acute wound, subacute wound, subchronic wound, and chronic wound by time course. Also, wound healing course can be classified into coagulation phase, inflammation phase, proliferation phase and remodeling phase. Moreover, wound healing can be classified into primary wound healing, secondary wound healing and tertiary wound healing according to types of surgical intervention. The TIME principles provide a systematic approach to the management of wounds. TIME leads to an optimal wound bed preparation( WBP). The objectives underpinning TIME are tissue non-viable or deficient (T), infection or inflammation (I), moisture imbalance (M) and epidermal margin;non advancing or undermined( E). PMID:22314172

Ogawa, Rei

2012-02-01

278

Hydrocephalus communicans after traumatic upper cervical spine injury with a cerebrospinal fluid fistula: a rare complication  

PubMed Central

Secondary hydrocephalus communicans after traumatic upper cervical spine injuries with leakage of cerebrospinal fluid is a rare and hardly described complication. A case of a 75-year-old woman sustained a type II dens axis without other injuries, especially without evidence of a hydrocephalus in the primary CT scan. Dorsal atlanto-axial fusion was performed. Postoperative drainage was prolonged and positive for ?2-transferrin. Wound revision with an attempt to seal the leakage was not successful. Secondary CT scans of the brain were performed due to neurological deterioration and showed a hydrocephalus with typical EEG findings. No anatomical reason for a circulative obstruction was found in the CT scan. After application of a ventriculo-peritoneal shunt the neurological status improved and the patient could be discharged to neurological rehabilitation. PMID:22752831

Mica, Ladislav; Neuhaus, Valentin; Poschmann, Enrico; Konu-Leblebicioglu, Dilek; Schwarz, Urs; Wanner, Guido A; Werner, Clement ML; Simmen, Hans-Peter

2010-01-01

279

Prevalence of immune disease in patients with wounds presenting to a tertiary wound healing centre.  

PubMed

Chronic leg ulcers are a significant cause of morbidity and mortality and account for considerable healthcare and socioeconomic costs. Leg ulcers are a recognised 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 1 January 2009 and 31 March 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 [33·4 cm(2) (69·05) compared to 22·5 cm(2) (63·65), P = 0·02]. Split thickness skin graft (STSG) and bioengineered alternative tissue (BAT) graft data was available on 177 grafts from 55 subjects. There was a significantly lower response rate to STSG in subjects with immune disease (50% compared to 97%, P = 0·0002), but response rates to BAT were not different. The association between immune diseases and chronic wounds may provide unique insights into pathways of wound healing, and warrants further study. PMID:22168783

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

2012-08-01

280

Local anesthetic wound infiltration for pain management after periacetabular osteotomy  

PubMed Central

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

2014-01-01

281

Ascending thoracic aorta: postoperative imaging evaluation.  

PubMed

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

2013-01-01

282

Topical Naltrexone as Treatment for Type 2 Diabetic Cutaneous Wounds  

PubMed Central

Objective: Type 2 diabetes (T2D) is associated with impaired cutaneous wound healing and can result in ulceration, infection, and/or amputation. More than 25 million people in the United States have T2D and are vulnerable to epithelial-related complications. Current therapies are limited in their efficacy. New treatments for full-thickness cutaneous wounds that focus on underlying diabetic pathways are needed. Approach: Topical application of the opioid receptor antagonist naltrexone (NTX) dissolved in cream reverses delayed wound closure in type 1 diabetic rat by the acceleration of reepithelialization and enhancement of angiogenesis and remodeling. NTX blocks the opioid growth factor (OGF)–OGF receptor (OGFr) axis and upregulates DNA synthesis and cell proliferation. To investigate whether NTX is an effective therapy for T2D wound closure, genetically obese mice (db/db) and normal C57Bl/6J mice received full-thickness cutaneous wounds. Wounds (5?mm in diameter) were treated topically three times daily with 10?5 M NTX or sterile saline dissolved in cream and photographed every 2 days. Results: Wounds in db/db mice treated with saline were 11–92% larger than those in normal mice throughout the 2-week observation. Topical NTX therapy in T2D mice reduced the residual wound size by 13–30% between days 8 and 14 relative to diabetic mice receiving saline. Reepithelialization and DNA synthesis, as analyzed by epithelial thickness and BrdU labeling indexes, respectively, were accelerated in NTX-treated wounds. Innovation and Conclusion: These data suggest that the OGF-OGFr axis plays a role in epithelial-related complications of T2D and that blockade of this pathway by NTX may be an effective treatment for wound repair. PMID:24940556

Immonen, Jessica A.; Zagon, Ian S.; McLaughlin, Patricia J.

2014-01-01

283

Sirolimus impairs wound healing  

Microsoft Academic Search

Background and aims  Clinically, the immunosuppressive drug sirolimus, used in organ transplantation, appears to impair wound healing. Little is\\u000a known about the mechanisms of action. We investigated the effect of sirolimus on wound healing, and we analyzed the expression\\u000a of stimulating mediators of angiogenesis (VEGF, vascular endothelial growth factor) and collagen synthesis (nitric oxide)\\u000a in wounds.\\u000a \\u000a \\u000a \\u000a Materials and methods  Groups of ten

Michael Schäffer; Robert Schier; Markus Napirei; Stefan Michalski; Thilo Traska; Richard Viebahn

2007-01-01

284

[Effectiveness, safety and cost-effectiveness of the negative pressure wound therapy on the treatment of chronic wounds: a systematic review].  

PubMed

Negative-pressure wound therapy (NPWT) is used to promote wound healing by using suction to drain excess fluid from wounds. A systematic literature review was undertaken to assess the effectiveness, safety and cost-effectiveness of NPWT for the treatment of chronic wounds. Medline, Embase, CENTRAL, CINAHL and the Cochrane Wounds Group Specialised Trials Register were searched. A total of 9 randomized controlled trials (n=568) comparing NPWT with conventional wound therapy and four economic evaluations identified through NHS EED database were included. Five trials showed significant differences in favour of NPWT in primary outcome measures; however, most studies had small sample sizes and low scientific validity. Complications and adverse effects of NPWT are scarce compared to those of conventional treatment. There is no conclusive scientific evidence on the effectiveness and cost-effectiveness of NPWT in the treatment of chronic wounds and therefore its widespread use is not justified. PMID:20889170

Trujillo-Martín, María; García-Pérez, Lidia; Serrano-Aguilar, Pedro

2011-09-17

285

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. PMID:24069526

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

2013-01-01

286

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

PubMed

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. PMID:24069526

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

2013-01-01

287

Effect of submucosal and intramuscular dexamethasone on postoperative sequelae after third molar surgery: comparative study.  

PubMed

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

2011-12-01

288

Postoperative jejunal feeding and outcome of pancreaticoduodenectomy  

Microsoft Academic Search

Complications following pancreaticoduodenectomy are common, partly because of nutritional debilitation. The aim of this study\\u000a was to evaluate the impact of early postoperative tube feeding on outcome of pancreaticoduodenectomy and determine the best\\u000a method for delivering enteral feeding. A retrospective review of 180 consecutive patients undergoing Whipple operations from\\u000a 1994 to 2000 was performed. Two nonrandomized patient groups were retrospectively

Hani Baradi; R. Matthew Walsh; J. Michael Henderson; David Vogt; Marc Popovich

2004-01-01

289

Serum cholesterol levels and postoperative atrial fibrillation  

PubMed Central

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

2014-01-01

290

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. PMID:23205061

Tutolo, Manuela; Briganti, Alberto; Suardi, Nazareno; Gallina, Andrea; Abdollah, Firas; Capitanio, Umberto; Bianchi, Marco; Passoni, Niccolo; Nini, Alessandro; Fossati, Nicola; Rigatti, Patrizio

2012-01-01

291

[Wasting and postoperative infection in cancer patients].  

PubMed

Denutrition decreases immunological responses of non-cancer patients, the healing is altered whereas infectious complications increase. Now during hospitalization, malnutrition prevails in cancer patients. The suppression of the adaptability to fasting which reduces the expenditure of energy at rest, an a normal metabolic response to nutrients' supply with the impossibility to compensate totally the metabolic deficits with the artificial nutrition alone, raise the fear of postoperative disorders, particularly an increase of the infectious risk. The key point is therefore to identify the cachexia's degree owing to a simple, predictive and consensual index. This check-up allows a postoperative complications' prevention by starting up a perioperative refeeding in high-risk subjects: that is to say all severe wasting patients, the people booked for a severe surgical procedure, especially for oesophageal and gastric neoplasms. Actually, we consider that the quality of the results depend more on the making up of the different nutritional solutions dispensed than to strictly providing for cancer patients' wants, which could be harmful in the postoperative period. Supplementation with antioxidant micronutrients or arginine, glutamine, ribonucleic acids and omega-3 fatty acids would allow an immuno- modulation of the renutrition. But complications strictly due to preoperative denutrition are still to be established. PMID:11244601

Tessier, C; Corda, B; Marty, J

2000-10-01

292

Wounds and Injuries  

MedlinePLUS

... general term that refers to harm caused by accidents, falls, hits, weapons, and more. In the U.S., ... punctured skin. They often happen because of an accident, but surgery, sutures, and stitches also cause wounds. ...

293

Topical advances in wound care.  

PubMed

There are fundamental differences between acute wounds that proceed to uncomplicated healing and those that become chronic wounds. Non-healing or chronic wounds can result from a combination of overlapping factors that prevent healing, including local tissue ischemia, repetitive trauma and ischemia/reperfusion injury, presence of tissue necrosis, impaired cellular and systemic host response to stress, and critical bacterial contamination. The bacterial burden in the wound contributes to a sustained inflammatory state, which inhibits normal progression to the proliferative phase of healing, thereby preventing restoration of tissue integrity. Appropriate wound bed preparation removes local barriers to healing and optimizes the tissue environment to achieve wound healing. It is an essential element of wound management that advances endogenous healing as well as the efficacy of topical and other wound therapy. This article will summarize a systematic approach to wound bed preparation using the "TIME" principle, and will highlight important advances in topical wound care. PMID:18793796

Stojadinovic, Alexander; Carlson, Jay W; Schultz, Gregory S; Davis, Thomas A; Elster, Eric A

2008-11-01

294

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

295

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. PMID:23738117

Yang, Guanghui; Prestwich, Glenn D.; Mann, Brenda K.

