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Jiang X, Xu Y, Li M, Jiao G, Rong X, Bu F. Antibiotic-loaded bone cement fixation technique combined with bilateral pectoralis major muscle flaps tension-free management for sternal infection after midline sternotomy. J Cardiothorac Surg 2024; 19:289. [PMID: 38745239 PMCID: PMC11092104 DOI: 10.1186/s13019-024-02749-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/29/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Deep sternal wound infection (DSWI) after midline sternotomy of cardiac surgery is a challenging complication that affects the outcome of surgery. This study aims to assess the clinical effectiveness of the antibiotic-loaded bone cement fixation technique combined with bilateral pectoralis major muscle flaps tension-free management in the treatment of DSWI. METHODS We retrospectively analyzed 5 patients with DSWI who underwent antibiotic-loaded bone cement combined with bilateral pectoralis major muscle flaps for chest wall reconstruction after sternotomy for cardiac surgery in a tertiary hospital in China from January 2020 to December 2021. The clinical and follow-up data were retrospectively analyzed. RESULTS All patients had no perioperative mortalities, no postoperative complications, 100% wound healing, and an average hospital stay length of 24 days. The follow-up periods were from 6 to 35 months (mean 19.6 months). None of the cases showed wound problems after initial reconstruction using antibiotic-loaded bone cement combined with bilateral pectoralis major muscle flaps. CONCLUSIONS We report our successful treatment of DSWI, using antibiotic-loaded bone cement fixation technique combined with bilateral pectoralis major muscle flaps tension-free management. The clinical and follow-up results are favorable.
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Affiliation(s)
- Xia Jiang
- Department of Cardiovascular Surgery, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, No.299 Qingyang Road, Wuxi, Jiang Su Province, 214203, China
| | - Yong Xu
- Department of Cardiovascular Surgery, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, No.299 Qingyang Road, Wuxi, Jiang Su Province, 214203, China
| | - Mingqiu Li
- Department of Cardiovascular Surgery, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, No.299 Qingyang Road, Wuxi, Jiang Su Province, 214203, China
| | - Guoqing Jiao
- Department of Cardiovascular Surgery, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, No.299 Qingyang Road, Wuxi, Jiang Su Province, 214203, China
| | - Xiaosong Rong
- Department of Cardiovascular Surgery, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, No.299 Qingyang Road, Wuxi, Jiang Su Province, 214203, China.
| | - Fanyu Bu
- Department of Chronic Wound, Wuxi Ninth People's Hospital affiliated to Soochow University, No.999 Liangqing Road, Wuxi, Jiang su Province, 214062, China.
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Lei P, Gao F, Qi J, Li Z, Zhong D, Su S. A new dressing system for accelerating wound recovery after primary total knee arthroplasty: a feasibility study. BMC Surg 2024; 24:112. [PMID: 38622645 PMCID: PMC11017543 DOI: 10.1186/s12893-024-02409-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Abstract
PURPOSE Currently, postoperative wound infection and poor healing of total knee arthroplasty have been perplexing both doctors and patients. We hereby innovatively invented a new dressing system to reduce the incidence of postoperative wound complications. METHODS We enrolled 100 patients who received primary unilateral total knee arthroplasty and then applied the new dressing system. The data collected included the number of dressing changes, postoperative hospital stay, Visual Analogue Scale score (VAS), the Knee Society Score (KSS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), ASEPSIS scores, The Stony Brook Scar Evaluation Scale (SBSES), wound complications, dressing cost, the frequency of shower and satisfaction. Subsequently, a statistical analysis of the data was performed. RESULTS Our findings demonstrated the average number of postoperative dressing changes was 1.09 ± 0.38, and the average postoperative hospital stay was 3.72 ± 0.98 days. The average cost throughout a treatment cycle was 68.97 ± 12.54 US dollars. Collectively, the results of VAS, KSS, and KOOS revealed that the pain and function of patients were continuously improved. The results of the four indexes of the ASEPSIS score were 0, whereas the SBSES score was 3.58 ± 0.52 and 4.69 ± 0.46 at two weeks and one month after the operation, respectively. We observed no wound complications until one month after the operation. Remarkably, the satisfaction rate of the patients was 91.85 ± 4.99% one month after the operation. CONCLUSION In this study, we invented a new dressing system for surgical wounds after total knee arthroplasty and further confirmed its clinical feasibility and safety. CHINESE CLINICAL TRIAL REGISTRY ChiCTR2000033814, Registered 13/ June/2020.
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Affiliation(s)
- Pengfei Lei
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.1367 West Wenyi Road, 310003, Hangzhou, Zhejiang Province, China
- Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital, Central South University, No.87 Xiangya Road, 410008, Changsha, Hunan Province, China
| | - Fawei Gao
- Department of Orthopedics, Xiangya Hospital, Central South University, No.87 Xiangya Road, 410008, Changsha, Hunan Province, China
| | - Jun Qi
- Department of Orthopedics, Xiangya Hospital, Central South University, No.87 Xiangya Road, 410008, Changsha, Hunan Province, China
| | - Zhigang Li
- Department of Orthopedics, Xiangya Hospital, Central South University, No.87 Xiangya Road, 410008, Changsha, Hunan Province, China
| | - Da Zhong
- Department of Orthopedics, Xiangya Hospital, Central South University, No.87 Xiangya Road, 410008, Changsha, Hunan Province, China
- Hunan key laboratary of aging biology, Xiangya Hospital, Central South University, No.87 Xiangya Road, 410008, Changsha, Hunan Province, China
| | - Shilong Su
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road. Haidian, 100191, Beijing, China.
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Zhang J, Zhou Y, Ye H, Chen C, Luo Y. Effect of laparoscopic-assisted transvaginal hysterectomy on wound complications in patients with early stage cervical cancer: A meta-analysis. Int Wound J 2024; 21:e14529. [PMID: 38069545 PMCID: PMC10961037 DOI: 10.1111/iwj.14529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/12/2023] [Accepted: 11/16/2023] [Indexed: 03/25/2024] Open
Abstract
Laparoscopic-assisted vaginal radical hysterectomy (LARVH) and abdominal radical hysterectomy (ARH) have been widely applied to treat cervical carcinoma. But LARVH and ARH have not been fully investigated in treating cervical carcinoma after injury associated with injury. This research is intended to provide an up-to-date basis for comparing LARVH with ARH in early stage cervical carcinoma. Comparison between LARVH and ARH in cervical carcinoma was carried out through a combination of related research. Eligible articles from databases such as PubMed and Embase were screened using an established search strategy. This report covered the results of LARVH versus ARH in cervical carcinoma. The average difference and the 95% confidence interval (CI) were used for the combination of consecutive variables. The combination of categorical variables was performed with the odds ratio (OR) 95% confidence interval. Through the identification of 1137 publications, eight of them were chosen to be analysed. Among them, 363 were treated with LARVH and 326 were treated with ARH. Eight trials showed that LARVH was associated with a reduced risk of postoperative wound infection than ARH (OR, 0.23; 95% CI, 0.1-0.55, p = 0.0009). Five trials showed that there was no difference in the risk of postoperative bleeding after surgery (OR, 1.17; 95% CI, 0.42-3.29, p = 0.76). We also did not differ significantly in the duration of the surgery (OR, 1.79; 95% CI, -6.58 to 10.15, p = 0.68). So, the two surgical methods differ significantly only in the risk of postoperative wound infection.
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Affiliation(s)
- Jun Zhang
- Department of GynecologyThe First College of Clinical Medical Science, China Three Gorges UniversityYichangChina
| | - Yuanhong Zhou
- Department of GynecologyThe First College of Clinical Medical Science, China Three Gorges UniversityYichangChina
| | - Hong Ye
- Department of GynecologyThe First College of Clinical Medical Science, China Three Gorges UniversityYichangChina
| | - Chuanqi Chen
- Department of Obstetrics and GynaecologyThe Central Hospital Of Enshi Tujia And Miao Autonomous PrefectureEnshiChina
| | - Youzhen Luo
- Department of GynecologyThe First College of Clinical Medical Science, China Three Gorges UniversityYichangChina
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Wu J, Lu W, Cheng G, Hu Q, Jiang B, Liao S. Assessing postoperative wound infection rates in ultrasound-guided microwave ablation versus conventional surgery for varicose veins. Int Wound J 2024; 21:e14584. [PMID: 38112035 PMCID: PMC10961856 DOI: 10.1111/iwj.14584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023] Open
Abstract
Varicose veins are the prevalent vascular disorder that has conventionally been managed via risky postoperative wound infections and conventional surgery. While ultrasound-guided microwave ablation (UMA) has gained attention as a minimally invasive alternative, there is still a lack of research examining its comparative effectiveness. A prospective comparative investigation was undertaken in the Zhejiang region of China from January to November 2023, involving 140 patients who had received the diagnosis of primary varicose veins. An equal number of 70 patients underwent UMA and conventional surgery. Exclusion criteria for the study encompassed adult patients aged 18-65, with the exception of those who had undergone prior venous surgery, deep vein thrombosis or peripheral arterial disease. The demographical characteristics, procedural details and complication profiles of patients who developed postoperative wound infections within 30 days were analysed statistically. The outcomes demonstrated that postoperative wound infections were significantly diminished (5.7%) with UMA in comparison to conventional surgery (17.1%). In addition, the average duration of procedures and length of hospital stay for UMA patients were both reduced, although neither of these differences was found to be statistically significant (p > 0.05). Infection management, age and gender distribution of varicose veins were comparable between the two groups (p > 0.05). A significant inverse correlation was observed between the severity of varicose veins and postoperative outcomes, as determined by the regression analysis (p < 0.05). Using UMA to treat varicose veins showed promise as an alternative to conventional surgery, specifically in minimizing the incidence of postoperative wound infections. Additional research and clinical consideration are needed regarding the potential transition toward minimally invasive techniques in treatment of varicose veins, as suggested by these results.
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Affiliation(s)
- Jiawen Wu
- Department of Vascular SurgeryThe Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's HospitalQuzhouChina
| | - Wei Lu
- Department of Vascular SurgeryThe Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's HospitalQuzhouChina
| | - Guobing Cheng
- Department of Vascular SurgeryThe Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's HospitalQuzhouChina
| | - Qiang Hu
- Department of Vascular SurgeryThe Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's HospitalQuzhouChina
| | - Buping Jiang
- Department of Vascular SurgeryThe Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's HospitalQuzhouChina
| | - Sheng Liao
- Department of Vascular SurgeryThe Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's HospitalQuzhouChina
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Lima DL, Nogueira R, Dominguez Profeta R, Huang LC, Cavazzola LT, Malcher F, Sreeramoju P. Current trends and outcomes for unilateral groin hernia repairs in the United States using the Abdominal Core Health Quality Collaborative database: A multicenter propensity score matching analysis of 30-day and 1-year outcomes. Surgery 2024; 175:1071-1080. [PMID: 38218685 DOI: 10.1016/j.surg.2023.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/18/2023] [Accepted: 11/27/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Different unilateral groin hernia repair approaches have been developed in the last 2 decades. The most commonly done approaches are open inguinal hernia repair by the Lichenstein technique, laparoscopic approach by either total extraperitoneal or transabdominal preperitoneal, and robotic transabdominal preperitoneal approach. Hence, this study aimed to compare early and late postoperative outcomes in patients who underwent unilateral robotic transabdominal preperitoneal, laparoscopic transabdominal preperitoneal, and laparoscopic total extraperitoneal, and open groin hernia repair using a United States national hernia database, the Abdominal Core Health Quality Collaborative Database. METHODS Prospectively collected data from the Abdominal Core Health Quality Collaborative database was retrospectively reviewed, including all adult patients who underwent elective unilateral groin hernia repair from 2015 to 2022, with a 1:1 propensity score match analysis conducted for balanced groups. The univariate analysis compared the groups across the preoperative, intraoperative, and postoperative timeframes. RESULTS The Abdominal Core Health Quality Collaborative database identified 14,320 patients who underwent elective unilateral groin hernia repair and had documented 30 days of follow-up. Propensity score matching stratified 1,598 patients to each group (total of 6,392). The median age was 64 years (interquartile range 53-74) for open groin hernia repair, whereas 60 (interquartile range 47-69) for laparoscopic transabdominal preperitoneal, 62 (interquartile range 48-70) for laparoscopic total extraperitoneal, and 60 (interquartile range 47-70) for robotic transabdominal preperitoneal were noted. Open groin hernia repair had more American Society of Anesthesiologists score 4 (52, 3%) patients (P < .001). A painful bulge was the most common indication (>85%). Operating room time >2 hours was more significant in the robotic transabdominal preperitoneal group (123, 8%; P < .001). Seroma rate was higher in the laparoscopic transabdominal preperitoneal (134, 8%; P < .001). A 1-year analysis had 1,103 patients. Hematoma, surgical site infection, readmission, reoperation, and hernia recurrence at 30 days or 1 year did not differ, with an overall recurrence rate of 6% (n = 67) at 1 year (P = .33). In patients with body mass index ≥30 kg/m2, the robotic approach had lower rates of surgical site occurrence (n = 12, 4%; P = .002) and seroma (n = 5, 2%; P < .001) compared with the other groups. When evaluating recurrence 1 year after surgery, the robotic transabdominal preperitoneal group had 10% versus 18% open groin hernia repair, 11% laparoscopic transabdominal preperitoneal, and 18% laparoscopic total extraperitoneal, but it was not statistically significant (P = .53). CONCLUSION There was no difference in readmission, reoperation, and surgical site infection among the surgical techniques at 30 days. However, laparoscopic transabdominal preperitoneal was associated with more seromas. Hernia recurrence at 1 year was similar across groups; the robotic approach had the lowest recurrence rate among all 3 repairs but did not reach statistical significance. The robotic approach performed better in patients with a body mass index of 30 kg/m2 for surgical site occurrence and seroma than in other surgical techniques.
