Infectious postoperative complications in oral surgery. An observational study

Background

The main objective of this investigation was to determine the incidence of infectious postoperative complications in oral surgery.

Material and Methods

A observational and descriptive study was developed, with the use of prospective registry of the patients admitted for oral surgery at the San Borja Arriarán Hospital Complex during twelve months observation period (April 2017 to March 2018).

Results

The sample consisted of 532 patients undergoing surgical procedures of oral surgery and 19 cases of infectious postoperative complications. The incidence of complications reached 3,57% and it was observed predominantly in exodontic type interventions. The most commonly observed complication was dry socket, reaching 2,5% of third molar surgeries and 3,7% of extractions of other teeth. Other postoperative complication were 7 cases of facial spaces abscesses, also observed predominantly in exodontic type interventions.

Conclusions

The results were similar to those reported in the literature both in their frequency and in the type of complication.

Key words:Oral surgery, incidence, postoperative complications, dry socket, third molar.

[Preservation of the muscle in the use of rectus abdominis free flap in breast reconstruction: from TRAM to DIEP (Deep inferior epigastric perforator) flap. Technical notes and results]

The advantages of TRAM (Transverse Rectus Abdominus Muscle) flap for breast reconstruction is now well recognised. This technique allows a cosmetic reconstruction with a more natural shape than with conventional reconstruction with prosthesis. However the disadvantage is the need of removal of part or all rectus abdominis muscle. If the techniques of free flap are now recognised to be more reliable than pedicle TRAM they have not demonstrate a superiority in term of parietal sequellae. To avoid such problem some teams have progressively developed the DIEP (Deep Inferior Epigastric Peforator Flap). This flap is harvested only on the transmuscular perforators. We are presenting here our expertise which progressively has leed us from free partial TRAM to DIEP. From december 1995 to january 1997 we have practice 18 breast reconstructions with free flap. On 13 DIEP we had only one parietal complication due to incomplete closing of the aponeurosis at the lowest part of the surgical approach. This complication was easily corrected as the muscle was still tonic. On 5 TRAM, clinical examination finds parietal weakness on 3 cases. We believe that this technique is full of promises as it brings autologous tissue with no complication on donor site.

[Significance of the detection of fimbriae protein type adhesins on bacteria isolated in acute pyelonephritis in children]

A prospective bacteriological study in 50 children with acute pyelonephritis (APN) (32 girls and 18 boys) and 132 children with lower urinary tract infections (LUTI) (89 girls and 43 boys) was conducted from May to December 1993. Infection was defined by Kass' criteria and APN was defined by the clinical findings. C-Reactive Protein (CRP) assay and postcontrast computed tomography in the presence of a doubt concerning the diagnosis. Escherichia coli (EC) was the bacterial species most frequently isolated (76%). A systematic search for fimbriae protein adhesins (group PAP: pyelonephritis associated pil) on the EC was performed by haemagglutination (human group A red blood cells). 64% of EC possessed fimbriae protein adhesions in the APN group versus only 20% in the LUTI group. In children in whom an organic abnormality was demonstrated, the incidence of fimbriae protein-positive EC was 33% while in children with no organic abnormality, particularly without reflux, 89% of EC presented fimbriae protein. A statistically significant difference was demonstrated between these two groups (p < 0.01). The results of this study illustrate the important role of these adhesins in the development of APN. These adhesins facilitate countercurrent ascension of bacteria in the ureter towards the upper urinary tract and can make the bacteria resistant to certain antibiotics. Testing for fimbriae protein can be useful in clinical practice when investigating the aetiology of APN in the absence of demonstrated reflux. A latex test should soon be available to facilitate the detection of fimbriae protein.

[Unstable fractures of the distal radius: a new classification]

We have carried out a retrospective study of 100 fractures of the distal radius which were classified according to 3 principal factors, namely the amount of displacement (D), the involvement of the epiphysis (E), and the degree of metaphyseal comminution (M). Each of these 3 groups was further divided into 4 levels of increasing instability. The fractures were assessed 3 months after injury. Most occurred in old patients with low grades in the DEM scale, often in association with osteoporosis and following a simple fall. Metaphyseal comminution and the degree of displacement did not correlate with the degree of osteoporosis. The highest grades of epiphyseal lesions occurred in young patients, and intact epiphyses were seen in the more osteoporotic population. The Kapandji technique, using 3 Kirschner wires, was used in 58 cases, mostly with low grades of DEM, and gave satisfactory results, but in 14% anterior carpal translation was noted. This may lead to anterior instability. External fixation was employed in 32 patients with higher grade fractures. A good anatomical result was usually obtained but the wrists were more stiff. In 7 of these patients fixation of articular fragments by wires was also needed. Reduction and immobilisation in a cast was undertaken in 7 cases with variable results. Double cortical pinning was used in 3 patients and was useful in the highest grades of displacement. We outline a scheme for treatment based on our classification.