2011-01-01

296

Surgical Wound Case Studies With the Versatile 1 Wound Vacuum System for Negative Pressure Wound Therapy  

Microsoft Academic Search

Negative pressure wound therapy consists of a wound dressing, a drainage tube inserted into the dressing, an occlusive trans- parent film, and a connection to a vacuum source that supplies the negative pressure. A new product called the Versatile 1 Wound Vacuum System (BlueSky Medical, La Costa, Calif) is available for negative pressure wound therapy. This article de- scribes the

Penny E. Campbell; Phyllis A. Bonham

2006-01-01

297

Prognostic Significance of Complications after Laparoscopic Colectomy for Colon Cancer  

PubMed Central

Aims This study sought to evaluate the prognostic significance of postoperative complications for colon cancer patients undergoing laparoscopic surgery. Methods From May 2006 to May 2009, a total 224 patients who underwent laparoscopic curative resection (R0) for colon cancer were included in our retrospective study. Postoperative complications were evaluated according to a standardized grading system. The main outcome measurements of our study were overall survival (OS) and relapse-free survival (RFS), which were then compared between the no complication and complication groups. Univariate and multivariate analysis were used to assess the correlation between complications and prognosis. Results Fifty-nine postoperative complications occurred in 43 patients. The overall morbidity rate was 26.3%. The 5-year OS in the complication group was 41.4% compared with 78.5% in the no complication group (P<0.001). The cumulative incidence of relapse was also more aggressive in patients with complications (5-year RFS: complication group 40.9% vs. no complication group 82.1%, P<0.001). Multivariate analysis identified complications as a significant factor increasing the risk for both OS (RR 2.737; 95% CI 1.512–4.952; P?=?0.001) and RFS (RR 4.247; 95% CI 2.291–7.876; P<0.001). Conclusion Postoperative complications could pose a significant adverse impact not only on OS but also on RFS in patients with colon cancer even when laparoscopic R0 resection is available. PMID:25299478

Xia, Xiang; Wu, Weidong; Zhang, Kundong; Cen, Gang; Jiang, Tao; Cao, Jun; Huang, Kejian; Huang, Chen; Qiu, Zhengjun

2014-01-01

298

Early complications after cleft palate repair: a multivariate statistical analysis of 709 patients.  

PubMed

This study presents a large consecutive institutional experience with primary cleft palate repairs. The purpose of this study was to determine the incidence of early complications after cleft palate surgery in a series of nonsyndromic children treated at the authors' comprehensive cleft center. This retrospective analysis includes 709 consecutive patients with cleft palate treated by 6 different staff surgeons at Guwahati Comprehensive Cleft Care Center between April 2011 and December 2012. Secondary cases were excluded from this study. The patients were initially followed up between 1 week and 1 month after surgery. The overall incidence of early complications was determined, and the effect of the extent of clefting, the type of repair, the age at repair, and the operating surgeon were analyzed. Early complications in this study include dehiscence of the wound, fistula formation, hanging palate, and total or partial flap necrosis. There was a 2.4% rate (17/709) of take-back to the operating room in the immediate postoperative period for control of bleeding, although no blood transfusions were required. The incidence of postoperative fistulas in this series was 3.9% (20/512). There was a statistically significant increase in the incidence of cleft palatal fistula for Veau IV clefts, but there were no significant differences with respect to operating surgeon, patient sex, patient age, and type of palatoplasty. The complication and fistula rate is consistent with other published reports from developed countries and provides evidence for the value of this model for surgical delivery in the developing world. PMID:25148623

Deshpande, Gaurav Shekhar; Campbell, Alex; Jagtap, Rasika; Restrepo, Carolina; Dobie, Hannah; Keenan, Henry Tait; Sarma, Hiteswar

2014-09-01

299

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

PubMed Central

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

Houreld, Nicolette N.

2014-01-01

300

Post-operative constrictive pericarditis complicated with lymphocytopenia and hypoglobulinemia.  

PubMed

A 71-year-old man who had a history of open chest surgery was admitted due to anasarca and bilateral pleural effusions. Although imaging modalities could not demonstrate any pericardial abnormalities, right-sided cardiac catheterization revealed 'dip and plateau' in diastolic pressure waveform. He was admitted frequently because of the episodic right-sided congestive heart failure and hypoproteinemia due to protein-losing enteropathy. The peripheral lymphocyte count and serum gamma-globulin concentration were gradually decreased, and finally showed lymphocytopenia and hypoglobulinemia. On the last admission, the patient showed extensive cellulitis on both legs, and he developed septicemia, and finally died due to septic shock. Post-mortem examination showed that both visceral and parietal layers of the pericardium adhered tightly with mediastinal fibrosis. This case report suggested that constrictive pericarditis should be considered even if there is a lack of typical abnormal pericardial imaging findings when patients have a history of open chest surgery and recurrent right-sided congestive heart failure. In addition, we should be aware of a serious outcome due to immune compromised conditions such as lymphocytopenia and dysglobulinemia in this disorder. PMID:15497516

Ohsawa, Masaki; Nakamura, Motoyuki; Pan, Li-hua; Shizuka, Takehito; Nakagawa, Jun-ichi; Ishida, Hirobumi; Ouchi, Mami; Shiroto, Takahiro; Hotta, Kazuhiko; Sawai, Takashi; Hiramori, Katsuhiko

2004-09-01

301

Case of the weeping wound: formation of a lacrimal pseudocyst following lateral canthal surgery.  

PubMed

An 87-year-old woman presented with a subcutaneous fluid collection overlying the right lateral orbital rim 2 days after undergoing a lateral tarsal strip. Drainage and excision of fibrinous granulation tissue occurred twice within the first postoperative month, with the formation of a lacrimal pseudocyst. The pseudocyst repeatedly enlarged following drainage, necessitating 4 needle aspirations. A third attempt at excision, coupled with cautery to the wound base, and loose wound closure succeeded in breaking the cycle of pseudocyst recurrence. However, the wound continued to drain, so aggressive cautery and botulinum toxin were used to obliterate the area of presumed lacrimal gland laceration and slow tear production. The possibility of damage to the lacrimal system should be entertained in the scenario of a postoperative weeping wound. Formation of a lacrimal pseudocyst should be considered when a cystic lesion appears following surgical intervention in the lateral canthal region. PMID:24317106

Clark, Thomas J; Dubovy, Sander R; Shriver, Erin M

2014-01-01

302

[Wound infection following appendectomy. Metronidazole vs ornidazole as single-dose prophylaxis in non-perforated appendix].  

PubMed

In an open prospective randomized study, the postoperative wound infection rate following removal of an unperforated appendix was evaluated in 187 patients who received either metronidazole (1 g suppositories) or ornidazole (500 mg iv or 500 mg suppositories) in a single dose preoperatively. The overall postoperative infection rate was 2.1%. Metronidazole and ornidazole suppositories are a cheap method of preventing postoperative infection in cases of unperforated appendix. PMID:3175579

Barth, A; Kuhn, P; Bertschmann, W

1988-10-01

303

Sutureless prepuceplasty with wound healing by second intention: An alternative surgical approach in children's phimosis treatment  

PubMed Central

Background A new technique for the treatment of children's phimosis is presented that minimizes the repairing time, the postoperative complications and maintains the physical foreskin appearance intact. Methods Eightyseven children with phimosis were treated with this new developed technique, between 2003 and 2005. Sutureless prepuceplasty creates a permanent surgical extension of the close prepuce. Stretching and retraction of phimotic foreskin reveals a tight prepuce ring that is cutting in its dorsal surface longitudinally. Rarely triple symmetric incisions in the preputial outlet are necessary. The foreskin is loose and moves absolutely free in bilateral courses. The wounds are healing by second intention. Antisepsis, steroids and Elicina cream, (which contains allantoin, collagen, elastin, glycolic acid and vitamins A, D, and E) should apply daily, for twenty to thirty days. Results The foreskin is moving in centripetal or efferent courses absolutely loosely, painlessly and bloodlessly. The mean time of follow-up was 27 months (one to four years). No complications were observed. Conclusion Sutureless prepuceplasty may present an acceptable alternative in children's phimosis reconstruction. PMID:18318903

Christianakis, Efstratios

2008-01-01

304

Lethal cardiac tamponade due to aortotomy wound dehiscence after cardiac valve replacement: a forensic presentation.  

PubMed

Lethal cardiac tamponade due to aortotomy wound dehiscence after cardiac valve replacement (CVR) are apparently unreported in the recent literature. An uncommon example of delayed non-valvular lethal complication of CVR occurring in the early out-patient period is reported here. The forensic aspects of wound dehiscence in cardiovascular surgery for cardiac valve replacement are discussed, and complemented by a study of the fracture ends of suture material in wound breakdown associated with the suture failure. PMID:1513227

Patel, F

1992-07-01

305

Topical Negative Pressure Therapy in Wound Care: Effectiveness and guidelines for clinical application  

Microsoft Academic Search

The aim in the treatment of any type of wound is to achieve normal and timely healing. Complicated\\u000awound healing may affect functional ability and almost always involves appearance\\u000aor “looks” despite reconstructive measures. Recent figures on either the incidence of wounds\\u000aor the total cost of wound care in the Netherlands are not available.\\u000aA reporting system to the

C. M. Moues-Vink

2009-01-01

306

ANGIOGENESIS IN WOUNDS TREATED BY MICRODEFORMATIONAL WOUND THERAPY  

PubMed Central

Summary Background Data Mechanical forces play an important role in tissue neovascularisation and are a constituent part of modern wound therapies. The mechanisms by which Vacuum Assisted Closure (VAC) modulates wound angiogenesis are still largely unknown. Objective To investigate how VAC treatment affects wound hypoxia and related profiles of angiogenic factors as well as to identify the anatomical characteristics of the resultant, newly formed vessels. Methods Wound neovascularization was evaluated by morphometric analysis of CD31- stained wound cross sections as well as by corrosion casting analysis. Wound hypoxia and mRNA expression of HIF-1? and associated angiogenic factors were evaluated by pimonidazole hydrochloride staining and quantitative RT-PCR, respectively. VEGF protein levels were determined by western blot analysis. Results VAC-treated wounds were characterized by the formation of elongated vessels aligned in parallel and consistent with physiologically function, compared to occlusive dressing control wounds that showed formation of tortuous, disoriented vessels. Moreover, VAC-treated wounds displayed a well-oxygenated wound bed, with hypoxia limited to the direct proximity of the VAC-foam interface, where higher VEGF levels were found. By contrast, occlusive dressing control wounds showed generalized hypoxia, with associated accumulation of HIF-1? and related angiogenic factors. Conclusions The combination of established gradients of hypoxia and VEGF expression along with mechanical forces exerted by VAC therapy was associated with the formation of more physiological blood vessels compared to occlusive dressing control wounds. These morphological changes are likely a necessary condition for better wound healing. PMID:21217515

Erba, Paolo; Ogawa, Rei; Ackermann, Maximilian; Adini, Avner; Miele, Lino F; Dastouri, Pouya; Helm, Doug; Mentzer, Steven J; D'Amato, Robert J; Murphy, George F; Konerding, Moritz A; Orgill, Dennis P

2012-01-01

307

[Liver gunshot wounds].  