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Affiliation(s)
| | - Raquel Nogueira
- Montefiore Medical Center, New York, NY. http://www.twitter.com/NogueiraRaquel_
| | | | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Leandro Totti Cavazzola
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. http://www.twitter.com/cavazzola
| | - Flavio Malcher
- NYU Langone, New York, NY. http://www.twitter.com/flavio_malcher
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Xiao B, Chen T, Zhao Q, Zhao M, Yang G, Zhong X, Xu Y. Risk factors for surgical site infection after percutaneous endoscopic lumbar discectomy. Int Wound J 2024; 21:e14605. [PMID: 38149500 PMCID: PMC10961887 DOI: 10.1111/iwj.14605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/10/2023] [Indexed: 12/28/2023] Open
Abstract
The objective of this study was to investigate the risk factors associated with surgical site infection (SSI) after percutaneous endoscopic lumbar discectomy (PELD) in patients with lumbar disc herniation (LDH). A retrospective analysis was performed on a cohort of 335 patients who underwent PELD between January 2016 and January 2023. Data were derived from the Hospital Information System (HIS), and a comprehensive statistical assessment was performed using IBM SPSS Statistics version 25.0. Both univariate and multivariate logistic regression analyses assessed a range of risk determinants, such as age, body mass index (BMI), comorbidities, laboratory test parameters and surgery-related variables. The incidence of SSI after PELD was 2.7% (9/335). Univariate analysis highlighted BMI, diabetes mellitus, long-term corticosteroid consumption, surgical time and cerebrospinal fluid leakage as significant predictors of SSI. Multivariate logistic regression identified BMI, diabetes mellitus, long-term corticosteroid consumption, surgical time and cerebrospinal fluid leakage as significant risk factors for SSI after PELD. High BMI, diabetes mellitus, long-term corticosteroid consumption, long surgical time and postoperative cerebrospinal fluid leakage are predisposing factors for SSI in patients undergoing PELD. Precise interventions focused on such risk components, including careful preoperative assessment and strategic postoperative care, are essential to reduce the incidence of SSI and improve surgical efficacy.
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Affiliation(s)
- Bo Xiao
- Department of OrthopaedicsPidu District People's Hospital of ChengduChengduPeople's Republic of China
| | - Tian‐yi Chen
- Department of OrthopaedicsPidu District People's Hospital of ChengduChengduPeople's Republic of China
| | - Qiang Zhao
- Department of OrthopaedicsPidu District People's Hospital of ChengduChengduPeople's Republic of China
| | - Ming Zhao
- Department of OrthopaedicsPidu District People's Hospital of ChengduChengduPeople's Republic of China
| | - Guo‐qi Yang
- Department of OrthopaedicsPidu District People's Hospital of ChengduChengduPeople's Republic of China
| | - Xiao‐hui Zhong
- Department of OrthopaedicsPidu District People's Hospital of ChengduChengduPeople's Republic of China
| | - Yin‐zhi Xu
- Department of OrthopaedicsPidu District People's Hospital of ChengduChengduPeople's Republic of China
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Liu J, Wang Q. Impact of surgical site infection after open and laparoscopic surgery among paediatric appendicitis patients: A meta-analysis. Int Wound J 2024; 21:e14524. [PMID: 38084057 PMCID: PMC10961035 DOI: 10.1111/iwj.14524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 03/25/2024] Open
Abstract
Operative site wound infection is one of the most frequent infections in surgery. A variety of studies have shown that the results of laparoscopy might be superior to those of an open procedure. Nevertheless, there is still a lack of clarity as to whether there is a difference between open and laparoscopy with respect to the occurrence of wound infections in different paediatric operations. In this review, we looked at randomized, controlled studies that directly measured the rate of wound infection following an appendectomy with a laparoscope. We looked up four main databases for randomized, controlled studies that compare the treatment of paediatric appendicitis with laparoscopy. The surgeries included appendectomy. Through our search, we have determined 323 related papers and selected five qualified ones to be analysed according to the eligibility criteria. Five trials were also assessed for the quality of the documents. In the 5 trials, there were no statistically significant differences in the incidence of post-operative wound infection among the paediatric appendectomy and the open-access group (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.34-1.15, p = 0.13). The four trials did not show any statistically significant difference in abdominal abscesses among the laparoscopic and open-access treatment groups (OR, 1.64; 95% CI, 0.90-3.01, p = 0.11). The four trials did not reveal any statistically significant difference in operating time (mean difference, -4.36; 95% CI, -17.31 to 8.59, p = 0.51). In light of these findings, the use of laparoscopy as compared with the open-approach approach in paediatric appendectomies is not associated with a reduction in the risk of wound infection.
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Affiliation(s)
- Jun Liu
- Maternal and Child Health Hospital of Hubei ProvinceTongji Medical College, Huazhong University of Science and Technology/SurgeryWuhanChina
| | - Qian Wang
- Maternal and Child Health Hospital of Hubei ProvinceTongji Medical College, Huazhong University of Science and Technology/SurgeryWuhanChina
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Ahmed A, Gandhi S, Ganam S, Diab ARF, Mhaskar R, Sujka J, DuCoin C, Docimo S. Ventral hernia repair using bioresorbable poly-4-hydroxybutyrate mesh in clean and contaminated surgical fields: a systematic review and meta-analysis. Hernia 2024; 28:575-584. [PMID: 38345668 DOI: 10.1007/s10029-023-02951-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/16/2023] [Indexed: 04/06/2024]
Abstract
PURPOSE Use of biologic or synthetic mesh in hernia repair shifts is based on evolving evidence. Poly-4-hydroxybutyrate (P4HB) biosynthetic mesh is a potential alternative to biologic and synthetic mesh in ventral hernia repair (VHR). This meta-analysis assesses the efficacy of P4HB mesh in clean and contaminated surgical settings. METHODS Two authors searched literature on PubMed, reviewing titles and abstracts of all articles to determine inclusion eligibility. Post-operative data were compared via transformation method to convert the proportion of patients with the outcome of interest into a suitable quantity for random-effects synthesis using STATA software. RESULTS Initial search yielded 287 citations. Six studies were included and categorized on whether hernia repairs were conducted in clean (CDC class I) or contaminated cases (CDC class II-IV). The pooled proportion of surgical site infection (SSI), surgical site occurrence (SSO), hernia recurrence, total surgical complications, and reoperation were calculated in 391 clean and 81 contaminated cases. For clean vs. contaminated cases, the following pooled proportions were noted: SSI (2% (CI 0-7%) vs 9% (CI 0-025) (p = 0.03), SSO: 14% (CI 5-25%) vs 35% (CI 22-50%) (p = 0.006), hernia recurrence (8% (CI 1-19%) vs 4% (CI 0-12%) (p = 0.769); surgical complications (17% (CI 6-32%) vs 50% (CI 27-72%) (p = 0.009). Reoperation data were available in 298 clean cases across four studies: 5% (CI 0-15%). CONCLUSIONS P4HB biosynthetic mesh may be more effective than previously thought, particularly in clean wounds. P4HB may also be superior to biologic mesh when compared to clinical trial data. Further research is necessary for more direct comparison.
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Affiliation(s)
- A Ahmed
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - S Gandhi
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - S Ganam
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA
| | - A-R F Diab
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA
| | - R Mhaskar
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - J Sujka
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA
| | - C DuCoin
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA
| | - S Docimo
- University of South Florida Morsani College of Medicine, Tampa, FL, USA.
- Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA.
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Huang EY, Broderick RC, Spurzem GJ, Li JZ, Blitzer RR, Cheverie JN, Sandler BJ, Horgan S, Jacobsen GR. Long-term outcomes of PGA-TMC absorbable synthetic scaffold in both clean and contaminated ventral hernia repairs. Surg Endosc 2024; 38:2231-2239. [PMID: 38498213 DOI: 10.1007/s00464-024-10777-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Biosynthetic meshes afford the cost advantages of being made from fully synthetic material, but are also biodegradable, making them a versatile option that can be used in both clean and contaminated cases. The aim of this study is to evaluate the safety profile and long-term outcomes of using GORE BIO-A (BIO-A) as an adjunct to abdominal wall reconstruction in all wound classes. METHODS A retrospective review identified patients undergoing abdominal hernia repair using BIO-A from October 2008 to June 2018. The primary outcome was hernia recurrence rate. Only patients with at least 6-month follow-up were included when looking at recurrence rates. Secondary outcomes included 30-day morbidity categorized according to CDC Surgical Site Infection Criteria, return to operating/procedure room (RTOR), 30-day readmission, length of stay (LOS), and mortality. RESULTS A total of 207 patients were identified, CDC Wound Classification breakdown was 127 (61.4%), 41 (19.8%), 14 (6.8%), and 25 (12.1%) for wound classes I, II, III, and IV, respectively. Median follow-up was 55.4 months (range 0.2-162.4). Overall recurrence rate was 17.4%. Contaminated cases experienced higher recurrence rates (28.8% versus 10.4%, p = 0.002) at a mean follow up of 46.9 and 60.8 months for contaminated and clean patients, respectively. Recurrent patients had higher BMI (32.4 versus 28.4 kg/m2, p = 0.0011), larger hernias (162.2 versus 106.7 cm2, p = 0.10), higher LOS (11.1 versus 5.6 days, p = 0.0051), and higher RTOR rates (16.7% versus 5.6%, p = 0.053). 51 (24.5%) patients experienced some morbidity, including 19 (9.2%) surgical site occurences, 7 (3.4%) superficial surgical site infections, 16 (7.7%) deep surgical site infections, and 1 (0.5%) organ space infection. CONCLUSION This study affirms the use of biosynthetic mesh as a cost-effective alternative in all wound classifications, yielding good outcomes, limited long-term complications, and low recurrence. rates.
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Affiliation(s)
- Estella Y Huang
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, CA, 92093-0740, USA
| | - Ryan C Broderick
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, CA, 92093-0740, USA
| | - Graham J Spurzem
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, CA, 92093-0740, USA.
| | - Jonathan Z Li
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, CA, 92093-0740, USA
| | - Rachel R Blitzer
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, CA, 92093-0740, USA
| | - Joslin N Cheverie
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, CA, 92093-0740, USA
| | - Bryan J Sandler
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, CA, 92093-0740, USA
| | - Santiago Horgan
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, CA, 92093-0740, USA
| | - Garth R Jacobsen
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MET Building 845, La Jolla, CA, 92093-0740, USA
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10
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Luo H, Xiong Y. Comparing surgical site wound infection after laparoscopic and open radical cystectomies in patients with bladder cancer. Int Wound J 2024; 21:e14718. [PMID: 38571455 PMCID: PMC10993015 DOI: 10.1111/iwj.14718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 04/05/2024] Open
Abstract
This study comprehensively compared the effects of laparoscopic and open radical cystectomies on postoperative wound infections and complications in patients with bladder cancer. We conducted a systematic search for relevant studies in PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases, from database inception to October 2023. Two researchers independently screened the literature, extracted data, and assessed the quality based on the inclusion and exclusion criteria. Data analysis was performed using Stata 17.0 software. Overall, 16 studies involving 1427 patients with bladder cancer were included. The analysis revealed that, compared with open radical cystectomy, laparoscopic radical cystectomy significantly reduced the incidence of wound infections (odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.23-0.64, p < 0.001) and complications (OR = 0.35, 95%CI: 0.26-0.47, p < 0.001) and significantly shortened the hospital stay duration (standardised mean difference [SMD] = -1.85, 95%CI: -2.34 to -1.36, p < 0.001). Thus, this study determined that laparoscopic radical cystectomy for the treatment of bladder cancer effectively reduced the occurrence of wound infections and complications, and significantly shortened the patient's hospital stay, demonstrating notable therapeutic effectiveness worthy of clinical application.
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Affiliation(s)
- Hua‐Ming Luo
- Department of UrologyYongchuan Hospital of Chongqing Medical UniversityChongqingChina
| | - Yong‐Jiang Xiong
- Department of UrologyYongchuan Hospital of Chongqing Medical UniversityChongqingChina
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11
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McCranie AS, Christodoulou N, Wolfe B, Malgor RD, Mathes DW, Winocour J, Yu JW, Kalia N, Kaoutzanis C. The use of flaps for management of deep sternal wound complications: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2024; 91:302-311. [PMID: 38442510 DOI: 10.1016/j.bjps.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/04/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Many options are available for reconstruction after deep sternal wound infections. However, these options have not been critically appraised. The aim of this systematic review and meta-analysis was to assess the existing evidence on sternal rewiring versus flap reconstruction and pectoralis major muscle flaps (PMFs) versus greater omental flaps (GOFs). METHODS A systematic review and meta-analysis was performed. CENTRAL, MEDLINE and EMBASE were searched. Outcomes of interest included mortality, treatment failure and length of hospital stay (LOS). RESULTS Fourteen studies were included. Nine studies compared flaps to rewiring, reporting on 618 patients. Patients treated with flaps had significantly lower mortality compared with patient treated with rewiring (Risk ratio [RR] 0.42, 95% confidence interval [CI]: 0.23-0.77, P < 0.01). Flap patients had significantly lower treatment failure compared with those who were treated with rewiring (RR 0.22, 95% CI: 0.14-0.37, P < 0.01). No statistically significant differences were observed in LOS between patients treated with flaps compared those treated with rewiring (standard mean difference -0.84, 95% CI: -1.91 to 0.24, P = 0.13). Five studies compared PMF with GOF, reporting on 599 patients. No statistically significant differences were found in mortality (RR 0.63, 95% CI: 0.24-1.68, P = 0.36), LOS (standard mean difference -14.52, 95% CI: -42.00 to 12.96, P = 0.30) or treatment failure (RR 1.37, 95% CI: 0.31-6.07, P = 0.68) in patients treated with PMF compared with patients treated with GOF. CONCLUSIONS Flap-based reconstruction demonstrated improved mortality and treatment outcomes compared to sternal rewiring. However, no significant differences were observed in outcomes between the PMF- and GOF-based reconstructions.
