State-of-the-art abdominal wall reconstruction and closure

Open ventral hernia repair is one of the most common operations performed by general surgeons. Appropriate patient selection and preoperative optimization are important to ensure high-quality outcomes and prevent hernia recurrence. Preoperative adjuncts such as the injection of botulinum toxin and progressive preoperative pneumoperitoneum are proven to help achieve fascial closure in patients with hernia defects and/or loss of domain. Operatively, component separation techniques are performed on complex hernias in order to medialize the rectus fascia and achieve a tension-free closure. Other important principles of hernia repair include complete reduction of the hernia sac, wide mesh overlap, and techniques to control seroma and other wound complications. In the setting of contamination, a delayed primary closure of the skin and subcutaneous tissues should be considered to minimize the chance of postoperative wound complications. Ultimately, the aim for hernia surgeons is to mitigate complications and provide a durable repair while improving patient quality of life.

Treating Wisely: The Surgeon's Role in Antibiotic Stewardship

: Antibiotic resistance continues to receive national attention as a leading public health threat. In 2015, President Barack Obama proposed a National Action Plan to Combat Antibiotic-Resistant Bacteria to curb the rise of "superbugs," bacteria resistant to antibiotics of last resort. Whereas many antibiotics are prescribed appropriately to treat infections, there continue to be a large number of inappropriately prescribed antibiotics. Although much of the national attention with regards to stewardship has focused on primary care providers, there is a significant opportunity for surgeons to embrace this national imperative and improve our practices. Local quality improvement efforts suggest that antibiotic misuse for surgical disease is common. Opportunities exist as part of day-to-day surgical care as well as through surgeons' interactions with nonsurgeon colleagues and policy experts. This article discusses the scope of the antibiotic misuse in surgery for surgical patients, and provides immediate practice improvements and also advocacy efforts surgeons can take to address the threat. We believe that surgical antibiotic prescribing patterns frequently do not adhere to evidence-based practices; surgeons are in a position to mitigate their ill effects; and antibiotic stewardship should be a part of every surgeons' practice.

Effect of delayed primary closure on the healing of ischemic wounds

OBJECTIVE

To study the influence of delayed primary closure on the healing of ischemic wounds in rats.

METHODS

Wounds sutured after a delay of 3 days were compared with primary closed wounds by biomechanical testing.

RESULTS

The delayed wounds were as strong as primary closed wounds when tested 10 days after wounding. Thirteen days after wounding (10 days after closure), nearly all the biomechanical parameters of the delayed wounds were increased, compared with those of primary closed wounds that had healed for 10 days. The wounds closed after a delay were weaker, however, when tested 20 days after wounding.

CONCLUSION

An ischemic wound can safely be left open for 3 days before suturing, i.e., for prevention of infection in contaminated wounds, without affecting the biomechanical properties at the time of removing the sutures, which is often performed clinically 10 to 12 days after the operation.