PubMed

The paper presents the 6 cases of liver shot wounds that were in supervision of the general surgery unit, County Hospital of Baia Mare, between the years 1990-1997. The patients were males, most of them being 20 to 30 years old. In 3 situations hunting rifles were involved, all followed by retention of metal foreign body. The wounds were plurivisceral in 5 of the 6 cases, the most frequently wounded was the right liver lobe. All the patients presented serious traumatic shock and haemorrhagic shock. Livertectomy was used in 40% of the cases being imposed by the dilacerant and transfixiant character of the wounds and also by the retention of foreign bodies in parenchime. We registered 2 demises, both in the first postoperatory hours. The paper proposes a few criteria that allow the application of a conservatory treatment:rapid favourable answer at deshocking therapy; hemodynamic stability; minimal hemoperitoneus (echographical and tomographical); absence of associated visceral wounds or, when they exist, of serious physiopathological consequences; access to performant means of imagistics. PMID:14768336

Botoi, G; Bl?jan, I; Neme?, S

2000-01-01

308

Shoelace Wound Closure for the Management of Fracture-Related Fasciotomy Wounds  

PubMed Central

Background. Compartment syndrome is a serious complication that might occur following fractures. The treatment of choice is emergent fasciotomy of all the involved muscle compartments to lower the compartment pressure. The classic management of fasciotomy wounds was split thickness skin graft. Patients and Methods. Seventeen patients with fracture-related compartment syndrome were managed by fasciotomy in the Orthopaedic Casualty Unit of our university hospital. The fractures included four femoral fractures and 13 fractures of the tibia and fibula. Results. All fasciotomy wounds healed eventually. Wound closure occurred from the corners inward. The skin closure was obtained at an overall average of 4.2 tightening sessions (range 3–7). Fracture healing occurred at an average of 15.4 weeks (range 12 to 22 weeks). No major complications were encountered in this series. Conclusion. Closure of fasciotomy wounds by dermatotraction could be performed in a staged fashion, using inexpensive equipment readily available in any standard operating room, until skin was approximated enough to heal either through delayed primary closure or secondary healing. PMID:24977081

Eid, Abdelsalam; Elsoufy, Mohamed

2012-01-01

309

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

Microsoft Academic Search

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

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

1999-01-01

310

The use of hyperspectral imaging (HSI) in wound healing  

NASA Astrophysics Data System (ADS)

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

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

2014-03-01

311

Association of Preoperative Biliary Drainage With Postoperative Outcome Following Pancreaticoduodenectomy  

PubMed Central

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

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

1999-01-01

312

Changes in Abdominal Wounds Following Treatment With Sirolimus and Steroids in a Rat Model  

Microsoft Academic Search

Wound healing complications have been observed in patients receiving sirolimus (SLR). This study examined the degree and duration of delayed healing in various protocols using SLR. Sprague-Dawley rats underwent a standard midline abdominal incision and wound closure. Groups of 6 rats each were randomized to receive different doses of SLR (2 and 5 mg\\/kg) with or without loading dose (10

M. W. Gaber; A. M. Aziz; X. Shang; R. Penmetsa; O. M. Sabek; M. R. T. Yen; L. W. Gaber; L. W. Moore; A. O. Gaber

2006-01-01

313

Pectoralis major muscle transposition for treatment of infected median sternotomy wounds  

Microsoft Academic Search

Median sternotomy, currently the standard incision in open heart procedures, is rarely complicated by wound infection, but when present, it is associated with a high morbidity and mortality. Adequate treatment can be provided by means of transposition of the pectoralis major muscle. After thorough sternal wound debridement the muscle, based on the thoraco-acromial pedicle, is transposed into the defect. From

S. J. M. Jongen; D. B. van Egmond; T. F. J. M. C. Specken; W. J. Morshuis; M. P. Carpentier Alting

1995-01-01

314

Recognizing and managing complications in blepharoplasty.  

PubMed

The goal of this article is to enhance the surgical precision and accuracy of surgeons performing upper and lower eyelid blepharoplasty. The most common blepharoplasty complications are described and how to avoid them is discussed in detail. Complications range from mild to severe and for each, preoperative measures to prevent, perioperative measures to avoid, and postoperative measures to minimize complications are detailed. After reading this article the surgeon should have a greater understanding of blepharoplasty complications and how to best manage and avoid them. PMID:24200381

Whipple, Katherine M; Korn, Bobby S; Kikkawa, Don O

2013-11-01

315

Burn wound: How it differs from other wounds?  

PubMed Central

Management of burn injury has always been the domain of burn specialists. Since ancient time, local and systemic remedies have been advised for burn wound dressing and burn scar prevention. Management of burn wound inflicted by the different physical and chemical agents require different regimes which are poles apart from the regimes used for any of the other traumatic wounds. In extensive burn, because of increased capillary permeability, there is extensive loss of plasma leading to shock while whole blood loss is the cause of shock in other acute wounds. Even though the burn wounds are sterile in the beginning in comparison to most of other wounds, yet, the death in extensive burns is mainly because of wound infection and septicemia, because of the immunocompromised status of the burn patients. Eschar and blister are specific for burn wounds requiring a specific treatment protocol. Antimicrobial creams and other dressing agents used for traumatic wounds are ineffective in deep burns with eschar. The subeschar plane harbours the micro-organisms and many of these agents are not able to penetrate the eschar. Even after complete epithelisation of burn wound, remodelling phase is prolonged. It may take years for scar maturation in burns. This article emphasizes on how the pathophysiology, healing and management of a burn wound is different from that of other wounds. PMID:23162236

Tiwari, V. K.

2012-01-01

316

Immunonutrition: Role in Wound Healing and Tissue Regeneration  

PubMed Central

Significance: The role of immunonutrition in wound healing has been an area of both interest and controversy for many years. Although deficiencies in certain nutrients have long been known to impair healing, supplementation of specific immune modulating nutrients has not consistently yielded improvements in wound healing. Still, the prospect of optimizing nutrition to assist the immune system in wound repair bears great significance in both medical and surgical fields, as the costs of wound care and repair cannot be ignored. Recent Advances: Recent studies have rekindled efforts to elucidate the roles of specific immunonutrients, and we now have a better understanding of the conditionally essential role of various nutrients such as arginine, which becomes essential in certain clinical situations such as for the trauma patient or patients at high risk for malnutrition. Immunonutrition in its current formulation usually includes supplementation with arginine, glutamine, omega-3 fatty acids, vitamins, and trace minerals, and its use has often been associated with decreased infectious complications and sometimes with improvements in wound healing. Critical Issues: A key to understanding the role of immunonutrition in wound healing is recognizing the distinct contributions and importance of the various elements utilized. Future Directions: Critical areas for future study include identifying the specific populations, timing, and ideal composition of immunomodulating diets in order to optimize the wound healing process. PMID:24761344

Chow, Oliver; Barbul, Adrian

2014-01-01

317

Hyperspectral characterization of an in vitro wound model  

NASA Astrophysics Data System (ADS)

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

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

2014-03-01

318

Anaesthetic complications in plastic surgery.  

PubMed

Anaesthesia related complications in plastic surgeries are fortunately rare, but potentially catastrophic. Maintaining patient safety in the operating room is a major concern of anaesthesiologists, surgeons, hospitals and surgical facilities. Circumventing preventable complications is essential and pressure to avoid these complications in cosmetic surgery is increasing. Key aspects of patient safety in the operating room are outlined, including patient positioning, airway management and issues related to some specific conditions, essential for minimizing post-operative morbidity. Risks associated with extremes of age in the plastic surgery population, may be minimised by a better understanding of the physiologic changes as well as the pre-operative and post-operative considerations in caring for this special group of patients. An understanding of the anaesthesiologist's concerns during paediatric plastic surgical procedures can facilitate the coordination of efforts between the multiple services involved in the care of these children. Finally, the reader will have a better understanding of the perioperative care of unique populations including the morbidly obese and the elderly. Attention to detail in these aspects of patient safety can help avoid unnecessary complication and significantly improve the patients' experience and surgical outcome. PMID:24501480

Nath, Soumya Sankar; Roy, Debashis; Ansari, Farrukh; Pawar, Sundeep T

2013-05-01

319

[Dressing and wound care pain].  

PubMed

Wound care is an important step for promoting wound healing. Nevertheless it is also a major source of pain for patients with wounds. The results of a survey showed that not only burn patients but also non-burn ones suffered from wound care pain which occurred in inpatients and outpatients. One of the significant factors causing wound care pain was that the dressing adhered to the wound bed. Although some agencies claimed that particular dressings with low adhesion can result in painless removal, the actual effects needed to be verified. Results of clinical trials revealed that for relieving wound care pain of certain kinds of wound, it was recommended to use particular dressings, such as banana leaf dressing, boiled potato peel bandage, Acticoat, Mepital or Mefix. PMID:17160873

Chin, Yen-Fan

2006-12-01

320

Postoperative pulmonary infections  

PubMed Central

Introduction Postoperative pulmonary infections are associated with cough, phlegm, shortness of breath, chest pain, temperature above 38°C, and pulse rate above 100 a minute. Up to half of people may have asymptomatic chest signs after surgery, and up to a quarter develop symptomatic disease. The main risk factor is the type of surgery, with higher risks associated with surgery to the chest, abdomen, and head and neck compared with other operations. Other risk factors include age over 50 years, chronic obstructive pulmonary disease (COPD), smoking, hypoalbuminaemia, and being functionally dependent. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of interventions to prevent postoperative pulmonary infections? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2007 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 17 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: advice to stop smoking preoperatively, anaesthesia, lung expansion techniques, and postoperative nasogastric decompression. PMID:19445796

2008-01-01

321

Spiral wound extraction cartridge  

DOEpatents

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

Wisted, Eric E. (Apple Valley, MN); Lundquist, Susan H. (White Bear Township, MN)

1999-01-01

322

Spiral wound extraction cartridge  

DOEpatents

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

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

1999-04-27

323

Diabetic Wound Care  

MedlinePLUS

What is a Diabetic Foot Ulcer? A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes and ... the foot. Of those who develop a foot ulcer, 6 percent will be hospitalized due to infection ...

324

Stress and Wound Healing  

Microsoft Academic Search

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

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

2006-01-01

325

Healing Invisible Wounds  

ERIC Educational Resources Information Center

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

Adams, Erica J.

2010-01-01

326

Thirty-day complications after laparoscopic or open cholecystectomy: a population-based cohort study in Italy  

PubMed Central

Objective The objective of the study is to evaluate short-term complications after laparoscopic (LC) or open cholecystectomy (OC) in patients with gallstones by using linked hospital discharge data. Design Population-based cohort study. Setting Data were obtained from the Regional Hospital Discharge Registry Lazio Region in Central Italy (around 5 million inhabitants) in 2007–2008. Participants All patients admitted to hospitals of Lazio with symptomatic gallstones (International Classification of disease, 9th Revision, Clinical Modification (ICD-9-CM)=574) who underwent LC (ICD-9-CM 51.23) or OC (ICD-9-CM 51.22). Outcome measures (1)‘30-day surgical-related complications’ defined as any complication of the biliary tract (including postoperative infection, haemorrhage or haematoma or seroma complicating a procedure, persistent postoperative fistula, perforation of bile duct and disruption of wound). (2) ‘30-day systemic complications’ defined as any complications of other organs (including sepsis, infections from other organs, major cardiovascular events and selected adverse events). Results 13?651 patients were included; 86.1% had LC, 13.9% OC. 2.0% experienced surgical-related complications (SRC), 2.1% systemic complications (SC). The OR of complications after LC versus OC was 0.60 (p<0.001) for SRC and 0.52 (p<0.001) for SC. In relation to SRC, the advantage of LC was consistent across age categories, severity of gallstones and previous upper abdominal surgery, whereas there was no advantage among people with emergency admission (OR=0.94, p=0.764). For SC, no significant advantage of LC was seen among very old people (OR=0.99, p=0.975) and among those with previous upper abdominal surgery (OR=0.86, p=0.905). Conclusions This large observational study confirms that LC is more effective than OC with respect to 30-day complications. Population-based linkage of administrative datasets can enlarge evidence of treatment benefits in clinical practice. PMID:23408075

Agabiti, Nera; Stafoggia, Massimo; Davoli, Marina; Fusco, Danilo; Barone, Anna Patrizia; Perucci, Carlo Alberto

2013-01-01

327

Endoscopic treatment of Crohn's complications.  