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Affiliation(s)
- Alec S McCranie
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Brandon Wolfe
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rafael D Malgor
- Division of Vascular Surgery and Endovascular Therapy, University of Colorado, Anschutz Medical Center, Aurora, CO, USA
| | - David W Mathes
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Julian Winocour
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jason W Yu
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nargis Kalia
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Christodoulos Kaoutzanis
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Diaddigo SE, LaValley MN, Kuonqui K, Janhofer DE, Ascherman JA. Flap management following orthotopic heart transplantation: A single institution's review of 66 sternal wound complications. J Plast Reconstr Aesthet Surg 2024; 90:266-272. [PMID: 38401198 DOI: 10.1016/j.bjps.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/14/2024] [Accepted: 02/01/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Sternotomy wound complications are more frequent after orthotopic heart transplantation (OHT) compared to other cardiac surgeries, primarily due to additional risk factors, including immunosuppression. Flap closure often becomes necessary for definitive treatment, although there is a scarcity of data on the outcomes of sternal wound reconstruction in this specific population. METHODS A retrospective analysis was conducted on 604 sternal wound reconstructions performed by a single surgeon between 1996 and 2023. Inclusion criteria comprised patients who underwent OHT as their primary cardiac procedure. Surgical interventions involved sternal hardware removal, debridement, and muscle flap closure. RESULTS The study included 66 patients, with culture-positive wound infection being the most common indication for reconstruction (51.5%). The median duration between transplantation and sternal wound reconstruction was 25 days. Bilateral pectoralis major myocutaneous advancement flaps (n = 63), rectus abdominis flaps (n = 2), or pectoralis major turnover flaps (n = 1) were used. Intraoperative wound cultures revealed positivity in 48 patients (72.7%), with Staphylococcus epidermidis being the most frequently cultured organism (25.0%). The overall complication rate was 31.8%, and two patient deaths were related to sternal wounds, resulting from multiorgan failure following septic shock. The majority of the patients reported excellent long-term functional and esthetic outcomes. CONCLUSIONS Sternal wounds following OHT pose a significant morbidity risk. Our strategy focuses on immediate and aggressive antibiotic therapy, thorough debridement, and definitive closure with bilateral pectoralis myocutaneous advancement flaps. This approach has demonstrated complication and mortality rates comparable to the general cardiac surgery population, as well as excellent functional and esthetic results.
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Affiliation(s)
- Sarah E Diaddigo
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Myles N LaValley
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Kevin Kuonqui
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - David E Janhofer
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Jeffrey A Ascherman
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, USA.
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13
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Gaskins J, Huang LC, McPhail L, O'Connor S. Robotic approach for retromuscular ventral hernia repair may be associated with improved wound morbidity in high-risk patients: a propensity score analysis. Surg Endosc 2024; 38:1013-1019. [PMID: 38091108 DOI: 10.1007/s00464-023-10630-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/29/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Retromuscular sublay (RMS) technique for repair of ventral hernias has gained popularity due to lower risk of recurrence and wound complications. Robotic approaches to RMS have been shown to decrease hospital stay; however, previous studies have failed to show a significant reduction in wound morbidity. Utilizing the Abdominal Core Health Quality Collaborative (ACHQC) database, this study sought to determine the effect of robotic approach on wound morbidity, while specifically focusing on a high-risk population. METHODS A retrospective review of elective robotic and open RMS repairs in the ACHQC database was performed. Patients deemed to be high-risk for wound complications were included: adult patients with BMI greater than 35 and who were either current smokers or diabetics. A propensity score match was then done to balance covariates between the two groups. Main outcomes of concern were surgical site occurrences (SSO), surgical site infections (SSI), and surgical site occurrence requiring procedural intervention (SSOPI) at 30-day follow-up. RESULTS A total of 917 patients met inclusion criteria. After propensity score matching, 211 patients matched for each approach. There was no difference in overall SSO (18% for Open vs 23% for Robotic, p = 0.23). Open repair was associated with higher rates of SSI (4% vs 1%, p = 0.032) and SSOPI (9% SSOPI vs 3%, p < 0. 015). As seen in previous studies, there was a higher rate of seroma associated with Robotic RMS repair (87% vs 48%, p < 0.001) in patients that developed an SSO. CONCLUSIONS In this analysis, a robotic approach was associated with decreased rates of SSI and SSOPI in obese patients who were either current smokers or diabetics. In effort to reduce wound morbidity and the associated physical and economic costs, robotic approach for retromuscular ventral hernia repair should be considered in this patient population.
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Affiliation(s)
- Jeffrey Gaskins
- Mountain Area Health Education Center, Inc, Asheville, NC, USA.
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lindsee McPhail
- Mountain Area Health Education Center, Inc, Asheville, NC, USA
- Mission Health, Asheville, NC, USA
| | - Sean O'Connor
- Mountain Area Health Education Center, Inc, Asheville, NC, USA
- Mission Health, Asheville, NC, USA
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Casson C, Blatnik J, Majumder A, Holden S. Is weight trajectory a better marker of wound complication risk than BMI in hernia patients with obesity? Surg Endosc 2024; 38:1005-1012. [PMID: 38082008 DOI: 10.1007/s00464-023-10596-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/14/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Complex ventral hernias are frequently repaired via an open transversus abdominis release (TAR). Obesity, particularly a BMI > 40, is a strong predictor of wound morbidity following this procedure. We aimed to determine if preoperative weight loss may still be beneficial in patients with persistently elevated BMIs. METHODS A retrospective chart review of patients with obesity (BMI ≥ 30) who underwent open TAR at a tertiary academic medical center from January 2018 to December 2021 was completed. Demographics, medical history, operative details, and postoperative data were analyzed. Weight and BMI were recorded at three time points: > 6 months prior to initial surgical consultation, surgical consultation, and day of surgery. RESULTS In total, 182 patients with obesity underwent an open TAR. Twenty-seven patients (14.8%) underwent surgery with a BMI > 40; they did not have any significant differences in surgical site occurrences (SSO, 48.1% vs 32.9%, p = 0.13) or surgical site infections (SSI, 25.9% vs 23.2%, p = 0.76) compared to those with a BMI ≤ 40. The average timeframe analyzed for preoperative weight loss was 592 days. Patients who had at least a 3% weight loss (n = 49, 26.9%) had decreased rates of SSI compared to those who did not have this weight loss (12.2% vs 27.8%, p = 0.03), despite the groups having similar BMIs at the time of surgery (36.4 vs 36.0, p = 0.50). Patients who only had a 1% weight loss did not see a decrease in SSI rate compared to those who did not (20.6% vs 25.4%, p = 0.45). CONCLUSION Weight loss may be a better indicator of a patient's risk for wound morbidity following TAR than BMI alone, as weight loss of at least 3% resulted in fewer SSIs despite similar BMIs at time of surgery. Further research into optimal timing and amount of weight loss, as well as effects on long-term outcomes, is needed to confirm these findings.
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Affiliation(s)
- Cameron Casson
- Division of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA.
| | - Jeffrey Blatnik
- Division of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
| | - Arnab Majumder
- Division of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
| | - Sara Holden
- Division of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
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15
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Chen IW, Kao CL, Hung KC. Comment to: should routine surgical wound drainage after ventral hernia repair be avoided? Hernia 2024; 28:283-284. [PMID: 37715826 DOI: 10.1007/s10029-023-02888-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/08/2023] [Indexed: 09/18/2023]
Affiliation(s)
- I-W Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan city, Taiwan
| | - C-L Kao
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung city, Taiwan
| | - K-C Hung
- Department of Anesthesiology, Chi Mei Medical Center, No. 901, ChungHwa Road, YungKung Dist, Tainan city, 71004, Taiwan.
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16
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Kong L, Wang J, Guo K. Effect of general and spinal anaesthesia on post-operative wound healing during laparoscopic totally extraperitoneal inguinal hernia repair: A meta-analysis. Int Wound J 2024; 21:e14670. [PMID: 38361225 PMCID: PMC10869659 DOI: 10.1111/iwj.14670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/26/2023] [Accepted: 12/29/2023] [Indexed: 02/17/2024] Open
Abstract
Totally extraperitoneal prosthetic (TEP) is a surgical technique for the treatment of hernia. The purpose of this research is to compare the efficacy of both general anaesthesia and spine anaesthesia for TEP herniorrhaphy. The number of patients who received TEP operations related to the injury from 2008 to 2022 was counted in this study. Patients with TEP operation were classified into general anaesthesia and spine anaesthesia. In this research, 186 related articles were found in the data base, and in the end, 8 were analysed. This study involved 2452 cases of hernia. The data of the operation time, the infection of the wound and the bleeding of the wound were analysed. The analysis of the data was done with RevMan 5.3. Results indicated that there was no significant difference between general anaesthesia and spinal anaesthesia in post-surgical rates for post-operative wound infection (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.49-1.83; p = 0.86); In general anaesthesia, there was no difference in the risk of post-operative wound haematoma when compared with those treated with spinal anaesthesia (OR, 2.96; 95% CI, 0.37-23.69; p = 0.31). In the seven trials, there was no difference in the duration of the surgery between the general anaesthetic and the spinal anaesthesia group (mean difference, -1.44; 95% CI, -4.11 to 1.22; p = 0.29). Data from the available meta-analysis indicate that there is no difference in the risk of post-operative wound infection or wound haematoma when treated with TEP.
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Affiliation(s)
- Liang Kong
- Department of AnaesthesiologyPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Jiming Wang
- Department of AnaesthesiologyPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Kai Guo
- Department of AnaesthesiologyPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
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17
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Shehab M, Thorbjørnsen K, Mani K, Björck M, Wanhainen A. Long Term Outcome After EndoVAC Hybrid Repair of Carotid Patch Infection. Eur J Vasc Endovasc Surg 2024; 67:352-353. [PMID: 37690491 DOI: 10.1016/j.ejvs.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Maysam Shehab
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden.
| | - Knut Thorbjørnsen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgery, Gävle County Hospital, Gävle, Sweden
| | - Kevin Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Martin Björck
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden; Institute of Clinical Medicine, Tartu University, Tartu, Estonia
| | - Anders Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgical and Peri-operative Sciences, Surgery, Umeå University, Umeå, Sweden
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Yim GH, Pikturnaite J, Harry L, Clement R, Pope-Jones S, Emam A, Marsden N. Enhanced recovery for acute open lower limb fracture 'fix and flap'. Injury 2024; 55:111234. [PMID: 38029681 DOI: 10.1016/j.injury.2023.111234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/10/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Enhanced recovery (ER) aims to achieve earlier recovery, reduced hospital length of stay (LoS) whilst improving outcomes. Our ER protocol for acute lower-limb open fracture (ALLOFs) includes dangling at day 3 and mobilising fully weight-bearing from day 5. Our aims were to evaluate the outcomes of ALLOFs using our ER protocol for limb salvage, LoS following 'fix & flap', return to theatre, rate of successful flap salvage, flap failure and deep infection rates. METHODS An observational study of a prospectively maintained lower limb flap database from September 2020 to January 2023 was undertaken. Search criteria encompassed patients with a Gustilo IIIB/C injury and a free flap reconstruction. Exclusions were for local/perforator flaps, soft tissue injury only, fracture related/prosthetic joint infections, or chronic osteomyelitis cases. RESULTS 161 patients were available for analysis, 126 male (78 %) and 35 female (22 %) with a median age of 40 years (12-79, interquartile range 30.0). 81 % of cases were high-energy injuries. For all patients, the median time to definitive fixation and soft tissue coverage from injury was 4 days (0-30, interquartile range 2). 18 cases (11.2 %) required return to theatre for flap exploration; 11 cases were successfully salvaged (61 %). Nine free flaps failed (5.4 %). The median total LoS from admission was 10 days (6 to 46, interquartile range 5), with a median LoS following definitive fixation and soft tissue coverage of 7 days (4 to 20, interquartile range 3). The median follow-up period was 18 months (12 to 38.2, interquartile range 9), with a deep infection rate of 6.5 %. CONCLUSION In isolated ALLOFs, our ER protocol is safe and effective in shortening the LoS. Our outcomes sit comfortably within acceptable ranges of contemporary literature for return to theatre, flap salvage/failure and deep infection. Our ER protocol actively involves our allied health professional colleagues early to facilitate discharge.
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Affiliation(s)
- Guang Hua Yim
- The Welsh Centre for Burns & Plastics, Morriston Hospital, Heol Maes Eglwys, Morriston SA6 6NL, Swansea, United Kingdom; Major Trauma Centre, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Jurga Pikturnaite
- The Welsh Centre for Burns & Plastics, Morriston Hospital, Heol Maes Eglwys, Morriston SA6 6NL, Swansea, United Kingdom; Major Trauma Centre, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Lorraine Harry
- The Welsh Centre for Burns & Plastics, Morriston Hospital, Heol Maes Eglwys, Morriston SA6 6NL, Swansea, United Kingdom; Major Trauma Centre, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Rhys Clement
- The Welsh Centre for Burns & Plastics, Morriston Hospital, Heol Maes Eglwys, Morriston SA6 6NL, Swansea, United Kingdom; Orthopaedic department, Morriston Hospital, Heol Maes Eglwys, Morriston SA6 6NL, Swansea, United Kingdom
| | - Sophie Pope-Jones
- The Welsh Centre for Burns & Plastics, Morriston Hospital, Heol Maes Eglwys, Morriston SA6 6NL, Swansea, United Kingdom; Major Trauma Centre, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Ahmed Emam
- The Welsh Centre for Burns & Plastics, Morriston Hospital, Heol Maes Eglwys, Morriston SA6 6NL, Swansea, United Kingdom; Major Trauma Centre, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Nicholas Marsden
- The Welsh Centre for Burns & Plastics, Morriston Hospital, Heol Maes Eglwys, Morriston SA6 6NL, Swansea, United Kingdom; Major Trauma Centre, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom.
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Lerch A, Chau AMT. The efficacy of post-operative drains for anterior cervical discectomy and fusion: a systematic review and meta-analysis. Br J Neurosurg 2024; 38:3-11. [PMID: 37698296 DOI: 10.1080/02688697.2023.2254833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/29/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Controversy remains with the use of post-operative subfascial drains for anterior cervical discectomy and fusion, with limited guidelines and a paucity of conclusive evidence. Thus, the aim of this meta-analysis was to analyse and collate an evidence summary to determine the efficacy of such drains. METHODS A systematic search of Medline (2002-2022.11), PubMed (2003-2022.11), Scopus (2002-2022.11), Cochrane Library (2015-2022.11) databases and reference lists of articles was conducted as per Cochrane systematic reviews standards. All relevant RCTs and NRCTs were included in this study. Data was extracted in a standardised form and analysed with RevMan version 5.4.1. Bias was assessed with RoB2 tool for RCTs and ROBINS-E tool for NRCTs. RESULTS Two RCTs (136 patients) and five NRCTs (7563 patients) were included. These had a moderate to high risk of bias, except for one very high-risk article. Meta-analysis results showed no significant differences for post-operative haematoma (P = 0.31), surgical site infection (P = 0.84), take back to theatre (P = 0.27), length of stay (P = 0.34), and estimated blood loss (P = 0.09). Dysphagia (P = 0.002) and median operative time (P = 0.02) were significantly increased in the drain cohort. CONCLUSION The low quality of available data in the included studies is insufficient to estimate the effect of post-operative drains for elective spondylotic ACDF. The findings suggest that if the decision to leave a drain in is left to the surgeon, then there is no difference in the rates of POH, SSI, LOS, or take back to the theatre. The significant association of dysphagia and increased operative time with drains, and the non-significant trend towards increased EBL with drains, must be considered in the context in which procedures may influence the decision to place drains. The results could not be stratified by various confounders that affect the decision-making process, including the number of levels operated. Due to the decreased quality and amount of evidence available, large-scale RCTs that adequately account for confounders should be performed.
