[Prevention of venous thromboembolism in musculoskeletal surgery]

Influence of Prescribed Blood Products on the Incidence of Deep Vein Thrombosis and Pulmonary Embolism in Surgical Patients

Deep vein thrombosis (DVT) and pulmonary embolisms (PEs) are common complications after surgical procedures. The influence of prescribed blood products on the occurrence of DVT and PE was evaluated in postsurgical patients in this retrospective case-control study. The records of 286 surgical patients were analyzed: DVT (n = 52), PE (n = 92), and a control group (n = 142). The amounts of prescribed blood, blood products, and vitamin K were reviewed, together with appropriate prescribing of low-molecular-weight heparins. The influence of prescribed blood products on the occurrence of DVT or PE was analyzed using multinomial logistic regression. We demonstrated a significant difference between the test and control groups ( P < .05) in relation to receiving packed red blood cells. Treatment with red blood cells was associated with an increased risk of PE but not DVT. Patients who developed PE after surgery were hospitalized for longer (median 10 days) than patients with DVT (median 6 days). There was no difference between the test and control groups concerning treatment with fresh frozen plasma. Inadequate thromboprophylaxis significantly increased the likelihood of DVT. There is a connection between receiving packed red blood cells and occurrence of postoperative PE in surgical patients. Thus, patients receiving red blood cells should be monitored more closely after surgery, as they are more likely to develop PE postoperatively.

[Treatment concept for a traumatic lesion of the prepatellar bursa]

OBJECTIVE

Rapid recovery of the skin and soft tissue of the affected knee joint with surgical debridement of the wound and gentle, as well as risk-balanced partial resection of the traumatic lacerated prepatellar bursa. Functional aftercare with directed administration of antibiotics only.

INDICATIONS

Acute, traumatic laceration of the prepatellar bursa.

CONTRAINDICATIONS

Heavy contamination of the wound. Large, not closable skin defect or deep abrasion. Preexisting local infection. Additional fracture of the patella. Limited patient's cooperation, e. g., alcohol addiction or dementia.

SURGICAL TECHNIQUE

Subdermal application of local anesthesia through the exposed wound margins. Exploration of the wound and excision of the wound margins. Dissection of the boundary layer between the bursa and the subcutaneous fat. Debridement of the wound and excision of the bruised and contaminated bursa tissue. Repetitive rinsing. Insertion of loop drainage. Single-layer wound closure. Crepe bandage.

POSTOPERATIVE MANAGEMENT

Crepe bandage until the first wound inspection. Wound inspection on postoperative day 2 with removal of the loop. Pain-adapted functional treatment. Antithrombotic therapy until full weight-bearing. Removal of the stitches on postoperative day 14. Antibiotic prophylaxis (1st generation cephalosporin) for immunocompromised or polymorbid patients or heavily contaminated wounds.

RESULTS

In 2013, we treated 50 traumatic lacerations of the prepatellar bursa. Four had to undergo further surgical treatment after primary care. In two other patients, one infected and one non-infected wound healing complication developed, which could be treated conservatively.