PubMed

The progression to fistula and strictures is part of the natural history of Crohn's disease (CD) and these complications negatively affect the quality of life of CD patients. Surgery is the traditional treatment of CD strictures. However, due the chronicity of the inflammatory process and the associated fibrosis, postoperative recurrence occurs frequently. The lack of specific drug to treat fibrotic strictures and their irreversible nature has drawn the attention to less invasive and bowel-sparing therapeutic modalities. Endoluminal therapies may provide effective option in relieving symptoms associated with CD complications and reduce the need for repeated surgery with substantial clinical benefit. This review will discuss the current use and efficacy of the endoscopic treatment of CD complications. New endoscopic modalities and recent advances will be also evaluated. PMID:24849124

Buda, Andrea; Okolo, Patrick I

2014-11-01

328

The effect of postoperative intravenous feeding (TPN) on outcome following major surgery evaluated in a randomized study.  

PubMed Central

Three hundred patients undergoing major general surgical procedures were randomized by means of a computer-assisted algorithm to receive either total parenteral nutrition (TPN) from the first postoperative day or only prolonged glucose administration (250-300 g/day) up to 15 days after operation. All patients receiving TPN were treated individually based on daily measurements of energy and nitrogen balances. The treatment goal was to keep the patients in positive energy balance (+20%) and close to nitrogen balance. The effects of the two "nutrition regimens" on outcome such as mortality rate, complications, the need of additional medical support and patient-related functional disabilities were investigated. No selection of patients was made, that is, malnourished patients were also randomized. There were no differences among TPN versus glucose treatment when results were analyzed according to intent to treat. Approximately 60% of all patients were able to start eating within 8 to 9 days after operation. No differences were observed between such patients regardless of being treated with TPN or glucose only. Patients on glucose treatment during 14 days had a significantly higher mortality rate (p < 0.05) than patients on either continuous and uncomplicated TPN treatment or short-term glucose treatment. Similar results for mortality rates also were seen with regard to severe complications (cardiopulmonary problems, sepsis, and wound-healing insufficiencies), functional disturbances, the need of additional medical support, and abnormalities in nutritional state. Twenty per cent of the patients randomized to TPN treatment showed a statistical trend (p < 0.10) toward a higher mortality rate (36%) compared with patients randomized to prolonged glucose treatment (21% mortality rate). These patients could not be identified by evaluation of preoperative factors. Thus, the overall evaluation of the results makes it likely that a fraction of high-risk patients (approximately 20%) were not doing well on immediate postoperative intravenous feeding, and it is possible that TPN to such patients accentuated their morbidity rate. Although patients (20%) on prolonged semi-starvation (14 days glucose treatment) had increased mortality rate and severe complications, it was possible that undernutrition induced a slightly different complication scenario than induced by TPN in the high-risk patients. The results demonstrate that in most surgical patients (60%), postoperative semi-starvation is not a limiting factor for outcome. In remaining 40%, inadequate nutrition was associated with both increased morbidity and mortality rates. In this sense, inadequate nutrition represents both too much and too little, whereas overfeeding seemed to be a larger problem than underfeeding.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:8439216

Sandström, R; Drott, C; Hyltander, A; Arfvidsson, B; Scherstén, T; Wickström, I; Lundholm, K

1993-01-01

329

Gunshot Wound Contamination with Squirrel Tissue: Wound Care Considerations  

PubMed Central

While report of animal bites contaminating wounds is reported commonly, direct wound contamination with squirrel flesh has never been reported in the literature. The patient suffered an accidental self-inflicted gunshot wound that drove squirrel flesh and buck shot deep within his right buttock. This case outlines his hospital course and wound treatment. The patient was treated with ten days of broad spectrum antibiotics, extensive debridement of the wound in the operating room, and further treatment of the wound with a vacuum dressing system. While squirrel tissue and buckshot had to be removed from the wound on day six of the hospital stay, the patient remained afebrile without signs or symptoms of systemic illness. PMID:24851187

Maerz, Porter W.; Falgiani, Tricia B.; Hoelle, Robyn M.

2014-01-01

330

[Efficacy of oncologic surgery. Does anesthesia influence the postoperative outcome?].  

PubMed

Major surgical interventions in tumour surgery are still associated with perioperative cardiopulmonary, infectious, thromboembolic, cerebral, and gastrointestinal complications. There are different prophylactic and therapeutic possibilities to anticipate or counteract these perioperative complications. The most important, including beta blockers and alpha-2-agonists for patients at coronary risk, preoperative optimisation of oxygen transport in high risk surgical patients and the concept of multimodal perioperative therapy (analgesia, early mobilisation, early enteral nutrition, and others) combined with high perioperative inspiratory oxygen concentration and maintenance of normothermia to reduce wound infection and cardiac complications are described in this paper. PMID:11370395

Möllhoff, T; Buerkle, H; Van Aken, H; Brodner, G

2001-04-01

331

Removal of adhesive wound dressing and its effects on the stratum corneum of the skin: comparison of eight different adhesive wound dressings.  

PubMed

In recent years, adhesive wound dressings have been increasingly applied postoperatively because of their ease of use as they can be kept in place without having to cut and apply surgical tapes and they can cover a wound securely. However, if a wound dressing strongly adheres to the wound, a large amount of stratum corneum is removed from the newly formed epithelium or healthy periwound skin. Various types of adhesives are used on adhesive wound dressings and the extent of skin damage depends on how much an adhesive sticks to the wound or skin surface. We quantitatively determined and compared the amount of stratum corneum removed by eight different wound dressings including polyurethane foam using acrylic adhesive, silicone-based adhesive dressing, composite hydrocolloid and self-adhesive polyurethane foam in healthy volunteers. The results showed that wound dressings with silicone adhesive and self-adhesive polyurethane foam removed less stratum corneum, whereas composite hydrocolloid and polyurethane foam using acrylic adhesive removed more stratum corneum. PMID:22883604

Matsumura, Hajime; Imai, Ryutaro; Ahmatjan, Niyaz; Ida, Yukiko; Gondo, Masahide; Shibata, Dai; Wanatabe, Katsueki

2014-02-01

332

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

PubMed

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

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

2012-07-01

333

Effect of propolis on mast cells in wound healing.  

PubMed

Wound healing is divided into three phases: inflammatory, proliferative and remodeling. Mast cells participate in all these phases. The aim of the present study was to determine the effects of propolis on the population of mast cells in oral surgical wounds in comparison to the results obtained with dexamethasone. This study was prospective, in vivo, randomized, semiexperimental, quantitative and comparative animal. A circular surgical wound was made on the dorsum of the tongue of 90 hamsters divided into three experimental groups: topical application of 30% propolis alcoholic extract (Group 1); 0.1% dexamethasone in orabase cream (Group 2); and orabase cream alone (Group 3). Applications were performed every 12 h throughout the experiment. The postoperative times for killing of the animals were 1, 3, 7, 14 and 28 days. The Student's t test for independent samples was employed in the statistical analysis. In the inflammatory phase of healing, propolis caused a greater reduction in the number of mast cells on the edge and in the central region of the surgical wound in comparison to dexamethasone. Moreover, the number of mast cells on day 1 was lower in the central region of the wounds treated with the orabase cream alone in comparison to dexamethasone. In conclusion, the anti-inflammatory action of propolis mediated by mast cells was more effective than dexamethasone in the inflammatory phase of healing. PMID:22179947

Barroso, Poliana Ribeiro; Lopes-Rocha, Ricardo; Pereira, Everton Miguel Ferreira; Marinho, Sandra Aparecida; de Miranda, João Luiz; Lima, Nádia Lages; Verli, Flaviana Dornela

2012-10-01

334

Office management of minor wounds.  

PubMed Central

OBJECTIVE: To review office interventions for minor wounds not requiring sutures, such as abrasions, bites, and lacerations. QUALITY OF EVIDENCE: Most information on minor wound management comes from descriptive studies. Few comparative studies examine the effectiveness of topical antisepsis for minor wounds. Several clinical trials have demonstrated that tissue adhesives produce short- and long-term cosmetic results equivalent to those achieved with suture materials. MAIN MESSAGE: Sterile saline is the least toxic solution for wound irrigation. Chlorhexidine (2%) and povidone iodine (10%) have been the most investigated antiseptic solutions. Systemic antibiotics are unnecessary for wounds unlikely to be infected. All bite wounds require special attention. Primary closure of bite wounds is indicated in certain circumstances: less than 12-hour-old nonpuncture wounds, uninfected wounds, and low-risk lesions (such as on the face). In spite of their many advantages, skin tapes should be used for low-tension wounds only. The popularity of tissue adhesives has greatly increased. Since the advent of newer products (with increased bonding strength and flexibility), adhesives are used to manage most lacerations except those in areas of high tension (e.g., joints) and on mucosal surfaces. CONCLUSION: Minor wounds not requiring sutures can be managed easily in the office. PMID:11340758

Gouin, S.; Patel, H.

2001-01-01

335

Reconstructive challenges in war wounds  

PubMed Central

War wounds are devastating with extensive soft tissue and osseous destruction and heavy contamination. War casualties generally reach the reconstructive surgery centre after a delayed period due to additional injuries to the vital organs. This delay in their transfer to a tertiary care centre is responsible for progressive deterioration in wound conditions. In the prevailing circumstances, a majority of war wounds undergo delayed reconstruction, after a series of debridements. In the recent military conflicts, hydrosurgery jet debridement and negative pressure wound therapy have been successfully used in the preparation of war wounds. In war injuries, due to a heavy casualty load, a faster and reliable method of reconstruction is aimed at. Pedicle flaps in extremities provide rapid and reliable cover in extremity wounds. Large complex defects can be reconstructed using microvascular free flaps in a single stage. This article highlights the peculiarities and the challenges encountered in the reconstruction of these ghastly wounds. PMID:23162233

Bhandari, Prem Singh; Maurya, Sanjay; Mukherjee, Mrinal Kanti

2012-01-01

336

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

NASA Astrophysics Data System (ADS)

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

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

1997-12-01

337

Complications following Surgery for Lumbar Stenosis in a Veteran Population  

PubMed Central

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

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

2013-01-01

338

Preoperative planning and postoperative imaging in shoulder arthroplasty.  

PubMed

The number of shoulder arthroplasties performed in the United States has more than doubled in the last decade. Additionally, there has been a trend toward use of reverse total shoulder arthroplasty and minimally invasive surgical techniques, such as resurfacing humeral head arthroplasty. Thus radiologists will more frequently encounter imaging of shoulder arthroplasty and these new designs. Successful postoperative radiologic evaluation of shoulder reconstructions requires an understanding of their fundamental hardware design, physiologic objective, preoperative imaging assessment, normal postoperative radiologic appearance, and findings and types of complication. This article discusses the designs of prostheses used around the shoulder joint, delineates indications and alternatives for each of the different types of hardware, reviews radiographic and cross-sectional preoperative imaging of shoulder arthroplasty, illustrates normal postoperative imaging findings and measurements, and provides examples of hardware complications. PMID:25184399

Petscavage-Thomas, Jonelle

2014-09-01

339

The effect of cephalothin prophylaxis on postoperative ventriculoperitoneal shunt infections.  