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Affiliation(s)
- Aaron Lerch
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Zhang J, Yuan Y, Gao H, Liao B, Qian J, Yan X. Comparative study on the technique and efficacy of microscope-assisted MI-TLIF and naked-eye MI-TLIF in lumbar revision surgery. J Orthop Surg Res 2024; 19:101. [PMID: 38297343 PMCID: PMC10832101 DOI: 10.1186/s13018-024-04591-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/28/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Lumbar revision surgery can be performed by simple lumbar nerve decompression or lumbar interbody fusion, including percutaneous endoscopic lumbar discectomy, transforaminal lumbar interbody fusion (TLIF), etc. However, lumbar revision surgery is very difficult in surgical operation. We sought to explore the technique safety and efficacy of microscope-assisted minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in lumbar revision surgery. METHODS Cases of postoperative recurrence following lumbar spine surgery (n = 63) treated from December 2016 to July 2021 were retrospectively analyzed, including 24 cases of microscope-assisted MI-TLIF (microscopic group) and 39 cases of naked-eye MI-TLIF (naked-eye group). The operation time, intraoperative blood loss, incision length, postoperative drainage, length of hospital stay, initial operation, and visual analog score (VAS) of low back and leg pain before and at 7 days and 3 months after the operation and the last follow-up were compared between the two groups. The Oswestry Dysfunction Index (ODI) and the Japanese Orthopaedic Association (JOA) scores before and after the operation and the Bridwell interbody fusion grades at 1 year were compared. The independent t tests, Mann-Whitney U tests, and Chi-square tests were used for analysis. RESULTS All 63 patients were successfully treated by operation and were followed up for an average of 31.5 ± 8.6 months (range 12-48 months). The two groups had no significant difference in sex, age, incision length, initial operation, or operative segment (P > 0.05). There was no significance in operation time, VAS score, ODI score, and JOA score of low back pain or Bridwell interbody fusion grade between the two groups (P > 0.05). Significant differences in intraoperative blood loss, postoperative drainage, and the lengths of hospital stay were observed between the two groups (P < 0.05). Cerebrospinal fluid leakage (n = 2), edema of nerve roots (n = 2), and incision infection (n = 1) were observed in the naked-eye group. There were no complications in the microscopic group, such as cerebrospinal fluid leakage, edema of nerve roots, and incision infection. CONCLUSION Although microscope-assisted MI-TLIF and naked-eye MI-TLIF are both effective during lumbar revision surgery, microscope-assisted MI-TLIF brings less trauma, less bleeding, shorter postoperative hospital stay, and faster recovery. Unlike traditional surgery, microscope-assisted MI-TLIF provides a clear visual field, adequate hemostasis, and nerve decompression.
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Affiliation(s)
- JiaHuan Zhang
- Department of Orthopeadics, Tangdu Hospital, Fourth Military Medical University, No.569, Xinsi Road, Xi'an, 710038, Shaanxi, China
- Xi'an Medical University, Xi'an, 710054, China
| | - YiFang Yuan
- Department of Orthopeadics, Tangdu Hospital, Fourth Military Medical University, No.569, Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - HaoRan Gao
- Department of Orthopeadics, Tangdu Hospital, Fourth Military Medical University, No.569, Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Bo Liao
- Department of Orthopeadics, Tangdu Hospital, Fourth Military Medical University, No.569, Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - JiXian Qian
- Department of Orthopeadics, Tangdu Hospital, Fourth Military Medical University, No.569, Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - XiaoDong Yan
- Department of Orthopeadics, Tangdu Hospital, Fourth Military Medical University, No.569, Xinsi Road, Xi'an, 710038, Shaanxi, China.
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Glasgow K, Conway Y, Mihas AK, Coffin MD, Stallworth J, Cichos KH, Spitler CA. Does pes anserinus tenotomy affect surgical site infection rate in operative tibial plateau fractures? Eur J Orthop Surg Traumatol 2024; 34:615-620. [PMID: 37667112 DOI: 10.1007/s00590-023-03711-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE To assess if pes anserinus tenotomy (PAT) during definitive open reduction and internal fixation (ORIF) of tibial plateau fractures is associated with a decreased risk of surgical site infection (SSI) and other postoperative complications. METHODS A retrospective review of all adults who underwent ORIF for tibial plateau fractures from April 2005 to February 2022 at single level 1 trauma center was performed. Patients who had a medial approach to the plateau with minimum three-month follow-up were required for inclusion. All patients with fasciotomy for compartment syndrome or with traumatically avulsed or damaged pes anserinus prior to ORIF were excluded. Two groups were created: those who received a pes anserinus tenotomy with repair (PAT group) and those whose pes anserinus were spared and left intact (control group). Patient demographics, injury and operative characteristics, and surgical outcomes were compared. The primary outcomes were rates of deep and superficial SSI. RESULTS The PAT group had significantly lower rates of deep SSI (9.2% vs. 19.7%, P = 0.009), superficial SSI (14.2% vs. 26.5%), P = 0.007), and any SSI (15.8% vs. 28.9%, P = 0.005). Multiple logistic regression showed that heart failure (aOR = 7.215, 95% CI 2.291-22.719, P < 0.001), and presence of open fracture (aOR = 4.046, 95% CI 2.074-7.895, P < 0.001) were independently associated with increased odds of deep SSI, while PAT was associated with a decreased odds of deep SSI (aOR = 0.481, 95% CI 0.231-0.992, P = 0.048). PAT had significantly lower rates of unplanned return to the operating room (20.8% vs. 33.7%, P = 0.010) and implant removal (10.0% vs. 18.0%, P = 0.042). CONCLUSION While these data do not allow for discussion of functional recovery or strength, pes anserinus tenotomy was independently associated with significantly lower rates of infection, unplanned operation, and implant removal. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Katie Glasgow
- Heersink School of Medicine, University of Alabama at Birmingham, 510 20th St S, Birmingham, AL, 35210, USA
| | - Yvonne Conway
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313 13th Street S, Birmingham, AL, 35205-5327, USA
| | - Alexander K Mihas
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313 13th Street S, Birmingham, AL, 35205-5327, USA
| | - Megan D Coffin
- Heersink School of Medicine, University of Alabama at Birmingham, 510 20th St S, Birmingham, AL, 35210, USA
| | - James Stallworth
- Heersink School of Medicine, University of Alabama at Birmingham, 510 20th St S, Birmingham, AL, 35210, USA
| | - Kyle H Cichos
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313 13th Street S, Birmingham, AL, 35205-5327, USA
| | - Clay A Spitler
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313 13th Street S, Birmingham, AL, 35205-5327, USA.
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 510 20th St South, Faculty Office Tower Suite 901, Birmingham, AL, 35294, USA.
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Wang J, Shang X, Huang J, Wang J. Effect of different surgical techniques on postoperative wound infection in patients with uterine prolapse: A meta-analysis. Int Wound J 2024; 21:e14588. [PMID: 38272813 PMCID: PMC10794079 DOI: 10.1111/iwj.14588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/27/2024] Open
Abstract
The assumption is that a number of controlled trials have been conducted to assess the impact of uterus retaining or hysterectomy on wound and haemorrhage, but there is no indication as to which method would be more beneficial for wound healing. This research is intended to provide a comprehensive overview of the availability of wound healing in case studies of both operative methods. From inception to October 2023, four databases were reviewed. The odds ratio (OR) and the mean difference (MD) for both groups were computed with a random effect model, as well as the corresponding 95% confidence intervals. A total of five studies were carried out in the overall design and enrolled 16 972 patients. No statistical significance was found in the rate of postoperative wound infection among the two treatments (OR,1.46; 95% CI,0.66,3.22 p = 0.35); The rates of bleeding after surgery did not differ significantly from one procedure to another (OR,1.41; 95% CI,0.91,2.17 p = 0.12); two studies demonstrated no statistical significance for the rate of incisional hernia after surgery (OR,2.58; 95% CI,0.37,18.05 p = 0.34). Our findings indicate that there is a similar risk between uterine preservation and hysterectomies for the incidence of wound infection, haemorrhage and protrusion of incision.
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Affiliation(s)
- Jinyun Wang
- People's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Xianping Shang
- People's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Jingjie Huang
- Community Health Service Center of Yangli StreetJinanChina
| | - Jing Wang
- Laiwu District Gaozhuang Street Community Health Service CentreJinanChina
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23
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Shen J, Xie X, Meng Y, Mu Y. Predictive value of preoperative neutrophil to lymphocyte ratio and platelet to lymphocyte ratio combined with operating room factors for surgical site infection after laparoscopic radical nephrectomy in renal cell carcinoma patients. Int Wound J 2024; 21:e14400. [PMID: 37718121 PMCID: PMC10788578 DOI: 10.1111/iwj.14400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Surgical site infections (SSIs) can pose significant risks to patients undergoing surgical procedures. This study aimed to investigate the risk factors and diagnostic value of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) for SSIs in patients undergoing laparoscopic radical nephrectomy for renal cell carcinoma. METHODS A retrospective analysis of 866 patients at our hospital was conducted between June 2016 and June 2022. The study divided patients into two groups: those with SSIs and those without. General data and operative room-related information were collected. Inclusion and exclusion criteria were clearly defined. Peripheral blood indicators were analysed, and observation indicators were meticulously selected, including surgery time, usage of a laminar flow operating room and intraoperative hypothermia. Statistical analysis was performed using SPSS 25.0 software, including univariate, multivariate analysis and receiver operating characteristic (ROC) curve analysis. RESULTS Thirty-six out of 866 patients developed SSIs. Statistically significant differences were found for surgery time, usage of non-laminar flow operating rooms and intraoperative hypothermia (p < 0.05). ROC curve analysis showed an AUC of 0.765 (95% CI: 0.636-0.868) for serum NLR and PLR, with optimal cut-off values at NLR 4.8 and PLR 196, indicating moderate to strong discriminative ability for SSIs. CONCLUSIONS The study identified non-laminar flow operating rooms, extended surgery time, and intraoperative hypothermia as significant risk factors for SSIs. Serum NLR and PLR were found valuable as biomarkers for SSIs diagnosis, holding potential for preoperative risk assessment and improved patient safety in renal cell carcinoma care.
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Affiliation(s)
- Jun Shen
- Department of Urology SurgeryThe Frist Affiliated Hospital of Guizhou University of Traditional Chinese MedicineGuiyangChina
| | - Xun Xie
- Department of NephrologyThe Frist Affiliated Hospital of Guizhou University of Traditional Chinese MedicineGuiyangChina
| | - Yonghui Meng
- Department of Urology SurgeryThe Frist Affiliated Hospital of Guizhou University of Traditional Chinese MedicineGuiyangChina
| | - Youyou Mu
- Department of Urology SurgeryThe Frist Affiliated Hospital of Guizhou University of Traditional Chinese MedicineGuiyangChina
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Liu X, Wei C, Wang J, Li M. Effect of tumour necrosis factor-a inhibitors exposure on surgical site infections in rheumatoid arthritis patients undergoing elective orthopaedic surgery: A meta-analysis. Int Wound J 2024; 21:e14538. [PMID: 38272825 PMCID: PMC10788641 DOI: 10.1111/iwj.14538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 11/16/2023] [Accepted: 11/18/2023] [Indexed: 01/27/2024] Open
Abstract
A meta-analysis investigation was executed to evaluate the effect of tumour necrosis factor-a inhibitor exposure on surgical site infections in rheumatoid arthritis patients undergoing elective orthopaedic surgery. A comprehensive literature investigation till October 2023 was applied, and 82 470 individuals with orthopaedic surgery were in the chosen investigations' starting point. Odds ratio (OR) in addition to 95% confidence intervals (CIs) was utilized to compute the value of the effect of tumour necrosis factor-a inhibitors exposure on surgical site infections in rheumatoid arthritis patients undergoing elective orthopaedic surgery by the dichotomous approaches and a fixed or random model. Tumour necrosis factor uses had significantly higher surgical site infections (OR, 1.65; 95% CI, 1.21-2.25, p = 0.001) compared with tumour necrosis factor non-use in rheumatoid arthritis patients undergoing elective orthopaedic surgery. However, no significant difference was found between discontinued and continued tumour necrosis factor on surgical site infections (OR, 0.61; 95% CI, 0.35-1.05, p = 0.07) in rheumatoid arthritis patients undergoing elective orthopaedic surgery.Significantly higher surgical site infections was found comparing tumour necrosis factor uses to non-use; however, no significant difference was found between discontinued and continued tumour necrosis factor on surgical site infections in rheumatoid arthritis patients undergoing elective orthopaedic surgery. However, care must be exercised when dealing with its values because of the low sample size of some of the nominated investigations for the meta-analysis.
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Affiliation(s)
- Xinglin Liu
- School of Clinical MedicineWeifang Medical UniversityWeifangChina
| | - Cuie Wei
- School of Clinical MedicineWeifang Medical UniversityWeifangChina
| | - Jianan Wang
- School of Clinical MedicineWeifang Medical UniversityWeifangChina
| | - Ming Li
- Rheumatology and Immunology DepartmentThe First Affiliated Hospital of Weifang Medical CollegeWeifangChina
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Zhu J, Si M, Huang Z. Effect of tobacco usage on surgical site wound problems after primary total hip and total knee arthroplasty: A meta-analysis. Int Wound J 2024; 21:e14375. [PMID: 37675771 PMCID: PMC10784423 DOI: 10.1111/iwj.14375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023] Open
Abstract
The meta-analysis aims to assess and compare the effect of tobacco usage on surgical site wound problems (SSWPs) after primary total hip and total knee arthroplasty (PTH&TKA). Using dichotomous random- or fixed-effects models, the outcomes of this meta-analysis were examined, and the odds ratio (OR) with 95% confidence intervals (CIs) was computed. Fifteen studies from 2001 to 2023 were enrolled for the present meta-analysis including 560 819 personals with PTH&TKA. Smokers had significantly higher SSWPs (OR, 1.53; 95% CI, 1.21-1.94, p < 0.001) compared with non-smokers in personals with PTH&TKA. Current smokers had significantly higher SSWPs (OR, 1.59; 95% CI, 1.40-1.80, p < 0.001) compared with non-smokers in personals with PTH&TKA. Current smokers had significantly higher SSWPs (OR, 1.42; 95% CI, 1.19-1.70, p < 0.001) compared with former smokers in personals with PTH&TKA. However, former smokers and non-smokers had no significant difference in SSWPs (OR, 1.11; 95% CI, 0.95-1.30, p = 19) in personals with PTH&TKA. The examined data revealed that in personals with PTH&TKA smokers had significantly higher SSWPs compared with non-smokers, and current smokers had significantly higher SSWPs compared with non-smokers and former smokers; however, former smokers and non-smokers had no significant difference in SSWPs. Yet, attention should be implemented while relating to its values since some of the comparisons were made using a low number of selected studies.