[Urethroplasty using appendiceal mucosa. A preliminary study of urethroplasty using free colonic mucosa in rats]

The use of skin, buccal or vesical mucosa for free graft urethroplasties is associated with a high incidence of postoperative stenosis and fistulas. In order to develop a new urethral substitute, the appendicular mucosa is proposed as a new material. As animals do not possess an appendix, an animal model of colonic mucosa urethroplasty was used in this study. Forty rats were submitted to distal segmental urethrectomy. For 14 rats, a simple urethral catheter was inserted without urethroplasty (group I), for 7 rats, urethroplasty was performed using a collagen tube (group II), and for 19 rats, a free colonic mucosa urethroplasty was performed (Group III). After 3 to 6 weeks, a microscopic and macroscopic study was performed. A newly formed urethra was only observed in the last group (Group III). Histological examination visualized a typical non-secreting urothelium. In the light of this study, free gastrointestinal mucosa appears to be suitable for urethroplasties. Until a human clinical application is developed, early histological studies will probably help to explain the development of this neo-urothelium, which remains hypothetical at the present time.

Use of a digestive mucosal graft in urethroplasty. An experimental study--prospective utilization of the appendix mucosa

Colic mucosa was used as a graft for urethral construction in 9 Sprague-Dawley rats. A urethrectomy was performed in each rat and then a urethroplasty built with the colic mucosa taken from a segmental colectomy. After 6 weeks to 3 months, all of these rats developed a typical urothelium. The digestive mucosa has been transformed into urothelium or acts as a stent to guide regrowth from each end. These results are encouraging, but the use of the appendix mucosa for hypospadias repair and for urethroplasty deserves further study.

The Hueston flap in reconstruction of fingertip skin loss: results in a series of 41 patients

We reviewed 43 Hueston flaps in 41 patients (average age, 35 years) following distal fingertip skin loss. Mean advancement of the flap was 13 mm. Patients with single-digit injuries missed an average of 36 days off work. At the follow-up evaluation (mean, 3 years), 10 patients complained of pain (1 with functional impairment), 30 complained of cold intolerance, and 24 had nail deformities. Sensibility of advanced skin was normal by Semmes-Weinstein test in 33 cases, while two-point discrimination averaged 7 mm. This discrimination was virtually identical to contralateral digits in 31 of the cases. Overall, 30 patients were satisfied with their results, while 11 patients were mildly displeased. In 10 patients, this involved impairment of function, while the remaining patient was displeased with the appearance.

[Free appendix mucosa urethroplasty. A preliminary experimental study of free grafts of digestive tract mucosa]

The various tissues used as free grafts in urethroplasties are associated with a high incidence of fistulae and strictures. The search for a new, more effective substitute has led the authors to study the possibility of using a new type of mucosa: appendicular mucosa. The size and cylindrical structure of the appendix and its easy resection make it an original and adapted urethral substitute. As most animals do not possess an appendix, an animal model of subcutaneous free graft of colonic mucosa was studied. Segmental transverse colonectomy was performed in 16 rats. The mucosa was stripped and then grafted subcutaneously. Three to six weeks after the operation, this mucosa was still perfectly viable in 11 rats. Its fixation ensures a better take of the graft. Histological examination revealed that the epithelium retained the features of gastrointestinal mucosa: monostratified, pavement and secretory. The results of this preliminary study are very encouraging and justify continuation of experimental studies of free appendicular mucosal urethroplasties. A practical application is expected in the correction of severe hypospadias or extensive urethral strictures.

An unusual variety of scapho-capitate syndrome

We report a patient who sustained a displaced fracture of the lunate in association with fractures of the scaphoid and capitate. Union of the scaphoid and capitate fractures followed fixation with Herbert screws, 25 additional cases from the literature have been reviewed.

[Effect of early mobilization following Kapandji's method of intrafocal wiring in fractures of the distal end of the radius. Results of a prospective study of 60 cases]

We have undertaken a prospective study of the management of fractures of the distal radius using three Kirschner wires as advocated by Kapandji. 30 were immobilised and the other 30 allowed early movement. Complications involving pin migration and rupture of extensor tendons occurred only in the latter group, and one patient in the other group developed Reflex Sympathetic Dystrophy. At three months there was no statistically significant difference in movement or level of pain between the two groups. Grip was better after two months in those mobilised early. The final radiographic appearances were similar in both groups. Early mobilisation should only be used in patients who have good quality bone and will carefully observe instructions after operation.