PubMed Central

Postoperative infection is an important complication after insertion of a ventriculoperitoneal (VP) shunt in children with hydrocephalus. A randomized double-blind placebo-controlled study was performed to determine the efficacy of cephalothin in preventing postoperative shunt infection. Sixty-three children who presented for elective VP shunt insertion between January 1982 and December 1985 and who did not have a history of shunt infections were randomly assigned to receive four doses of prophylactic cephalothin, 25 mg/kg (32 patients), or of a multivitamin placebo (31 patients). Postoperative infection developed in 6% of the treatment group, compared with 10% of the placebo group, a difference that was not statistically significant, although a clinical significance may have been masked by the small sample size. A large multicentre trial is needed to determine the efficacy of antibiotic prophylaxis in reducing the incidence of postoperative VP shunt infections. PMID:3552176

Rieder, M J; Frewen, T C; Del Maestro, R F; Coyle, A; Lovell, S

1987-01-01

340

The role of postoperative factors in surgical site infections: time to take notice.  

PubMed

Surgical site infections (SSIs) continue to occur, in many instances despite high compliance with best practice measures primarily revolving around pre- and intraoperative periods. Postoperative factors have traditionally been considered to play a relatively minor role in the causation of SSIs. An increasing body of evidence, however, suggests that many SSIs occur as a result of pathogens gaining access to surgical wounds either hematogenously, through drains, or through slowly healing wounds due to systemic anticoagulation or other factors, particularly in the setting of high compliance with standard perioperative antibiotic prophylaxis. Evidence also supports frequent acquisition of methicillin-resistant Staphylococcus aureus (MRSA) during the postoperative period. These findings, coupled with lack of clear efficacy of various pre- and intraoperative interventions such as MRSA decolonization and use of vancomycin for prophylaxis against this organism, should force us to consider the important role that postoperative factors may play in the causation of SSIs in the current era. PMID:25028464

Manian, Farrin A

2014-11-01

341

Antimicrobial Activity of Artemisia absinthium Against Surgical Wounds Infected by Staphylococcus aureus in a Rat Model.  

PubMed

The wound infection is one of the frequent complications in patients undergoing surgical operations. Staphylococcus aureus is the most common cause of surgical wounds. Artemisia absinthium has been shown to bear strong antimicrobial activity, especially against Gram-positive pathogens. This study was designed to investigate the antimicrobial effects of A. absinthium against surgical wounds infected by S. aureus in a rat model. Twenty male Sprague-Dawley rats were divided randomly into two equal groups of treated and control rats. A circular incision was created on the dorsal inter-scapular region of each rat. After skin wounding, rats were inoculated locally with 1 × 10(4) CFU of S. aureus at sites of skin wounds. The extract was applied topically twice a day throughout the experiment. Animals of the control group were left untreated. Results have revealed that topical application of A. absinthium extract on the infected wound sites produced significant antibacterial activity against S. aureus. PMID:24293717

Moslemi, Hamid Reza; Hoseinzadeh, Hesamoddin; Badouei, Mahdi Askari; Kafshdouzan, Khatereh; Fard, Ramin Mazaheri Nezhad

2012-12-01

342

Complications of surgery for radiotherapy skin damage  

SciTech Connect

Complications of modern surgery for radiotherapy skin damage reviewed in 28 patients who had 42 operations. Thin split-thickness skin grafts for ulcer treatment had a 100 percent complication rate, defined as the need for further surgery. Local flaps, whether delayed or not, also had a high rate of complications. Myocutaneous flaps for ulcers had a 43 percent complication rate, with viable flaps lifting off radiated wound beds. Only myocutaneous flaps for breast reconstruction and omental flaps with skin grafts and Marlex mesh had no complications. The deeper tissue penetration of modern radiotherapy techniques may make skin grafts and flaps less useful. In reconstruction of radiation ulcers, omental flaps and myocutaneous flaps are especially useful, particularly if the radiation damage can be fully excised. The pull of gravity appears detrimental to myocutaneous flap healing and, if possible, should be avoided by flap design.

Rudolph, R.

1982-08-01

343

Serpina3n accelerates tissue repair in a diabetic mouse model of delayed wound healing  

PubMed Central

Chronic, non-healing wounds are a major complication of diabetes and are characterized by chronic inflammation and excessive protease activity. Although once thought to function primarily as a pro-apoptotic serine protease, granzyme B (GzmB) can also accumulate in the extracellular matrix (ECM) during chronic inflammation and cleave ECM proteins that are essential for proper wound healing, including fibronectin. We hypothesized that GzmB contributes to the pathogenesis of impaired diabetic wound healing through excessive ECM degradation. In the present study, the murine serine protease inhibitor, serpina3n (SA3N), was administered to excisional wounds created on the dorsum of genetically induced type-II diabetic mice. Wound closure was monitored and skin wound samples were collected for analyses. Wound closure, including both re-epithelialization and contraction, were significantly increased in SA3N-treated wounds. Histological and immunohistochemical analyses of SA3N-treated wounds revealed a more mature, proliferative granulation tissue phenotype as indicated by increased cell proliferation, vascularization, fibroblast maturation and differentiation, and collagen deposition. Skin homogenates from SA3N-treated wounds also exhibited greater levels of full-length intact fibronectin compared with that of vehicle wounds. In addition, GzmB-induced detachment of mouse embryonic fibroblasts correlated with a rounded and clustered phenotype that was prevented by SA3N. In summary, topical administration of SA3N accelerated wound healing. Our findings suggest that GzmB contributes to the pathogenesis of diabetic wound healing through the proteolytic cleavage of fibronectin that is essential for normal wound closure, and that SA3N promotes granulation tissue maturation and collagen deposition. PMID:25299783

Hsu, I; Parkinson, L G; Shen, Y; Toro, A; Brown, T; Zhao, H; Bleackley, R C; Granville, D J

2014-01-01

344

Serpina3n accelerates tissue repair in a diabetic mouse model of delayed wound healing.  

PubMed

Chronic, non-healing wounds are a major complication of diabetes and are characterized by chronic inflammation and excessive protease activity. Although once thought to function primarily as a pro-apoptotic serine protease, granzyme B (GzmB) can also accumulate in the extracellular matrix (ECM) during chronic inflammation and cleave ECM proteins that are essential for proper wound healing, including fibronectin. We hypothesized that GzmB contributes to the pathogenesis of impaired diabetic wound healing through excessive ECM degradation. In the present study, the murine serine protease inhibitor, serpina3n (SA3N), was administered to excisional wounds created on the dorsum of genetically induced type-II diabetic mice. Wound closure was monitored and skin wound samples were collected for analyses. Wound closure, including both re-epithelialization and contraction, were significantly increased in SA3N-treated wounds. Histological and immunohistochemical analyses of SA3N-treated wounds revealed a more mature, proliferative granulation tissue phenotype as indicated by increased cell proliferation, vascularization, fibroblast maturation and differentiation, and collagen deposition. Skin homogenates from SA3N-treated wounds also exhibited greater levels of full-length intact fibronectin compared with that of vehicle wounds. In addition, GzmB-induced detachment of mouse embryonic fibroblasts correlated with a rounded and clustered phenotype that was prevented by SA3N. In summary, topical administration of SA3N accelerated wound healing. Our findings suggest that GzmB contributes to the pathogenesis of diabetic wound healing through the proteolytic cleavage of fibronectin that is essential for normal wound closure, and that SA3N promotes granulation tissue maturation and collagen deposition. PMID:25299783

Hsu, I; Parkinson, L G; Shen, Y; Toro, A; Brown, T; Zhao, H; Bleackley, R C; Granville, D J

2014-01-01

345

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

PubMed

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

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

2014-07-01

346

Detection of postoperative granulation tissue with an ICG-enhanced integrated OI\\/X-ray System  

Microsoft Academic Search

BACKGROUND: The development of postoperative granulation tissue is one of the main postoperative risks after lumbar spine surgery. This granulation tissue may lead to persistent or new clinical symptoms or complicate a follow up surgery. A sensitive non-invasive imaging technique, that could diagnose this granulation tissue at the bedside, would help to develop appropriate treatments. Thus, the purpose of this

Reinhard Meier; Sophie Boddington; Christian Krug; Frank L Acosta; Daniel Thullier; Tobias D Henning; Elizabeth J Sutton; Sidhartha Tavri; Jeffrey C Lotz; Heike E Daldrup-Link

2008-01-01

347

Selective Management of Posterior Stab Wounds  

PubMed Central

Selective management of 473 patients with stab wounds limited to the posterior abdomen was reviewed. This group was composed of predominantly young, healthy men. Laporotomy was based primarily on clinical findings. Tenderness, not localized to the area of injury, or absent or rare bowel sounds best identified patients with serious injuries. Omental protrusion was frequently associated with significant organ injury. Peritoneal lavage and local wound exploration were used infrequently. All patients with fatal injuries were operated on or died within four hours of admission. Diagnosis was delayed in five serious injuries: one diaphragmatic, three retroperitoneal colon perforations and one duodenal injury, all of which were identified and treated successfully in the initial hospital admission without any complications. Seventy-six percent of the patients never required surgery. Sixteen percent of all patients had significant organ injury, and six percent had “nonessential” laporotomy. Overall morbidity was 12 percent and mortality was 1.1 percent. The colon, liver, diaphragm, and kidneys were the most common organs injured. Thus, clinical assessment alone is a reliable means of selectively managing patients with posterior abdominal stab wounds. PMID:3573058

Ocampo, H.; Yamaguchi, M.; Mackabee, J.; Ordog, G.; Fleming, A.

1987-01-01

348

Mucormycosis of a median sternotomy wound.  

PubMed

Mucormycosis is an unusual complication of cardiothoracic surgery. The fungi may infect the sternotomy wound causing a progressive gangrene or seed the implanted prosthetic valve or graft resulting in endocarditis or graft failure. There have been six previous reports of mucormycosis following cardiothoracic surgical procedures. Four cases involved prosthetic devices, the remaining two are examples of sternal wound mucormycosis acquired from the use of contaminated elasticized bandages. The first case of sternal wound mucormycosis not associated with elasticized bandages is reported here. The infection occurred in a diabetic patient who had undergone coronary artery bypass surgery and mitral valve replacement. The patient received corticosteroids and broad-spectrum antibiotics at the time of and after operation. The patient developed invasive sternal mucormycosis and died on day 10 after surgery, despite aggressive surgical débridement and amphotericin B therapy. No elasticized bandages were used and the source of the infection was not identified. Previous cases of mucormycosis in cardiothoracic surgery are reviewed and the specific clinical setting in which this fungal disease should be suspected defined. PMID:7953452

Abter, E I; Lutwick, S M; Chapnick, E K; Chittivelu, S; Lutwick, L I; Sabado, M; Jacobowitz, I

1994-08-01

349

Proteases and Delayed Wound Healing  

PubMed Central

Significance Proteases and their inhibitors contribute to the balance between extracellular matrix (ECM) degradation and deposition, creating an equilibrium that is essential for the timely and coordinated healing of cutaneous wounds. However, when this balance is disrupted, wounds are led into a state of chronicity characterized by abundant levels of proteases and decreased levels of protease inhibitors. Recent Advances Researchers have sought to investigate the roles of proteases within both acute and chronic wounds and how the manipulation of protease activity may aid healing. Indeed, numerous wound dressings have been developed that target such proteases in an attempt to promote wound healing. Critical Issues The normal tissue response to injury involves a complex interaction between cells and cellular mediators. In particular, the inflammatory response is augmented in chronic wounds which are characterized by elevated levels of proinflammatory cytokines and proteases. While controlling levels of inflammation and protease expression is a critical part of normal wound healing, elevated and prolonged expression of proteases produced during the inflammatory phase of healing can lead to excessive ECM degradation associated with impaired healing. Future Directions It seems plausible that future research should aim to investigate the ways in which proteases may be targeted as an alternative therapeutic approach to wound management and to assess the benefits and draw-backs of utilizing wound fluids to assess wound progression in terms of proteolytic activity. PMID:24688830

McCarty, Sara M.; Percival, Steven L.