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Affiliation(s)
- Jiwen Zhu
- 5th Department of OrthopaedicsThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Mengdi Si
- 5th Department of OrthopaedicsThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Zongqiang Huang
- 5th Department of OrthopaedicsThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
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26
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de'Angelis N, Schena CA, Moszkowicz D, Kuperas C, Fara R, Gaujoux S, Gillion JF, Gronnier C, Loriau J, Mathonnet M, Oberlin O, Perez M, Renard Y, Romain B, Passot G, Pessaux P. Robotic surgery for inguinal and ventral hernia repair: a systematic review and meta-analysis. Surg Endosc 2024; 38:24-46. [PMID: 37985490 DOI: 10.1007/s00464-023-10545-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/13/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND This systematic review and meta-analysis assessed the effectiveness of robotic surgery compared to laparoscopy or open surgery for inguinal (IHR) and ventral (VHR) hernia repair. METHODS PubMed and EMBASE were searched up to July 2022. Meta-analyses were performed for postoperative complications, surgical site infections (SSI), seroma/hematoma, hernia recurrence, operating time (OT), intraoperative blood loss, intraoperative bowel injury, conversion to open surgery, length of stay (LOS), mortality, reoperation rate, readmission rate, use of opioids, time to return to work and time to return to normal activities. RESULTS Overall, 64 studies were selected and 58 were used for pooled data analyses: 35 studies (227 242 patients) deal with IHR and 32 (158 384 patients) with VHR. Robotic IHR was associated with lower hernia recurrence (OR 0.54; 95%CI 0.29, 0.99; I2: 0%) compared to laparoscopic IHR, and lower use of opioids compared to open IHR (OR 0.46; 95%CI 0.25, 0.84; I2: 55.8%). Robotic VHR was associated with lower bowel injuries (OR 0.59; 95%CI 0.42, 0.85; I2: 0%) and less conversions to open surgery (OR 0.51; 95%CI 0.43, 0.60; I2: 0%) compared to laparoscopy. Compared to open surgery, robotic VHR was associated with lower postoperative complications (OR 0.61; 95%CI 0.39, 0.96; I2: 68%), less SSI (OR 0.47; 95%CI 0.31, 0.72; I2: 0%), less intraoperative blood loss (- 95 mL), shorter LOS (- 3.4 day), and less hospital readmissions (OR 0.66; 95%CI 0.44, 0.99; I2: 24.7%). However, both robotic IHR and VHR were associated with significantly longer OT compared to laparoscopy and open surgery. CONCLUSION These results support robotic surgery as a safe, effective, and viable alternative for IHR and VHR as it can brings several intraoperative and postoperative advantages over laparoscopy and open surgery.
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Affiliation(s)
- Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France.
- Faculty of Medicine, University of Paris Cité, Paris, France.
| | - Carlo Alberto Schena
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France.
| | - David Moszkowicz
- Service de Chirurgie Générale et Digestive, AP-HP, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP, Nord-Université de Paris, Colombes, France
| | | | - Régis Fara
- Department of Digestive Surgery, Hôpital Européen, Marseille, France
| | - Sébastien Gaujoux
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | | | - Caroline Gronnier
- Eso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Pessac, France
| | - Jérôme Loriau
- Department of Digestive Surgery, St-Joseph Hospital, Paris, France
| | - Muriel Mathonnet
- Department of General, Endocrine and Digestive Surgery, University Hospital of Limoges, Limoges, France
| | - Olivier Oberlin
- Service de Chirurgie, Groupe Hospitalier Privé Ambroise-Paré - Hartmann, Paris, France
| | - Manuela Perez
- Département de chirurgie viscérale, métabolique et cancérologie (CVMC), CHRU de Nancy-hôpitaux de Brabois, Vandœuvre-lès-Nancy, France
| | - Yohann Renard
- Departement of General Surgery, Reims Champagne-Ardenne University, Reims, France
| | - Benoît Romain
- Department of Digestive Surgery, Strasbourg University, Strasbourg, France
| | - Guillaume Passot
- Department of Surgical Oncology, Hopital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Patrick Pessaux
- Visceral and Digestive Surgery, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France
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Wu C, Zhao B, Fields A, Castillo-Angeles M, Sonderman K, Askari R, Havens J, Nitzschke S. High Body Mass Index is Associated With Increased Risk of Complications After Emergency Ventral Hernia Repair. J Surg Res 2024; 293:553-560. [PMID: 37832306 DOI: 10.1016/j.jss.2023.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/12/2023] [Accepted: 09/03/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Emergency general surgery is a risk factor for postoperative morbidity and mortality. Patients with obesity are at greater risk for complications following ventral hernia repair (VHR). Our study aimed to determine the association of obesity with postoperative outcomes in patients requiring emergency VHR. METHODS Our retrospective study used the 2016-2020 National Surgical Quality Improvement Program database to identify patients undergoing emergency VHR. Patients were classified by body mass index (BMI): normal weight 18.5-24.9 kg/m2, overweight 25-29.9 kg/m2, obesity 30-39.9 kg/m2, morbid obesity 40-49.9 kg/m2, and super morbid obesity (SMO) ≥50 kg/m2. The primary outcome of interest was surgical site infection (SSI). RESULTS From 2016 to 2020, a total 11,593 patients underwent emergency VHR. Patients with higher BMI had increased incidences of postoperative complications. Compared to other patients with obesity, SMO patients had higher rates of SSI (11.5% versus 5.5%, P < 0.001), prolonged ventilatory support (4.0% versus 1.5%, P < 0.001), length of stay ≥4 d (52.7% versus 42.2%, P < 0.001), reoperation (6.4% versus 3.4%, P < 0.001), and readmission (11.3% versus 7.2%, P < 0.001). Super morbid obesity (SMO) patients had increased odds of SSI (odds ratio [OR] 5.55, 95% confidence interval [CI] 3.47-8.88), prolonged ventilatory support (OR 1.92, 95% CI 1.07-3.45), and reoperation (OR 1.97, 95% CI 1.26-3.09) compared to normal weight patients. CONCLUSIONS Patients with BMI ≥50 kg/m2 undergoing emergency VHR have increased overall incidences of SSIs, prolonged mechanical ventilation, reoperation, and readmission, and this remains significant when compared to other patients with obesity. This population is at significant risk for postoperative morbidity, and increased vigilance in perioperative management is imperative to ensure safe, high-quality care.
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Affiliation(s)
- Christine Wu
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Bixiao Zhao
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Adam Fields
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Manuel Castillo-Angeles
- Division of Trauma, Burn, Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kristin Sonderman
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Division of Trauma, Burn, Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Reza Askari
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Division of Trauma, Burn, Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joaquim Havens
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Division of Trauma, Burn, Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephanie Nitzschke
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Division of Trauma, Burn, Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts
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Unbehaun P, Prantl L, Langer S, Spindler N. Antibiotic therapy in reconstructive surgery of deep sternal wound infections. Clin Hemorheol Microcirc 2024; 86:183-194. [PMID: 38007643 DOI: 10.3233/ch-238121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
BACKGROUND The choice of antibiotics and length of administration in the treatment of deep sternal wound infections (DSWI) is unclear. The reason for this is the lack of studies and local differences in resistance. An increase in resistance can be observed in gram-positive cocci, which are the most frequently detected in deep sternal infections. The duration of administration is often 2- 6 weeks or longer, although the benefit of prolonged antibiotic administration has not been confirmed by studies. We evaluated the antibiotic treatment during surgical treatment, consisting of surgical wound debridement and plastic chest reconstruction. METHODS Retrospective analysis of patients (n = 260) who underwent reconstructive surgery in the Department of Plastic Surgery at Leipzig University Hospital from 01.05.2012 - 31.12.2020. The duration of intake, results of microbiological swabs and resistance were investigated. RESULTS At the time of discharge, closed wound conditions were noted in 177 of 260 cases (68.1%). The largest proportion of patients (n = 238) was treated with a latissimus dorsi flap (91.5%).Antibiotic treatment was conducted in 206 of 260 cases (79.2%). The mean duration of antibiotic administration was 21.4 days (±17.6). Prolonged treatment over 14 days did not alter outcome (p = 0.226), in contrast, the number of multidrug resistances (p < 0.001). There was no prove of resistance against linezolid which is effective against the most common found infectious agents Staphylococcus epidermidis (n = 93; 24.0 %) & Staphylococcus aureus (n = 47; 12.1 %). CONCLUSION There is no evidence of benefit from antibiotic therapy over 14 days, whereas multidrug resistance increases with prolonged antibiotic use. In the absence of infectious agents or clinical signs of inflammation, surgical treatment without additional antibiotic treatment is effective.Linezolid is a suitable antibiotic in the treatment of gram-positive infections which are the most frequent in DSWI.
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Affiliation(s)
- P Unbehaun
- Department of Plastic, Hand and Reconstructive Surgery, Universitätsklinikum Regensburg, Regensburg, Germany
| | - L Prantl
- Universitätsklinikum Regensburg, Regensburg, Germany
| | - S Langer
- Universitätsklinikum Leipzig, Leipzig, Germany
| | - N Spindler
- Varisano Krankenhaus Bad Soden, Bad Soden, Germany
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Guo D, Liao F, Yang L, Liu B, Chen L. The influence of minimally invasive esophagectomy on wound infection in patients undergoing esophageal cancer surgery: A meta-analysis. Int Wound J 2024; 21:e14598. [PMID: 38272810 PMCID: PMC10789583 DOI: 10.1111/iwj.14598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/27/2024] Open
Abstract
The impacts of minimally invasive esophagectomy (MIE) in comparison with open esophagectomy (OE) on postoperative complications, wound infections and hospital length of stay in patients with esophageal carcinoma (ESCA) using meta-analysis to provide reliable evidence for clinical practice. A search strategy was developed and computer searches were performed on Embase, Web of Science, PubMed, Cochrane Library, Wanfang, China Biomedical Literature Database and China National Knowledge Infrastructure databases for clinical studies that reported the effects of MIE in comparison with OE in patients with ESCA. The retrieval time was from their inception to October 2023. Two authors independently performed literature screening, and data extraction and literature quality evaluation were performed separately for the included studies. Meta-analysis was performed using Stata 17.0 software. Overall, 26 studies with 2427 ESCA patients were included in this study, of which 1203 were in the MIE group and 1224 were in the OE group. The results showed that, compared with OE, ESCA patients who underwent MIE were less likely to develop postoperative wound infections (odds ratio [OR] = 0.31, 95% confidence intervals [CIs]: 0.20-0.49, p < 0.001) and complications (OR = 0.23, 95% CI: 0.18-0.30, p < 0.001) and have a shorter hospital stay (standardized mean difference = -1.93, 95% CI: -2.38 to -1.48, p < 0.001). MIE has advantages over OE in terms of shorter hospital stay and reduced incidence of postoperative wound infections and complications.
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Affiliation(s)
- Dongming Guo
- Department of Thoracic SurgeryWest China Hospital, Sichuan UniversityChengduSichuanChina
- Department of Thoracic Cancer CenterChongqing University Cancer HospitalChongqingChina
| | - Fei Liao
- Department of Thoracic Cancer CenterChongqing University Cancer HospitalChongqingChina
| | - Lin Yang
- Department of Thoracic SurgeryWest China Hospital, Sichuan UniversityChengduSichuanChina
| | - Bowei Liu
- Department of Thoracic SurgeryWest China Hospital, Sichuan UniversityChengduSichuanChina
| | - Longqi Chen
- Department of Thoracic SurgeryWest China Hospital, Sichuan UniversityChengduSichuanChina
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Feller K, Schipper L, Liu J, Phan TQV, Kroeger K, Joeckel KH, Lax H. Management of Sternal Wound Infection-Determinants of Length of Stay and Recurrence of Infection after Muscle Flap Coverage. Thorac Cardiovasc Surg 2024; 72:63-69. [PMID: 36780925 DOI: 10.1055/s-0043-1761923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
AIM The aim of this study was to define determinants of length of hospital stay (LOS) longer than mean and recurrence of infection (ROI) after complete healing of patients with deep sternal wound infections (DSWI). PATIENTS AND METHODS In this observational study, we included 303 patients (155 females and 148 males, with mean age of 68 years) treated from 2016 to 2020 at the Department of Plastic Surgery of the HELIOS Klinik Krefeld, Germany. All patients received extensive necrosectomy, repetitive negative pressure therapy periods, and final transplantation of a pectoral musculocutaneous flap. In the German diagnosis-related group (DRG)-system, the mean inpatient LOS depends on the number of surgical procedures and is longer in those with four or more surgical procedures (DRG IO2B) and shorter in those with fewer procedures (DRGs I02C and I02D). The determinants which have a significant effect on LOS longer than mean and ROI after complete healing were identified by estimating a logistic regression model. The effect of the different calculated determinants was quantified as odds ratio. To measure the discriminant ability of the model between patients, we determined a receiver operating characteristic curve. The fit of the model was quantified by comparing predicted probabilities of the model with empirical probabilities of the data. The goodness of fit was then measured by applying the Hosmer-Lemeshow test. RESULTS Among patients in DRG IO2B (n = 246), the variable clopidogrel and therapeutic anticoagulation was the most important determinant for a longer LOS, with an odds ratio of 5.83 (95% CI = 0.83/40.80). Female sex and renal insufficiency also prolonged LOS. Applying this analysis to the patients with group DRG groups I02C and I02D (n = 57), none of these parameters were predictive. The variable immunosuppression was the most important determinant for ROI (n = 49) (OR = 4.67; 95% CI = 1.01/21.52). Body mass index also played a role, but with a much smaller influence. CONCLUSION There are specific risk factors for LOS longer than mean and ROI in patients with DSWI that can be identified on admission. Addressing these risk factors, if possible, could reduce the rate of patients with LOS longer than mean and ROI.
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Affiliation(s)
- Kathrin Feller
- Departement of Plastic and Aesthetic Surgery, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Lukas Schipper
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Juan Liu
- Department of Anesthesiology, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Truong Quang Vu Phan
- Departement of Plastic and Aesthetic Surgery, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Knut Kroeger
- Department of Angiology, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Karl-Heinz Joeckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Hildegard Lax
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
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van Kroonenburgh I, Tan SKH, Heiden P, Wirths J, Matis G, Seifert H, Visser-Vandewalle V, Andrade P. Incidence and Management of Hardware-Related Wound Infections in Spinal Cord, Peripheral Nerve Field, and Deep Brain Stimulation Surgery: A Single-Center Study. Stereotact Funct Neurosurg 2023; 102:13-23. [PMID: 38052193 DOI: 10.1159/000535054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/16/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Neuromodulation using deep brain stimulation (DBS), spinal cord stimulation (SCS), and peripheral nerve field stimulation (PNFS) to treat neurological, psychiatric, and pain disorders is a rapidly growing field. Infections related to the implanted hardware are among the most common complications and result in health-related and economic burden. Unfortunately, conservative medical therapy is less likely to be successful. In this retrospective study, we aimed to identify characteristics of the infections and investigated surgical and antimicrobial treatments. METHODS A retrospective analysis was performed of patients with an infection related to DBS, SCS, and/or PNFS hardware over an 8-year period at our institution. Data were analyzed for type of neurostimulator, time of onset of infection following the neurosurgical procedure, location, and surgical treatment strategy. Surgical treatment of infections consisted of either a surgical wound revision without hardware removal or a surgical wound revision with partial or complete hardware removal. Data were further analyzed for the microorganisms involved, antimicrobial treatment and its duration, and clinical outcome. RESULTS Over an 8-year period, a total of 1,250 DBS, 1,835 SCS, and 731 PNFS surgeries were performed including de novo system implantations, implanted pulse generator (IPG) replacements, and revisions. We identified 82 patients with infections related to the neurostimulator hardware, representing an incidence of 3.09% of the procedures. Seventy-one percent of the patients had undergone multiple surgeries related to the neurostimulator prior to the infection. The infections occurred after a mean of 12.2 months after the initial surgery. The site of infection was most commonly around the IPG, especially in DBS and SCS. The majority (62.2%) was treated by surgical wound revision with simultaneous partial or complete removal of hardware. Microbiological specimens predominantly yielded Staphylococcus epidermidis (39.0%) and Staphylococcus aureus (35.4%). After surgery, antimicrobials were given for a mean of 3.4 weeks. The antimicrobial regime was significantly shorter in patients with hardware removal in comparison to those who only had undergone surgical wound revision. One intracranial abscess occurred. No cases of infection-related death, sepsis, bacteremia, or intraspinal abscesses were found. CONCLUSION Our data did show the predominance of S. epidermidis and S. aureus as etiologic organisms in hardware-related infections. Infections associated with S. aureus most likely required (partial) hardware removal. Aggressive surgical treatment including hardware removal shortens the duration of antimicrobial treatment. Clear strategies should be developed to treat hardware-related infections to optimize patient management and reduce health- and economic-related burden.
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Affiliation(s)
- Ingeborg van Kroonenburgh
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Department of Craniomaxillofacial and Plastic Surgery, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Sonny K H Tan
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium
| | - Petra Heiden
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany,
- Department of Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany,
| | - Jochen Wirths
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Georgios Matis
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Pablo Andrade
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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McBee PJ, Larsen NK, Reilly MJ, Walters RW, Olson MA, Fitzgibbons RJ. Association of Nicotine Cessation Time on the Incidence of Recurrent Incisional Hernia Repair and Postoperative Surgical Site Occurrences. Am Surg 2023; 89:6127-6133. [PMID: 37501283 DOI: 10.1177/00031348231192042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
BACKGROUND Nicotine products are believed to be associated with a higher incidence of incisional hernia (IH) recurrence and postoperative complications after IH repair. METHODS A retrospective analysis of the Abdominal Core Health Quality Collaborative (ACHQC) database was performed. Outcomes included risk of IH recurrence, 30-day surgical site infection (SSI), and 30-day surgical site occurrence (SSO). RESULTS We included 14,663 patients. Nicotine users who quit within 1 year of surgery had a 26% higher risk of IH recurrence compared to patients who quit more than a year before surgery or never users. Patients who quit using nicotine within 1 year of surgery had a 54% higher odds of SSI compared to former nicotine users who quit more than a year before surgery. CONCLUSION Former nicotine users with less than 1 year of nicotine use cessation before surgery exhibited worse outcomes than those with more than a year of cessation or no prior use.
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Affiliation(s)
- Patrick J McBee
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Nicholas K Larsen
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Matthew J Reilly
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Ryan W Walters
- Department of Clinical Research, Creighton University School of Medicine, Omaha, NE, USA
| | - Molly A Olson
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
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Xu Z, Zhang K, Cheng K, Sun G, Zhang Y, Jia J. A meta-analysis comparing the effects of cemented and uncemented prostheses on wound infection and pain in patients with femoral neck fractures. Int Wound J 2023; 20:4122-4129. [PMID: 37555547 PMCID: PMC10681411 DOI: 10.1111/iwj.14306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 08/10/2023] Open
Abstract
To providing evidence-based recommendations for surgery in patients with femoral neck fractures, a meta-analysis was conducted to comprehensively evaluate the effects of cemented and uncemented prostheses on postoperative surgical site wound infection and pain in these patients. Relevant studies on the use of cemented prostheses in femoral neck fractures were retrieved from PubMed, EMBASE, Cochrane Library, Ovid, CNKI, and Wanfang databases from the time of their establishment until March 2023. Two authors independently screened and extracted data from the included and excluded literature according to predetermined criteria. Review Manager 5.4 software was used to perform meta-analyses on the collected data. A total of 27 articles comprising 34 210 patients (24 646 cases in the cemented group and 9564 cases in the uncemented group) were included in the final analysis. The results of the meta-analysis showed that, compared with the uncemented group, cemented prostheses significantly reduced the incidence of surgical site wound infections (odds ratio [OR]: 0.75, 95% confidence interval [CI]: 0.64-0.88, p < 0.001) and relieved surgical site wound pain (standardised mean difference: -0.76, 95% CI: -1.12-0.40, p < 0.001), but did not reduce the incidence of pressure ulcers after surgery (OR: 0.50, 95% CI: 0.20-1.26, p = 0.140). Therefore, existing evidence suggests that the use of cemented prostheses in femoral neck fracture surgery can significantly reduce the incidence of surgical site wound infections and relieve surgical site wound pain, which is worthy of clinical recommendation.
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Affiliation(s)
- Ze Xu
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Ke Zhang
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Kai Cheng
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Guangwei Sun
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Yaning Zhang
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Jian Jia
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
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Xie J, Du Y, Tan Z, Tang H. Association between malnutrition and surgical site wound infection among spinal surgery patients: A meta-analysis. Int Wound J 2023; 20:4061-4068. [PMID: 37391942 PMCID: PMC10681542 DOI: 10.1111/iwj.14297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 07/02/2023] Open
Abstract
A surgical site infection (SSI) is one of the most common complications of spinal surgery. Malnutrition has also been linked to SSI after other surgical procedures. However, whether malnutrition is a risk factor for SSI after spinal surgery remains controversial. Therefore, we performed a meta-analysis to comprehensively evaluate the relationship between malnutrition and SSI. Relevant studies of the correlation between malnutrition and SSI were retrieved from the Cochrane Library, EMBASE, PubMed, Web of Science, China National Knowledge Infrastructure and Wanfang Data from database inception to 21 May 2023. Two reviewers independently assessed the included studies, and a meta-analysis was performed using STATA 17.0 software. A total of 24 articles with 179 388 patients were included: 3919 and 175 469 cases comprised the SSI and control groups, respectively. The meta-analysis results showed that malnutrition significantly increased the SSI incidence (odds ratio, 1.811; 95% confidence interval, 1.512-2.111; p < 0.001). These results suggest that patients with malnutrition are at higher risk for SSI after surgery. However, because of significant differences in sample sizes among studies, and because some studies had limitations to their methodological quality, further validation of these results by additional high-quality studies with larger sample sizes is necessary.
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Affiliation(s)
- Jiang Xie
- Department of Spine Surgery and Orthopaedics, Xiangya HospitalCentral South UniversityChangshaChina
- National Clinical Research Center for Geriatric Disorders, Xiangya HospitalCentral South UniversityChangshaChina
| | - Yuxuan Du
- Department of Spine Surgery and Orthopaedics, Xiangya HospitalCentral South UniversityChangshaChina
- National Clinical Research Center for Geriatric Disorders, Xiangya HospitalCentral South UniversityChangshaChina
| | - Zejiu Tan
- Department of Spine Surgery and Orthopaedics, Xiangya HospitalCentral South UniversityChangshaChina
- National Clinical Research Center for Geriatric Disorders, Xiangya HospitalCentral South UniversityChangshaChina
| | - Hao Tang
- Department of Spine Surgery and Orthopaedics, Xiangya HospitalCentral South UniversityChangshaChina
- National Clinical Research Center for Geriatric Disorders, Xiangya HospitalCentral South UniversityChangshaChina
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Han GR, Johnson ER, Jogerst KM, Calderon E, Hewitt WR, Pearson DG, Harold KL. Outcomes of a Large Series of Laparoscopic Ventral Hernia Repairs after Liver Transplantation. Am Surg 2023; 89:5520-5526. [PMID: 36827614 DOI: 10.1177/00031348231156762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND The hernia defects that develop in liver transplant recipients tend to be complex. Unfortunately, there is a paucity of data to guide post-transplant hernia management. Our goal was to evaluate the outcomes following laparoscopic ventral hernia repair (LVHR) in liver transplant recipients. METHODS A retrospective review of a prospectively kept database of liver transplant patients at a single tertiary healthcare facility was completed. All patients between 2007 and 2020 who underwent LVHR for a hernia at their transplant incision site were included. The primary outcome studied was hernia recurrence. Secondary outcomes included time-to-hernia repair, complications, and length of stay (LOS). RESULTS There were 89 patients who met inclusion criteria. 82% were male, mean age was 60 years, and mean body mass index was 30.2 kg/m2. 94.4% were on tacrolimus and 36% on mycophenolate mofetil. Median time-to-hernia repair was 16 months with a mean mesh size of 743 cm2 and length of stay of 3.7 days. None required conversion to an open operation. Postoperative complications included ileus (20.2%), acute kidney injury (11.2%), pneumonia (6.7%), and bleeding requiring re-operation (1.1%). Hernia-related complications included chronic suture site pain (1.1%), seroma requiring intervention (3.3%), surgical site infection (3.3%), nonoperative mesh infection (1.1%), and mesh infection requiring explantation (1.1%). Median follow-up was 23 months. Hernia recurrence occurred in 4.5% and no predictive variables for recurrence were identified. CONCLUSIONS Although the hernia defects that develop in liver transplant recipients are complex and their comorbidities significant, LVHR can safely and effectively repair these defects with low rates of recurrence and complications.
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Affiliation(s)
- Ga-Ram Han
- Department of General Surgery, Mayo Clinic, Phoenix, AZ, USA
| | | | | | | | | | - David G Pearson
- Department of General Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Kristi L Harold
- Department of General Surgery, Mayo Clinic, Phoenix, AZ, USA
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Qiu B, Han J, Zhao J. Effect of thoracoscopic and thoracotomy on postoperative wound complications in patients with lung cancer: A meta-analysis. Int Wound J 2023; 20:4217-4226. [PMID: 37596788 PMCID: PMC10681477 DOI: 10.1111/iwj.14322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 08/20/2023] Open
Abstract
Because of the difficult surgical procedures, patients with lung cancer who have received thoracic surgery tend to have postoperative complications. It may lead to postoperative complications like wound infection, wound haematoma and pneumothorax. A lot of research has assessed the effect of various surgery methods on postoperative complications in pulmonary cancer. The purpose of this meta-analysis is to establish if thoracoscopic is superior to that of thoracotomy in the rate of post-operative complications. From the beginning to the end of June 2023, we performed an exhaustive search on four main databases for key words. The Hazard of Bias in Non-Randomized Interventional Studies (ROBINS-I) was evaluated in the literature. In the end, 13 trials that fulfilled the eligibility criteria underwent further statistical analyses. The results showed that thoracoscopic intervention decreased the risk of post operative wound infection (dominant ratio [OR], 3.00; 95% confidence margin [CI], 1.98, 4.55; p < 0.00001) and air-leakage after operation (OR, 1.30; 95% CI, 1.04, 1.63; p = 0.02). There was no statistically significant difference between the two groups in terms of the rate of haemorrhage after operation (OR, 0.10; 95% CI, 0.73, 1.66; p = 0.63). Our findings indicate that thoracoscopic is less likely to cause post operative infection and gas leakage than thoracotomy, and it does not decrease the risk of postoperative haemorrhage. As some of the chosen trials are too small to conduct meta-analyses, care must be taken when handling the data. In the future, a large number of randomized, controlled trials will be required to provide additional evidence for this research.
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Affiliation(s)
- Bin Qiu
- Department of Thoracic SurgeryAffiliated Hospital of Weifang Medical UniversityWeifangChina
| | - Jinlong Han
- Department of Interventional OncologyAffiliated Hospital of Weifang Medical UniversityWeifangChina
| | - Jin Zhao
- Department of Thoracic SurgeryAffiliated Hospital of Weifang Medical UniversityWeifangChina
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Han X, Kong D, He X, Xie S, Li C. A meta-analysis of the effect of laparoscopic gastric resection on the surgical site wound infection in patients with advanced gastric cancer. Int Wound J 2023; 20:4300-4307. [PMID: 37493021 PMCID: PMC10681515 DOI: 10.1111/iwj.14332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/27/2023] Open
Abstract
By conducting a meta-analysis of relevant clinical studies on the treatment of advanced gastric cancer (GC) using laparoscopic and open surgeries, we aimed to evaluate the impact of these two surgical approaches on postoperative surgical site infections (SSIs) in patients with advanced GC. We aimed to provide evidence-based support for preventing SSIs in postoperative patients with advanced GC. From database establishment until May 2023, we systematically searched PubMed, Cochrane Library, MEDLINE, Embase, China National Knowledge Infrastructure, and Wanfang Data databases for relevant studies comparing laparoscopic and open surgeries for the treatment of advanced GC. Two researchers independently performed the literature screening and data extraction based on predefined inclusion and exclusion criteria. The meta-analysis was conducted using STATA 17.0. Twenty articles involving 3084 patients met the inclusion criteria, including 1462 patients in the laparoscopic group and 1622 cases in the open surgery group. The meta-analysis results revealed that the incidence of postoperative SSIs was significantly lower in the laparoscopic group than in the open surgery group (odds ratio = 0.341, 95% confidence interval: 0.219-0.532, p < 0.001). The current evidence indicates that laparoscopic radical gastrectomy can significantly reduce the incidence of postoperative site infections in patients with advanced GC.