2013-01-01

350

Corneal wound healing following laser in situ keratomileusis (LASIK): a histopathological study in rabbits  

Microsoft Academic Search

AIMSTo investigate the histopathological changes of rabbit corneas after laser in situ keratomileusis (LASIK) and to evaluate the corneal wound healing process.METHODSA LASIK was performed on white rabbit eyes. Postoperatively, rabbits were killed on days 1 and 7, and at 1, 3, and 9 months.RESULTSPeriodic acid Schiff (PAS) positive material and disorganised collagen fibre were seen along the interface of

Takuji Kato; Kiyoo Nakayasu; Yuji Hosoda; Yasuo Watanabe; Atsushi Kanai

1999-01-01

351

Mobilised bone marrow-derived cells accelerate wound healing.  

PubMed

Massive skin defects caused by severe burn and trauma are a clinical challenge to surgeons. Timely and effective wound closure is often hindered by the lack of skin donor site. Bone marrow-derived cells (BMDCs) have been shown to 'differentiate' into multiple tissue cells. In this study we focused on the direct manipulation of endogenous BMDCs, avoiding the immunocompatibility issues and complicated cell isolation, purification, identification and amplification procedures in vitro on wound repair. We found that mobilisation of the BMDCs into the circulation significantly increased the amount of BMDCs at the injury site which in turn accelerated healing of large open wound. We used a chimeric green fluorescent protein (GFP) mouse model to track BMDCs and to investigate their role in full-thickness skin excisional wounds. We have shown that bone marrow mobilisation by granulocyte colony stimulating factor (G-CSF) exerted multiple beneficial effects on skin repair, both by increasing the engraftment of BMDCs into the skin to differentiate into multiple skin cell types and by upregulating essential cytokine mRNAs critical to wound repair. The potential trophic effects of G-CSF on bone marrow stem cells to accelerate wound healing could have a significant clinical impact. PMID:22734442

Wang, Yu; Sun, Yu; Yang, Xiao-Yan; Ji, Shi-Zhao; Han, Shu; Xia, Zhao-Fan

2013-08-01

352

Wounding, wound healing and staining of mature pear fruit  

Microsoft Academic Search

Incidence of wounding in commercially-harvested `d'Anjou' and `Bosc' pear fruit, healing of wounds to decrease decay caused by Botrytis cinerea, Mucor piriformis, Penicillium expansum, and Penicillium solitum at ?1°C, 20°C, and 28°C, and formation of compounds potentially involved in resistance were determined. Use of a blue food coloring to make wounds on fruit more visible on packinghouse lines was evaluated.

Robert A Spotts; Peter G Sanderson; Cheryl L Lennox; David Sugar; Louis A Cervantes

1998-01-01

353

Incidence and management of complications after neoadjuvant chemotherapy followed by extrapleural pneumonectomy for malignant pleural mesothelioma  

Microsoft Academic Search

Objective: To investigate the incidence and management of postoperative complications after neoadjuvant chemotherapy followed by extrapleural pneumonectomy for malignant pleural mesothelioma. Methods: Patients with histologically proven mesothelioma of clinical stages T1–3, N0–2, M0 and considered to be completely resectable received neoadjuvant chemotherapy (cisplatin+gemcitabine or cisplatin+pemetrexed) followed by extrapleural pneumonectomy and postoperative radiotherapy. The incidence and management of postoperative complications in

Isabelle Opitz; Peter Kestenholz; Didier Lardinois; Michael Müller; Valentin Rousson; Didier Schneiter; Rolf Stahel; Walter Weder

2006-01-01

354

Complications in hair-restoration surgery.  

PubMed

Most complications associated with hair restoration are completely preventable and arise from variables that are directly controlled by the surgeon and the patient. Physicians who thoroughly grasp the nuances of modern surgical techniques and fully understand the physiologic dynamics of the balding process are least likely to generate a physician-controlled error. Highly motivated, well-educated patients who carefully follow instructions and take an active role in the postoperative recovery process minimize the chance of patient-controlled errors. This article discusses potential complications associated with surgical hair restoration, and the roles of the patient and physician in minimizing the risk of complications. PMID:24017992

Konior, Raymond J

2013-08-01

355

Early respiratory complications after liver transplantation.  

PubMed

The poor clinical conditions associated with end-stage cirrhosis, pre-existing pulmonary abnormalities, and high comorbidity rates in patients with high Model for End-Stage Liver Disease scores are all well-recognized factors that increase the risk of pulmonary complications after orthotopic liver transplantation (OLT) surgery. Many intraoperative and postoperative events, such as fluid overload, massive transfusion of blood products, hemodynamic instability, unexpected coagulation abnormalities, renal dysfunction, and serious adverse effects of reperfusion syndrome, are other factors that predispose an individual to postoperative respiratory disorders. Despite advances in surgical techniques and anesthesiological management, the lung may still suffer throughout the perioperative period from various types of injury and ventilatory impairment, with different clinical outcomes. Pulmonary complications after OLT can be classified as infectious or non-infectious. Pleural effusion, atelectasis, pulmonary edema, respiratory distress syndrome, and pneumonia may contribute considerably to early morbidity and mortality in liver transplant patients. It is of paramount importance to accurately identify lung disorders because infectious pulmonary complications warrant speedy and aggressive treatment to prevent diffuse lung injury and the risk of evolution into multisystem organ failure. This review discusses the most common perioperative factors that predispose an individual to postoperative pulmonary complications and these complications' early clinical manifestations after OLT and influence on patient outcome. PMID:24409054

Feltracco, Paolo; Carollo, Cristiana; Barbieri, Stefania; Pettenuzzo, Tommaso; Ori, Carlo

2013-12-28

356

Early respiratory complications after liver transplantation  

PubMed Central

The poor clinical conditions associated with end-stage cirrhosis, pre-existing pulmonary abnormalities, and high comorbidity rates in patients with high Model for End-Stage Liver Disease scores are all well-recognized factors that increase the risk of pulmonary complications after orthotopic liver transplantation (OLT) surgery. Many intraoperative and postoperative events, such as fluid overload, massive transfusion of blood products, hemodynamic instability, unexpected coagulation abnormalities, renal dysfunction, and serious adverse effects of reperfusion syndrome, are other factors that predispose an individual to postoperative respiratory disorders. Despite advances in surgical techniques and anesthesiological management, the lung may still suffer throughout the perioperative period from various types of injury and ventilatory impairment, with different clinical outcomes. Pulmonary complications after OLT can be classified as infectious or non-infectious. Pleural effusion, atelectasis, pulmonary edema, respiratory distress syndrome, and pneumonia may contribute considerably to early morbidity and mortality in liver transplant patients. It is of paramount importance to accurately identify lung disorders because infectious pulmonary complications warrant speedy and aggressive treatment to prevent diffuse lung injury and the risk of evolution into multisystem organ failure. This review discusses the most common perioperative factors that predispose an individual to postoperative pulmonary complications and these complications’ early clinical manifestations after OLT and influence on patient outcome. PMID:24409054

Feltracco, Paolo; Carollo, Cristiana; Barbieri, Stefania; Pettenuzzo, Tommaso; Ori, Carlo

2013-01-01

357

Pancreaticodigestive anastomosis and the postoperative management strategies to prevent postoperative pancreatic fistula formation after pancreaticoduodenectomy.  

PubMed

Over the past 100 years, advances in surgical techniques and perioperative management have reduced the morbidity and mortality after pancreaticoduodenectomy (PD). Many techniques have been proposed for the reconstruction of the pancreaticodigestive anastomosis to prevent the development of a postoperative pancreatic fistula (POPF), but which is the best approach is still highly debated. We carried out a systematic review to determine and compare the effectiveness of various methods of anastomosis after PD. A meta-analysis and most randomized controlled trials (RCTs) showed that the mortality, POPF rate and incidence of other postoperative complications were not statistically different between the pancreaticogastrostomy and pancreaticojejunostomy (PJ) groups. One RCT showed that a binding PJ significantly decreased the risk of POPF and other postoperative complications compared with conventional PJ. External duct stenting reduced the risk of clinically relevant POPF in a meta-analysis and RCTs. The prophylactic use of octreotide after PD does not result in a reduced incidence of POPF. In conclusion, our findings suggest that the successful management of pancreatic anastomoses may depend more on the meticulous surgical technique, surgical volume, and other management parameters than on the type of technique used. However, some new approaches, such as binding PJ, and the use of external stents should be considered in further RCTs. PMID:23842691

Hashimoto, Daisuke; Chikamoto, Akira; Ohmuraya, Masaki; Hirota, Masahiko; Baba, Hideo

2014-07-01

358

The management of perineal wounds  

PubMed Central

Management of perineal wounds can be very frustrating as these invariably get contaminated from the ano-genital tracts. Moreover, the apparent skin defect may be associated with a significant three dimensional dead space in the pelvic region. Such wounds are likely to become chronic and recalcitrant if appropriate wound management is not instituted in a timely manner. These wounds usually result after tumor excision, following trauma or as a result of infective pathologies like hideradenitis suppurativa or following thermal burns. Many options are available for management of perineal wounds and these have been discussed with illustrative case examples. A review of literature has been done for listing commonly instituted options for management of the wounds in perineum. PMID:23162235

Sharma, Ramesh K.; Parashar, Atul

2012-01-01

359

Pharmacological management of postoperative ileus.  

PubMed

The duration of postoperative ileus following abdominal surgery is quite variable, and prolonged postoperative ileus is an iatrogenic phenomenon with important influence on patient morbidity, hospital costs and length of stay in hospital. Adequate treatment for prolonged postoperative ileus is important to improve patient morbidity and clinical efficiency. Both clinical and pharmacological management strategies have improved rapidly over the last decade, and appropriate and timely management using multimodal techniques should be used for optimal care. In this review, we define postoperative ileus, describe the pathogenesis and briefly discuss clinical management before detailing potential pharmacologic management options. PMID:19399212

Zeinali, Farhad; Stulberg, Jonah J; Delaney, Conor P

2009-04-01

360

Does cooling the tonsillar fossae during thermal welding tonsillectomy have an effect on postoperative pain and healing?  