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Affiliation(s)
- Xue Han
- Internal Medicine DepartmentZhongshan Dongsheng HospitalZhongshanChina
| | - Defeng Kong
- Department of Critical Care MedicineBeijing Changping District HospitalBeijingChina
| | - Xuefeng He
- Internal Medicine DepartmentZhongshan Dongsheng HospitalZhongshanChina
| | - Shiyu Xie
- Internal Medicine DepartmentZhongshan Dongsheng HospitalZhongshanChina
| | - Chunlin Li
- Department of Intervention TherapyCancer Hospital of Shantou University Medical CollegeShantouChina
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Drivas E, Gachabayov M, Kajmolli A, Stadlan Z, Felsenreich DM, Castaldi M. Quilting Suture Technique After Mastectomy: A Meta-Analysis. Am Surg 2023; 89:6045-6052. [PMID: 37144600 DOI: 10.1177/00031348231173995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND There is no level 1a evidence testing quilting suture (QS) technique after mastectomy on wound outcomes. The aim of this systematic review and meta-analysis evaluates QS and association with surgical site occurrences as compared to conventional closure (CC) for mastectomy. METHODS MEDLINE, PubMed, and Cochrane Library were systematically searched to include adult women with breast cancer undergoing mastectomy. The primary endpoint was postoperative seroma rate. Secondary endpoints included rates of hematoma, surgical site infection (SSI), and flap necrosis. The Mantel-Haenszel method with random-effects model was used for meta-analysis. Number needed to treat was calculated to assess clinical relevance of statistical findings. RESULTS Thirteen studies totaling 1748 patients (870 QS and 878 CC) were included. Seroma rates were statistically significantly lower in patients with QS (OR [95%CI] = .32 [.18, .57]; P < .0001) than CC. Hematoma rates (OR [95%CI] = 1.07 [.52, 2.20]; P = .85), SSI rates (OR [95%CI] = .93 [.61, 1.41]; P = .73), and flap necrosis rates (OR [95%CI] = .61 [.30, 1.23]; P = .17) did not significantly vary between QS and CC. CONCLUSION This meta-analysis found that QS was associated with significantly decreased seroma rates when compared to CC in patients undergoing mastectomy for cancer. However, improvement in seroma rates did not translate into a difference in hematoma, SSI, or flap necrosis rates.
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Affiliation(s)
- Eleni Drivas
- Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Mahir Gachabayov
- Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Agon Kajmolli
- Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Zehavya Stadlan
- Department of Surgery, New York Medical College, Valhalla, NY, USA
| | | | - Maria Castaldi
- Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Surgery, New York Medical College, Valhalla, NY, USA
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Spengler C, Masberg F, Mett R. [The split turnover pectoralis muscle flap: an easy and safe method for sternal wound coverage]. HANDCHIR MIKROCHIR P 2023; 55:437-442. [PMID: 37369224 DOI: 10.1055/a-2060-0814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
The conventional pectoralis muscle flap is well known for the reconstruction of sternal defects after deep sternal wound infection. The pectoralis muscle flap can be harvested as an advancement flap based on the thoracoacromial artery, or it can be harvested as a turnover flap based on intercostal perforators of the internal thoracic artery. A disadvantage of the advancement flap can be seen in its limited reach, especially for covering the lower third of the sternum. The turnover flap is well suited for coverage of the lower and middle sternal third, but then lacks the length for coverage of the cranial third. The authors describe a new method for splitting up the pectoralis turnover muscle flap along its muscle fibres in order to gain additional length. Between 2017 and 2022, we treated 12 patients with this method. Total wound coverage and closure have been achieved in all 12 patients. Thus, the split turnover pectoralis flap is a safe and effective method for sternal wound treatment.
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Affiliation(s)
- Claas Spengler
- Klinik für Plastische und Ästhetische Chirurgie, HELIOS Kliniken Schwerin, Schwerin, Germany
| | - Frank Masberg
- Klinik für Plastische und Ästhetische Chirurgie, HELIOS Kliniken Schwerin, Schwerin, Germany
| | - Roland Mett
- Klinik für Plastische und Ästhetische Chirurgie, HELIOS Kliniken Schwerin, Schwerin, Germany
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Morgan A, Spicer S, Fadare A. Other Factors that Can Affect Wound Healing With Elective Lumbar Spine Surgery and Perioperative Nutritional Supplementation in Patients. Spine (Phila Pa 1976) 2023; 48:E389. [PMID: 37235797 DOI: 10.1097/brs.0000000000004724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Ajani Morgan
- Department of Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ
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Pruna-Guillen R, Morales-Rey I, Quintana E, Sandoval E. Sternal protection technique for open chest management. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 37922119 DOI: 10.1510/mmcts.2023.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
On some occasions, postoperative mediastinal bleeding or right ventricular failure forces surgical teams to pursue a strategy of open-chest management and delayed sternal closure. One notable source of postoperative bleeding is the sternum, either due to medullar bleeding or bone margin oozing, which may be difficult to control. Furthermore, in cases with right ventricular failure or dilatation needing an open-chest strategy, sternal margins might erode and injure the right ventricular anterior wall. We propose a simple but effective sternal protection technique during open-chest management and further delayed chest closure. Using leftover tubing from the cardiopulmonary bypass circuit or a mediastinal 32 Fr drain, both sternal margins are covered and secured with sutures. Moreover, in case of profuse bleeding, a thrombin-derived haemostatic agent can be applied between the bone marrow and the tube for an additional level of haemostasis. The sternal wound is isolated with a latex membrane and covered with transparent sterile adhesive sheets to achieve vacuum sealing.
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Affiliation(s)
- Robert Pruna-Guillen
- Department of Cardiovascular Surgery, Institut Cardiovascular, Hospital Clìnic, 170th Villarroel St., 08036 Barcelona, Spain
| | - Ignacio Morales-Rey
- Department of Cardiovascular Surgery, Institut Cardiovascular, Hospital Clìnic, 170th Villarroel St., 08036 Barcelona, Spain
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Institut Cardiovascular, Hospital Clìnic, 170th Villarroel St., 08036 Barcelona, Spain
| | - Elena Sandoval
- Department of Cardiovascular Surgery, Institut Cardiovascular, Hospital Clìnic, 170th Villarroel St., 08036 Barcelona, Spain
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Hu Z, Guo X, Chen L, Lei W. Transnasal negative pressure therapy for accelerating healing and improving the prognosis of pharyngocutaneous fistula. Head Neck 2023; 45:2809-2818. [PMID: 37695059 DOI: 10.1002/hed.27505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Pharyngocutaneous fistula (PCF) is one of the most common complications of total laryngectomy. This study is to investigate the efficacy of a novel platform called transnasal negative pressure therapy (TNPT) in the management of PCF. METHODS We retrospectively reviewed 47 patients who underwent total laryngectomy between April 2015 and February 2021 and developed PCF in our hospital. We focused on the healing rate, dressing change frequency, and healing time between the TNPT and non-TNPT groups. The 2 years overall survival (OS) was compared through the log-rank test. RESULTS There were 18 patients in the TNPT group and 29 in the non-TNPT group. There was no significant between-group difference in the healing rate (chi-square test). However, the frequency of dressing changes was significantly lower (p < 0.001) and the healing time was significantly shorter (p = 0.0194) in the TNPT group than in the non-TNPT group. The 2-year OS rate was significantly higher in the TNPT group (p = 0.0473, log-rank test). CONCLUSION TNPT promoted wound healing after surgery for PCF and improved the 2-year OS rate. This tool is worthy of clinical application and promotion.
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Affiliation(s)
- Zhangwei Hu
- Department of Otolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, China
| | - Xueqin Guo
- Department of Otolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, China
| | - Lin Chen
- Department of Otolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, China
| | - Wenbin Lei
- Department of Otolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, China
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Siddiqui A, Lyons NB, Anwoju O, Cohen BL, Ramsey WA, O'Neil CF, Ali Z, Liang MK. Mesh Type With Ventral Hernia Repair: A Systematic Review and Meta-analysis of Randomized Trials. J Surg Res 2023; 291:603-610. [PMID: 37542774 DOI: 10.1016/j.jss.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/28/2023] [Accepted: 07/05/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Synthetic mesh is widely utilized for clean ventral hernia repair; however, it is unclear if synthetic mesh provides the same benefits with high-risk patients or during contaminated cases. Many surgeons use biologic mesh in these settings, but there is little evidence to support this practice. Our objective was to compare the clinical outcomes of utilizing biologic mesh versus synthetic mesh during ventral hernia repair. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a review of the literature was conducted using Cochrane library, EMBASE, Clinicaltrials.gov, and PubMed for randomized controlled trials published that compared biologic versus synthetic mesh during ventral hernia repair. The primary outcome was major complications defined as deep or organ space surgical site infection, reoperations, and hernia recurrences. RESULTS Of 1889 manuscripts screened, four publications were included. The four studies included a total of 758 patients, with 381 receiving biologic mesh and 377 receiving synthetic mesh. Compared to biologic mesh, synthetic mesh had lower rates of major complications (38.6% versus 23.4, risk ratio = 0.55, 95% confidence interval = 0.35 to 0.86, P = 0.009) and hernia recurrence (24.5 % versus 10.3%, risk ratio = 0.44, 95% confidence interval = 0.28 to 0.69, P = 0.004). In addition, there was a lower percentage of surgical site infection and reoperation in the synthetic mesh group. CONCLUSIONS Contrary to current surgical teaching, placement of permanent synthetic mesh into a contaminated field yielded rates of complications that were comparable or reduced compared to biologic mesh.
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Affiliation(s)
- Ali Siddiqui
- Department of Surgery, HCA Healthcare Kingwood, University of Houston, Kingwood, Texas
| | - Nicole B Lyons
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
| | - Oluwatunmininu Anwoju
- Department of Surgery, HCA Healthcare Kingwood, University of Houston, Kingwood, Texas
| | - Brianna L Cohen
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Walter A Ramsey
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Christopher F O'Neil
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Zuhair Ali
- Department of Surgery, HCA Healthcare Kingwood, University of Houston, Kingwood, Texas
| | - Mike K Liang
- Department of Surgery, HCA Healthcare Kingwood, University of Houston, Kingwood, Texas
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Zhu W, Wu L, Xie W, Zhang G, Gu Y, Hou Y, He Y. Wound infection in robotic-assisted radical prostatectomy compared with retropubic radical prostate surgery: A meta-analysis. Int Wound J 2023; 20:3550-3557. [PMID: 37675805 PMCID: PMC10588328 DOI: 10.1111/iwj.14228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 09/08/2023] Open
Abstract
A meta-analysis investigation was executed to measure the wound infection (WI) in robotic-assisted radical prostatectomy (RRP) compared with retropubic radical prostate surgery (RRPS). A comprehensive literature investigation till February 2023 was applied, and 1197 interrelated investigations were reviewed. The 19 chosen investigations enclosed 107 153 individuals with prostate cancer (PC) at the starting point. 72 008 of them were utilising RRP, and 35 145 were utilising RRPS. Odds ratio (OR) in addition to 95% confidence intervals (CIs) was utilised to compute the value of the WI in RRP compared with RRPS by the dichotomous approaches and a fixed or random model. RRP had significantly lower surgical site wound infection (SSWI) (OR, 0.33; 95% CI, 0.21-0.52, P < .001) and infected lymphoceles (ILs) (OR, 0.45; 95% CI, 0.22-0.92, P = .03) compared with RRPS in individuals with PC. RRP had significantly lower SSWI and ILs compared with RRPS in individuals with PC. However, care must be exercised when dealing with its values because of the low sample size of some of the nominated investigations for the meta-analysis.
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Affiliation(s)
- Wei Zhu
- The Department of Urologythe First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing UniversityZhejiangChina
| | - Lingfeng Wu
- The Department of Urologythe First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing UniversityZhejiangChina
| | - Wenhua Xie
- The Department of Urologythe First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing UniversityZhejiangChina
| | - Gaoyue Zhang
- The Department of Urologythe First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing UniversityZhejiangChina
| | - Yanqin Gu
- The Department of Urologythe First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing UniversityZhejiangChina
| | - Yansong Hou
- The Department of Urologythe First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing UniversityZhejiangChina
| | - Yi He
- The Department of Urologythe First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing UniversityZhejiangChina
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Hajibandeh S, Qayum MK, Hajibandeh S, Bodkhe K, Nawaz G, Faridi N, Peixoto D, Kar I. Complete Versus Partial Excision of an Infected Mesh Following Abdominal Wall Hernia Repair: A Systematic Review and Meta-analysis. Am Surg 2023; 89:4344-4352. [PMID: 35722833 DOI: 10.1177/00031348221109816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To evaluate comparative outcomes of complete and partial excision of infected mesh following abdominal wall hernia repair. METHODS A systematic search of electronic databases, including MEDLINE, EMBASE, CINAHL, and CENTRAL, and bibliographic reference lists with application of a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits was conducted. Surgical site infection chronic sinus formation, recurrent hernia, and need for reoperation were the evaluated outcome measures. RESULTS Six comparative observational studies were identified, reporting a total of 317 patients of whom 193 underwent complete mesh excision and the remaining 123 patients underwent partial mesh excision for an infected mesh following abdominal wall hernia repair. The complete mesh excision was associated with significantly lower rates of SSIs (OR: .36; 95% CI, .16-.81, P = .01), chronic sinus formation (OR: .11; 95% CI, .02-.71, P = .02), and reoperation (OR: .10; 95% CI, .03-.33, P = .0001) compared to the partial mesh excision. There was no significant difference in hernia recurrence rate (OR: 3.96.16, 95% CI .62-25.44, P = .15) between two groups. The between-study heterogeneity was moderate in all the analyses. CONCLUSIONS Complete mesh excision may be associated with lower SSI, chronic sinus formation and need for reoperation when compared to the partial mesh excision in an infected mesh event. However, the available evidence has failed to report the outcomes with respect to the main confounding factors which, together with other important outcomes such as fistula formation, should be considered by future high quality research.