PubMed

The objective of this study was to evaluate the effect of cooling the tonsillar fossa during thermal welding tonsillectomy on pain and wound healing. Prospective, blinded, clinical study was conducted. 30 patients who underwent tonsillectomy by thermal welding were evaluated. When one of the tonsillar fossa was cooled by isotonic fluid, the other has left untreated. Postoperative pain and mucosal healing pattern were assessed. Data were recorded and statistically analyzed. Healing process of the cooled down tonsillar fossae were significantly better on the 7th and 14th postoperative day (p < 0.01). Control tonsillar fossae had significantly higher pain scores on the 3rd, 7th and 14th postoperative day (p < 0.05). Administration of isotonic fluid, during thermal welding tonsillectomy for cooling tonsillar fossae, accelerates wound-healing process significantly and decreases tonsillectomy related pain complaints post-operatively. PMID:22843096

Tepe Karaca, Ci?dem; Celebi, Saban; Oysu, Ca?atay; Celik, Oner

2013-01-01

361

Postoperative nausea and vomiting  

PubMed Central

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

2014-01-01

362

Preparation and characterization of biodegradable anti-adhesive membrane for peritoneal wound healing.  

PubMed

Postoperative adhesions remain a significant complication of abdominal surgery although the wide variety of physical barriers has been developed to reduce the incidence of adhesion. In this study, the bilayered composite membrane formed by the association of a methoxy poly (ethylene glycol)-poly (L-lactide-co-glycolide) (mPEG-PLGA) film and a crosslinked collagen-hyaluronic acid (Col-HA) membrane with fibronectin (FN) coating was prepared for promoting wound healing and providing tissue adhesion resistance simultaneously. In vitro adhesion test revealed that fibroblasts attached better on Col-HA membrane compared to those on mPEG-PLGA film, PLGA film or Interceed (oxidized cellulose) while mPEG-PLGA film had the lowest cell adhesive property. In confocal microscopic observation, the actin filaments were significantly further polymerized when 50 or 100 microg/cm(3) fibronectin was incorporated on the COL-HA membranes. After 7-day culture, fibroblasts penetrated throughout the Col-HA-FN network and the cell density increased whereas very few cells were found attached on the surface of the mPEG-PLGA film. In vivo evaluation test showed that the composite membrane could remain during the critical period of peritoneal healing and did not provoke any inflammation or adverse tissue reaction. PMID:17334698

Park, Si-Nae; Jang, Han Jeong; Choi, Yu Suk; Cha, Jae Min; Son, Seo Yeon; Han, Seung Hun; Kim, Jung Hyun; Lee, Woo Jung; Suh, Hwal

2007-03-01

363

Short-term complications of percutaneous tracheostomy: experience of a district general hospital--otolaryngology department.  

PubMed

Percutaneous tracheostomy is a procedure frequently carried out in a critical care setting. It is performed in the majority of cases by anaesthetists in the United Kingdom. The ENT surgeon is only called in situations where it is deemed by the intensivist that percutanous tracheostomy would prove too great a risk. In this situation the patient was taken to the operating theatre for a surgical tracheostomy. In our paper, a retrospective analysis was performed of all percutaneous tracheostomies carried out by ENT surgeons in the Royal Glamorgan Hospital, during a two-year period from July 1999 to July 2001, to assess whether percutaneous tracheostomy is a feasible option as a first line procedure in all elective tracheostomies. Thirty-six patients were included in the study. The mean age was 60.2 years. Haemorrhage was noted to be a problem in only one patient and two patients developed postoperative wound infection that was treated with systemic antibiotics. No other complications were encountered. We propose that all ENT surgeons should be trained in performing percutaneous tracheostomy and that it should be used as the gold standard in elective tracheostomy insertion. In cases where difficulties are likely to be anticipated, percutaneous tracheostomy can still be considered as the first option. This can be performed in the operating theatre setting with the knowledge that if any complication should occur then conversion to surgical tracheostomy can be done without delay. PMID:12537616

Kumar, Manoj; Jaffery, Ali; Jones, Mathew

2002-12-01

364

Healing in the irradiated wound  

SciTech Connect

Poor or nonhealing of irradiated wounds has been attributed to progressive obliterative endarteritis. Permanently damaged fibroblasts may also play an important part in poor healing. Regardless of the cause, the key to management of irradiated skin is careful attention to prevent its breakdown and conservative, but adequate, treatment when wounds are minor. When wounds become larger and are painful, complete excision of the wound or ulcer is called for and coverage should be provided by a well-vascularized nonparasitic distant flap.16 references.

Miller, S.H.; Rudolph, R. (Univ. of California, San Diego (USA))

1990-07-01

365

Wound Healing and the Dressing*  

PubMed Central

The evolution of surgical dressings is traced from 1600 b.c. to a.d. 1944. The availability of an increasing variety of man-made fibres and films from 1944 onwards has stimulated work on wound dressings, and some of the more important contributions, both clinical and experimental, are discussed. The functions of a wound dressing and the properties which the ideal wound dressing should possess are given. The necessity for both histological and clinical evaluation of wound dressings in animals and in man is stressed. Wound dressings are the most commonly used therapeutic agents, but there is no means whereby their performance can be assessed. An attempt should be made either nationally or internationally to establish a standard method of assessing the performance of wound dressings. For this it is necessary to have an internationally agreed standard dressing which could be used as a reference or control dressing in all animal and human work. The only animal with skin morphologically similar to that of man is the domestic pig. Three types of wounds could be used: (1) partial-thickness wounds; (2) full-thickness excisions; and (3) third-degree burns. The development of standard techniques for the assessment of the efficiency of wound dressings would be of considerable benefit to the research worker, the medical profession, the patient, and the surgical dressings industry. PMID:13976490

Scales, John T.

1963-01-01

366

Early neurological complications of coronary artery bypass surgery  

Microsoft Academic Search

A prospective study of 312 patients undergoing elective coronary artery bypass surgery was undertaken to determine the incidence, severity, and functional impact of postoperative neurological complications. Detailed evaluation of the patients showed that neurological complications after surgery were common, occurring in 191 of the 312 patients (61%). Although such a high proportion of the total developed detectable changes, serious neurological

P J Shaw; D Bates; N E Cartlidge; D Heaviside; D G Julian; D A Shaw

1985-01-01

367

[Treatment of a patient with massive unhealed wound accompanied by wound sepsis in late stage after burn injury].  

PubMed

This article analyzed the medical records of a patient with 90% TBSA unhealed wound accompanied with wound sepsis 50 days post burn (PBD) and to discuss the ideal strategies of treatment for such patients in such condition. This was a 24-year-old male patient suffering from flame burn with 95% TBSA wound and severe inhalation injury. Meek skin grafting with autologous scalp was performed once to the thoracic and abdominal regions; intermingled skin grafting of autologous scalp microskin and large sheet of allograft was performed twice to the limbs within PBD 31. The patient was transferred to our hospital on PBD 50 with 90% TBSA wound unhealed, leaving a vast amount of necrotic tissue and allografts. Furthermore, he was complicated by sepsis, pulmonary infection, and gastric ulcer. Debridement and allogenic skin grafting were performed on the first day after hospitalization. When the condition of wounds was improved, transplantation of a large sheet of allogenic skin with inlaid small pieces of autologous skin, intermingled skin grafting of autologous and allogenic skin, and small pieces of autologous skin grafting were performed. Because of the shortage of donor area, the exposed wounds were temporarily covered with allogeneic skin. Epidermal growth factor was used to promote the healing of autologous skin donor site and deep partial-thickness burn wound. Autologous skin grafting was performed whenever source of healthy skin was available. Systemic use of effective antibiotics, nutritional support and therapy, and other comprehensive measures also contributed to the success of treatment of this patient suffering from wound sepsis. The patient was cured and discharged on PBD 145. PMID:23327916

Li, Zhi-qing; Wang, Jia-han; Wu, Qi; Yang, Lei

2012-12-01

368

Wound tube heat exchanger  

DOEpatents

What is disclosed is a wound tube heat exchanger in which a plurality of tubes having flattened areas are held contiguous adjacent flattened areas of tubes by a plurality of windings to give a double walled heat exchanger. The plurality of windings serve as a plurality of effective force vectors holding the conduits contiguous heat conducting walls of another conduit and result in highly efficient heat transfer. The resulting heat exchange bundle is economical and can be coiled into the desired shape. Also disclosed are specific embodiments such as the one in which the tubes are expanded against their windings after being coiled to insure highly efficient heat transfer.

Ecker, Amir L. (Duncanville, TX)

1983-01-01

369

Human Skin Wounds: A Major and Snowballing Threat to Public Health and the Economy  

PubMed Central

In the United States, chronic wounds affect around 6.5 million patients. It is claimed that an excess of US$25 billion is spent annually on treatment of chronic wounds and the burden is growing rapidly due to increasing health care costs, an aging population and a sharp rise in the incidence of diabetes and obesity worldwide. The annual wound care products market is projected to reach $15.3 billion by 2010. Chronic wounds are rarely seen in individuals who are otherwise healthy. In fact, chronic wound patients frequently suffer from “highly branded” diseases such as diabetes and obesity. This seems to have overshadowed the significance of wounds per se as a major health problem. For example, NIH’s Research Portfolio Online Reporting Tool (RePORT; http://report.nih.gov/), directed at providing access to estimates of funding for various disease conditions do list several rare diseases but does not list wounds. According to the latest data from the National Center for Health Statistics, 40 million inpatient surgical procedures were performed in the United States in 2000, followed closely by 31.5 million outpatient surgeries. The need for post-surgical wound care is sharply on the rise. Emergency wound care in an acute setting has major significance not only in a war setting but also in homeland preparedness against natural disasters as well as against terrorism attacks. An additional burden of wound healing is the problem of skin scarring, a $12 billion annual market. Current research advances in the field have led to solutions that have been effective in improving patient care. The immense economic and social impact of wounds in our society calls for allocation of a higher level of attention and resources to understand biological mechanisms underlying cutaneous wound complications. Investment in the detailed scrutiny of wounds presented clinically as well as in pre-clinical models seems prudent. PMID:19903300

Sen, Chandan K.; Gordillo, Gayle M.; Roy, Sashwati; Kirsner, Robert; Lambert, Lynn; Hunt, Thomas K.; Gottrup, Finn; Gurtner, Geoffrey C; Longaker, Michael T.

2009-01-01

370

Wounded Nucleons, Wounded Quarks, and Relativistic Ion Collisions  

E-print Network

A concept of wounded nucleons and/or wounded quarks plays an important role in parametrizing and to some extent explaining many a feature of the relativistic ion collisions. This will be illustrated in a historical perspective, up to and including the latest developpments.

Helena Bialkowska

2006-09-06

371

Advanced glycation end products delay corneal epithelial wound healing through reactive oxygen species generation.  

PubMed

Delayed healing of corneal epithelial wounds is a serious complication in diabetes. Advanced glycation end products (AGEs) are intimately associated with the diabetic complications and are deleterious to the wound healing process. However, the effect of AGEs on corneal epithelial wound healing has not yet been evaluated. In the present study, we investigated the effect of AGE-modified bovine serum albumin (BSA) on corneal epithelial wound healing and its underlying mechanisms. Our data showed that AGE-BSA significantly increased the generation of intracellular ROS in telomerase-immortalized human corneal epithelial cells. However, the generation of intracellular ROS was completely inhibited by antioxidant N-acetylcysteine (NAC), anti-receptor of AGEs (RAGE) antibodies, or the inhibitor of NADPH oxidase. Moreover, AGE-BSA increased NADPH oxidase activity and protein expression of NADPH oxidase subunits, p22phox and Nox4, but anti-RAGE antibodies eliminated these effects. Furthermore, prevention of intracellular ROS generation using NAC or anti-RAGE antibodies rescued AGE-BSA-delayed epithelial wound healing in porcine corneal organ culture. In conclusion, our results demonstrated that AGE-BSA impaired corneal epithelial wound healing ex vivo. AGE-BSA increased intracellular ROS generation through NADPH oxidase activation, which accounted for the delayed corneal epithelial wound healing. These results may provide better insights for understanding the mechanism of delayed healing of corneal epithelial wounds in diabetes. PMID:23955437

Shi, Long; Chen, Hongmei; Yu, Xiaoming; Wu, Xinyi

2013-11-01

372

[The diabetic foot: the Cinderella of complications].  

PubMed

The problems of the diabetic foot in general are badly known by patients as well as caregivers. They represent yet a major health problem. Recall that if the ulcers are treated early and adequately, they will heal in 70 to 90% of cases. "The diabetic foot" encompasses the whole of the anomalies of the function and/or of the structure of the foot, linked directly or indirectly to hyperglycaemia. The involvement of nerves, arteries and infection can concentrate on the foot that is also called the "crossroads of complications". These various complications are reviewed in detail. The neuropathy mainly sensitive with the diminution or even the disappearance of the sensitivity to pain and its modes of detection as well as this awful and poorly known complication that is the Charcot foot. The arteriopathy sub-diagnosed and yet very frequent, its modes of detection and its treatment. The difficulties of diagnosis of infection, another serious danger for the foot, its classification and treatment. The care of the wounds whose size and depth are too often under-estimated, their classification of important prognostic value. The care of the diabetic foot wounds too often treated as "classic" wounds forgetting those topics mentioned above will be described focusing on their specific characteristics which are debridement and above all offloading. The importance of the primary and secondary prevention will be highlighted. PMID:21089420

Dumont, I

2010-09-01

373

Infective complications of tattooing and skin piercing.  

PubMed

Body piercing appears to be gaining popularity and social acceptance. With the increase in the number of piercings and tattoos, it is likely that health care providers may see an increase in the complications resulting from these piercings. These may include the transmission of hepatitis viruses and bacteria at the time of the piercing or in the course of wound care. We review the infectious complications that have resulted from body piercing and tattooing that has been documented in the medical literature. PMID:20701856

Messahel, Ahmed; Musgrove, Brian

2009-01-01

374

Survival after postoperative morbidity: a longitudinal observational cohort study†  

PubMed Central

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

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

2014-01-01

375

Pregnancy Complications: Gonorrhea  

MedlinePLUS

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

376

Pregnancy Complications: Preeclampsia  

MedlinePLUS

... in the community. Home > Pregnancy > Pregnancy Complications > Preeclampsia Pregnancy complications Pregnancy complications may need special medical care. ... health care provider right away. What health and pregnancy complications can preeclampsia cause? Without treatment, preeclampsia can ...

377

Use of Incisional Negative Pressure Wound Therapy on Closed Median Sternal Incisions after Cardiothoracic Surgery: Clinical Evidence and Consensus Recommendations  

PubMed Central

Negative pressure wound therapy is a concept introduced initially to assist in the treatment of chronic open wounds. Recently, there has been growing interest in using the technique on closed incisions after surgery to prevent potentially severe surgical site infections and other wound complications in high-risk patients. Negative pressure wound therapy uses a negative pressure unit and specific dressings that help to hold the incision edges together, redistribute lateral tension, reduce edema, stimulate perfusion, and protect the surgical site from external infectious sources. Randomized, controlled studies of negative pressure wound therapy for closed incisions in orthopedic settings (which also is a clean surgical procedure in absence of an open fracture) have shown the technology can reduce the risk of wound infection, wound dehiscence, and seroma, and there is accumulating evidence that it also improves wound outcomes after cardiothoracic surgery. Identifying at-risk individuals for whom prophylactic use of negative pressure wound therapy would be most cost-effective remains a challenge; however, several risk-stratification systems have been proposed and should be evaluated more fully. The recent availability of a single-use, closed incision management system offers surgeons a convenient and practical means of delivering negative pressure wound therapy to their high-risk patients, with excellent wound outcomes reported to date. Although larger, randomized, controlled studies will help to clarify the precise role and benefits of such a system in cardiothoracic surgery, limited initial evidence from clinical studies and from the authors’ own experiences appears promising. In light of the growing interest in this technology among cardiothoracic surgeons, a consensus meeting, which was attended by a group of international experts, was held to review existing evidence for negative pressure wound therapy in the prevention of wound complications after surgery and to provide recommendations on the optimal use of negative pressure wound therapy on closed median sternal incisions after cardiothoracic surgery. PMID:25280449

Dohmen, Pascal M.; Markou, Thanasie; Ingemansson, Richard; Rotering, Heinrich; Hartman, Jean M.; van Valen, Richard; Brunott, Maaike; Segers, Patrique

2014-01-01

378

Use of incisional negative pressure wound therapy on closed median sternal incisions after cardiothoracic surgery: clinical evidence and consensus recommendations.  

PubMed

Abstract Negative pressure wound therapy is a concept introduced initially to assist in the treatment of chronic open wounds. Recently, there has been growing interest in using the technique on closed incisions after surgery to prevent potentially severe surgical site infections and other wound complications in high-risk patients. Negative pressure wound therapy uses a negative pressure unit and specific dressings that help to hold the incision edges together, redistribute lateral tension, reduce edema, stimulate perfusion, and protect the surgical site from external infectious sources. Randomized, controlled studies of negative pressure wound therapy for closed incisions in orthopedic settings (which also is a clean surgical procedure in absence of an open fracture) have shown the technology can reduce the risk of wound infection, wound dehiscence, and seroma, and there is accumulating evidence that it also improves wound outcomes after cardiothoracic surgery. Identifying at-risk individuals for whom prophylactic use of negative pressure wound therapy would be most cost-effective remains a challenge; however, several risk-stratification systems have been proposed and should be evaluated more fully. The recent availability of a single-use, closed incision management system offers surgeons a convenient and practical means of delivering negative pressure wound therapy to their high-risk patients, with excellent wound outcomes reported to date. Although larger, randomized, controlled studies will help to clarify the precise role and benefits of such a system in cardiothoracic surgery, limited initial evidence from clinical studies and from the authors' own experiences appears promising. In light of the growing interest in this technology among cardiothoracic surgeons, a consensus meeting, which was attended by a group of international experts, was held to review existing evidence for negative pressure wound therapy in the prevention of wound complications after surgery and to provide recommendations on the optimal use of negative pressure wound therapy on closed median sternal incisions after cardiothoracic surgery. PMID:25280449

Dohmen, Pascal M; Markou, Thanasie; Ingemansson, Richard; Rotering, Heinrich; Hartman, Jean M; van Valen, Richard; Brunott, Maaike; Segers, Patrique

2014-01-01

379

Negative pressure wound therapy: treating a venomous insect bite.  

PubMed

Reports of spider bites appear throughout North America. Bites associated with the brown recluse spider (Loxosceles recluse) cause serious medical complications because the venom of this spider contains a powerful necrotising agent with the potential to cause severe cutaneous necrosis. Although not much is known regarding the application of negative pressure wound therapy (NPWT) to spider bites, this therapy has considerable literature support for its efficacy, cost-effectiveness and ease of use in chronic, difficult-to-heal wounds. A case study using NPWT to successfully treat a non healing upper arm wound presumed due to a venomous spider bite is presented here. The patient was successfully treated with a new, less costly NPWT product called the Versatile 1 and a new combination drain plus dressing called the Miller DermiVex drain, both manufactured by Blue Sky Medical (Carlsbad, CA). PMID:17425551

Miller, Michael S; Ortegon, Marta; McDaniel, Cheryl

2007-03-01

380

Non-invasive ventilation in postoperative patients: a systematic review  

Microsoft Academic Search

Background  Postoperative pulmonary complications, generally defined as any pulmonary abnormality occurring in the postoperative period,\\u000a are still a significant issue in clinical practice increasing hospital length of stay, morbidity and mortality. Non-invasive\\u000a ventilation (NIV), primarily applied in cardiogenic pulmonary edema, decompensated COPD and hypoxemic pulmonary failure, is\\u000a nowadays also used in perioperative settings.\\u000a \\u000a \\u000a \\u000a \\u000a Objective  Investigate the application and results of preventive and

D. Chiumello; G. Chevallard; C. Gregoretti

2011-01-01

381

[Valvular heart disease: preoperative assessment and postoperative care].  

PubMed

Patients with valvular heart disease or with a prosthetic heart valve replacement are seen with increasing frequency in clinical practice. The medical care and evaluation of patients with valvular heart disease before valve surgery, but also the post-operative treatment is complex and managed by general practitioners, cardiologists and cardiac surgeons. In this mini-review we will first discuss the preoperative assessment of the two most common valvulopathies, aortic stenosis and mitral regurgitation. Then we will discuss the post-operative care, which includes the management of anticoagulation, serial follow up and as well as the diagnostic assessment of complications such as thromboembolism, hemolysis, endocarditis and valve dysfunction. PMID:24169481

Nägele, Reto; Kaufmann, Beat A

2013-10-30

382

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

PubMed Central

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

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

2014-01-01

383

Use of vacuum assisted closure in instrumented spinal deformities for children with postoperative deep infections  

PubMed Central

Background: Postoperative deep infections are relatively common in children with instrumented spinal deformities, whose healing potential is somewhat compromised. Children with underlying diagnosis of cerebral palsy, spina bifida and other chronic debilitating conditions are particularly susceptible. Vacuum-assisted closure (VAC) is a newer technique to promote healing of wounds resistant to treatment by established methods. This article aims to review the efficacy of the VAC system in the treatment of deep spinal infections following spinal instrumentation and fusion in children and adolescents. Materials and Methods: We reviewed 33 patients with deep postoperative surgical site infection treated with wound VAC technique. We reviewed clinical and laboratory data, including the ability to retain the spinal hardware, loss of correction and recurrent infections. Results: All patients successfully completed their wound VAC treatment regime. None had significant loss of correction and one had persistent infection requiring partial hardware removal. The laboratory indices normalized in all but three patients. Conclusions: Wound VAC technique is a useful tool in the armamentarium of the spinal surgeon dealing with patients susceptible to wound infections, especially those with neuromuscular diseases. It allows for retention of the instrumentation and maintenance of the spinal correction. It is reliable and easy to use. PMID:20419005

Canavese, Federico; Krajbich, Joseph I

2010-01-01

384

Multimodal imaging of ischemic wounds  

NASA Astrophysics Data System (ADS)

The wound healing process involves the reparative phases of inflammation, proliferation, and remodeling. Interrupting any of these phases may result in chronically unhealed wounds, amputation, or even patient death. Quantitative assessment of wound tissue ischemia, perfusion, and inflammation provides critical information for approp