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Affiliation(s)
- Shahin Hajibandeh
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Mohammed K Qayum
- Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
| | - Shahab Hajibandeh
- Department of Hepatobiliary and Pancreatic Surgery, University Hospital of Wales, Cardiff, UK
| | - Komal Bodkhe
- Department of Infectious Disease, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ghulam Nawaz
- Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
| | - Nadeem Faridi
- Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
| | - Dinez Peixoto
- Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
| | - Irfan Kar
- Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
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Soares do Brito J, Esperança Martins M, Goes R, Spranger A, Almeida P, Fernandes I, Portela J. Closed-incision negative-pressure wound therapy (ciNPWT) to minimize wound-related complications in lower limb reconstruction after bone tumor resection: preliminary proof-of-concept study. Eur J Orthop Surg Traumatol 2023; 33:2895-2902. [PMID: 36897409 DOI: 10.1007/s00590-023-03501-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/26/2023] [Indexed: 03/11/2023]
Abstract
AIMS The purpose of this study was to compare the impact of postoperative closed-incision negative-pressure wound therapy (ciNPWT) and conventional dressings in wound-related complications after bone tumor resection and reconstruction. PATIENTS AND METHODS A total of 50 patients with bone tumors and clinical indication for wide resection and reconstruction were included and divided into two groups (A and B). Bone defect reconstructions were achieved with modular endoprosthesis or biologic techniques, mainly involving allografts with free vascularized fibula. Group A received ciNPWT, and Group B conventional dressings. Wound-related complications, including wound dehiscence, persistent wound leakage, surgical site infections (SSIs), and causes for surgical revision, were assessed. RESULTS Nineteen patients were included in Group A and 31 in Group B. No significant differences were found between groups regarding epidemiologic and clinical presentation features, contrarily to reconstructive options, which were significantly different between both (Fisher = 10,100; p = 0.005). Additionally, Group A presented lower wound dehiscence rate (0 vs. 19.4%; χ2(1) = 4.179; p = 0.041), SSI rate (0 vs. 19.4%; χ2(1) = 4.179; p = 0.041), and surgical revision rate (5.3% vs. 32.3%; χ2(1) = 5.003; p = 0.025) compared to Group B. CONCLUSIONS This is the first study reporting the impact of ciNPWT after bone tumor resection and reconstruction, and its results support a potential role for this technique in diminishing postoperative wound complications and SSIs. A multicentric randomized controlled trial may help clarify the role and impact of ciNPWT after bone tumor resection and reconstruction.
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Affiliation(s)
- Joaquim Soares do Brito
- Department of Orthopedics and Trauma, Centro Hospitalar Universitário Lisboa Norte, 1649-028, Lisbon, Portugal.
| | - Miguel Esperança Martins
- Department of Medical Oncology, Centro Hospitalar Universitário Lisboa Norte, 1649-028, Lisbon, Portugal
- Translational Oncobiology Laboratory, Instituto de Medicina Molecular - João Lobo Antunes, Faculdade de Medicina de Lisboa, 1649-028, Lisbon, Portugal
| | - Rodrigo Goes
- Department of Orthopedics and Trauma, Centro Hospitalar Universitário Lisboa Norte, 1649-028, Lisbon, Portugal
| | - André Spranger
- Department of Orthopedics and Trauma, Centro Hospitalar Universitário Lisboa Norte, 1649-028, Lisbon, Portugal
| | - Paulo Almeida
- Department of Orthopedics and Trauma, Centro Hospitalar Universitário Lisboa Norte, 1649-028, Lisbon, Portugal
| | - Isabel Fernandes
- Department of Medical Oncology, Centro Hospitalar Universitário Lisboa Norte, 1649-028, Lisbon, Portugal
- Translational Oncobiology Laboratory, Instituto de Medicina Molecular - João Lobo Antunes, Faculdade de Medicina de Lisboa, 1649-028, Lisbon, Portugal
| | - José Portela
- Department of Orthopedics and Trauma, Centro Hospitalar Universitário Lisboa Norte, 1649-028, Lisbon, Portugal
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Shmelev A, Olsen MA, Bray JO, Nikolian VC. Surgeon volumes: preserving appropriate surgical outcomes in higher-risk patient populations undergoing abdominal wall reconstruction. Surg Endosc 2023; 37:7582-7590. [PMID: 37460820 DOI: 10.1007/s00464-023-10286-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/05/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND It is increasingly recognized that complex abdominal wall reconstruction (cAWR) necessitates specialized training. No studies have been conducted to assess whether a volume-outcomes relationship is present in cAWR. We sought to determine if outcomes for patients undergoing cAWR varied based on surgeon volume among participants in the Abdominal Core Health Quality Collaborative (ACHQC). METHODS All patients with ventral hernias undergoing elective cAWR with component separation (lateral component release) were selected from ACHQC database. Surgeons were ranked based on annual number of cAWR procedures performed and then grouped in tertiles. Patient characteristics, hernia risk factors, operative details, and 30-days outcomes were evaluated. RESULTS A total of 9206 patients were identified, of which 310 (3.4%), 723 (7.9%) and 8173 (88.7%) cAWRs were performed by low (105 surgeons), medium (49) and high-volume (66) surgeons, respectively. Patients operated upon by high-volume surgeons tended to have more comorbidities and higher ASA class (72.5% of class ≥ III, vs 53.5%). Hernia characteristics demonstrated that high-volume surgeons more commonly operated on patients presenting with recurrent hernias (50.2% vs 42%), wider hernias (13.5 cm vs 10.5 cm), associated ostomies (13% vs 3.6%), and prior of surgical site infections (32% vs 26%, P = 0.035). High-volume surgeons more commonly performed posterior component separation procedures (92% vs 84%), utilized permanent mesh (92% vs 88%), and placed mesh in sublay position. In spite of operating on more advanced hernias, high-volume surgeons achieved comparable rates (all P > 0.4) of 30-day surgical site infections (SSI: 6.9% vs 7.1%) and surgical site occurrences requiring procedural intervention (SSO-PI: 8.9% vs 10%). CONCLUSIONS High-volume surgeons maintain comparable outcomes following cAWR despite performing operations on patients with more comorbidities and advanced hernia disease. These findings should be integrated into the debates related to regionalizing abdominal wall reconstruction procedures among high-volume surgeons.
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Affiliation(s)
- Artem Shmelev
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Molly A Olsen
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Jordan O Bray
- Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L 233A, Portland, OR, 97239, USA
| | - Vahagn C Nikolian
- Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L 233A, Portland, OR, 97239, USA.
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Chiu HH, Tee YS, Hsu CP, Hsu TA, Cheng CT, Liao CH, Hsieh CH, Fu CY. The Role of Diagnostic Laparoscopy in the Evaluation of Abdominal Trauma Patients: A Trauma Quality Improvement Program Study. World J Surg 2023; 47:2357-2366. [PMID: 37433919 DOI: 10.1007/s00268-023-07113-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE We aimed to identify factors related to delayed intervention in abdominal trauma patients who underwent diagnostic laparoscopy using a nationwide databank. METHODS From 2017 to 2019, abdominal trauma patients who underwent diagnostic laparoscopy were retrospectively evaluated using the Trauma Quality Improvement Program. Patients who underwent delayed interventions after a primary diagnostic laparoscopy were compared with those who did not. Factors associated with poor outcomes that are usually correlated with overlooked injuries and delayed interventions were also analyzed. RESULTS Of the 5221 studied patients, 4682 (89.7%) underwent inspection without any intervention. Only 48 (0.9%) patients underwent delayed interventions after primary laparoscopy. Compared with patients receiving immediate interventions during primary diagnostic laparoscopy, patients receiving delayed interventions were more likely to have small intestine injuries (58.3% vs. 28.3%, p < 0.001). Among patients with hollow viscus injuries, a significantly higher probability of overlooked injuries that required delayed intervention was observed in patients with small intestine injuries (small intestine injury: 16.8%; gastric injury: 2.5%; large intestine injury: 5.2%). However, delayed small intestine repair did not significantly affect the risk of surgical site infection (SSI) (p = 0.249), acute kidney injury (AKI) (p = 0.998), or hospital length of stay (LOS) (p = 0.053). In contrast, significantly positive relationships between delayed large intestine repair and poor outcomes were observed (SSI, odds ratio = 19.544, p = 0.021; AKI, odds ratio = 27.368, p < 0.001; LOS, β = 13.541, p < 0.001). CONCLUSIONS Most examinations and interventions (near 90%) were successful during primary laparoscopy for abdominal trauma patients. Small intestine injuries were easily overlooked. Delayed small intestine repair-related poor outcomes were not observed.
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Affiliation(s)
- Han-Hsi Chiu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei Shan Township, Taibei, Taoyuan, Taiwan
| | - Yu-San Tee
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei Shan Township, Taibei, Taoyuan, Taiwan
| | - Chih-Po Hsu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei Shan Township, Taibei, Taoyuan, Taiwan
| | - Ting-An Hsu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei Shan Township, Taibei, Taoyuan, Taiwan
| | - Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei Shan Township, Taibei, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei Shan Township, Taibei, Taoyuan, Taiwan
| | - Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei Shan Township, Taibei, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei Shan Township, Taibei, Taoyuan, Taiwan.
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Pividori M, Gangloff D, Ferron G, Meresse T, Delay E, Rivoire M, Perez S, Vaucher R, Frobert P. Outcomes of DIEP flap reconstruction after pelvic cancer surgery: A retrospective multicenter case series. J Plast Reconstr Aesthet Surg 2023; 85:242-251. [PMID: 37531805 DOI: 10.1016/j.bjps.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Flap reconstruction is often required after pelvic tumor resection to reduce wound complications. The use of perforator flaps has been shown to reduce donor site morbidity. The purpose of this study was to evaluate the outcomes of pedicled deep inferior epigastric perforator (pDIEP) flap reconstruction. METHODS This was a retrospective multicenter study of patients who underwent immediate pDIEP flap reconstruction for a pelvic or perineal defect after tumor resection between November 2012 and June 2022. The primary outcome was abdominal donor site morbidity, and the secondary outcome was perineal morbidity. RESULTS Thirty-four patients (median age, 57.5 years) who underwent pelvic exenteration (n = 31), extralevator abdominoperineal excision (n = 2), or extended vaginal hysterectomy (n = 1) were included. The most common indications were recurrent cervical (n = 19) and anal (n = 4) squamous cell carcinoma. Twenty-nine patients (85%) had a history of radiotherapy. Only one patient (3%) had major (Clavien-Dindo ≥ III) donor site complications (surgical site infection due to tumor recurrence). Eleven patients (32%) had at least one major recipient site complication (surgical site infection [n = 1], total [n = 2] or partial [n = 1] flap loss, perineal dehiscence [n = 2], hematoma [n = 1], fistula [n = 5]). No incisional or perineal hernias were observed during follow-up. Ninety-day survival was 100%. CONCLUSION Pedicled DIEP flap reconstructions performed by experienced surgical teams had good outcomes for perineal or vaginal reconstruction, with low abdominal morbidity, in patients with advanced pelvic malignancies who had undergone median laparotomy. The risks and benefits of this procedure should be carefully evaluated preoperatively using clinical and imaging data.
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Affiliation(s)
- Marc Pividori
- Department of Reconstructive and Plastic Surgery, Hospices Civils de Lyon, 103, Grande-Rue de la Croix-Rousse, 69317 Lyon, France; Department of Reconstructive and Plastic Surgery, Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France.
| | - Dimitri Gangloff
- Department of Plastic Surgery, Institut Claudius Regaud Institut Universitaire du Cancer de Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse Cedex 9, France
| | - Gwenaël Ferron
- Department of Surgical Oncology, Institut Claudius Regaud Institut Universitaire du Cancer de Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse Cedex 9, France
| | - Thomas Meresse
- Department of Plastic Surgery, Institut Claudius Regaud Institut Universitaire du Cancer de Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse Cedex 9, France
| | - Emmanuel Delay
- Department of Reconstructive and Plastic Surgery, Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France
| | - Michel Rivoire
- Department of Surgical Oncology, Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France
| | - Simon Perez
- Department of Reconstructive and Plastic Surgery, Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France
| | - Richard Vaucher
- Department of Reconstructive and Plastic Surgery, Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France
| | - Paul Frobert
- Department of Reconstructive and Plastic Surgery, Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France
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Alimi Y, Deldar R, Sosin M, Lofthus A, Nijhar K, Bartholomew AJ, Fan KL, Bhanot P. Outcomes of Immediate Multistaged Abdominal Wall Reconstruction of Infected Mesh: Predictors of Surgical Site Complications and Hernia Recurrence. Ann Plast Surg 2023; 91:473-478. [PMID: 37713152 DOI: 10.1097/sap.0000000000003641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
BACKGROUND Mesh infection is one of the most devastating complications after ventral hernia repair. To date, no clear consensus exists on the optimal timing of definitive abdominal wall reconstruction (AWR) after excision of infected mesh. We evaluated outcomes of immediate multistaged AWR in patients with mesh infection. METHODS We performed a retrospective review of patients with mesh infection who underwent immediate, multistaged AWR, which consisted of exploratory laparotomy with debridement and mesh explantation, followed by definitive AWR during the same admission. Primary outcomes included hernia recurrence and surgical site occurrences, defined as wound dehiscence, surgical site infection, hematoma, and seroma. RESULTS Forty-seven patients with infected mesh were identified. At mean follow-up of 9.5 months, 5 patients (10.6%) experienced hernia recurrence. Higher body mass index (P = 0.006), bridge repair (P = 0.035), and postoperative surgical site infection (P = 0.005) were associated with hernia recurrence. CONCLUSION Immediate multistaged AWR is an effective surgical approach in patients with infected mesh.
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Affiliation(s)
| | | | - Michael Sosin
- Plastic Surgery Arts of New Jersey, New Brunswick, NJ
| | | | | | | | - Kenneth L Fan
- Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
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