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Wound Dehiscence (wound + dehiscence)
Selected AbstractsOur experience with third renal transplantation: Results, surgical techniques and complicationsINTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2007Mohammad Hossein Nourbala Background: Despite the popularity of kidney transplantation in the current era, second and third kidney transplantation are not yet widely accepted and practiced. Each center has its own regulations and experiences and there is no accepted protocol for third kidney transplantation. We report here our 15 years of experience with third kidney transplantation. Methods: This is a report of all the third kidney transplantations performed in Baqiyatallah Hospital, Tehran, Iran, between 1991 and 2006. Demographic data, surgical techniques, complications and outcomes are reported. Results: Of the nine third kidney transplant patients, six were male. The median age was 43 years (32,52). All of the patients received kidney from living donors. All operations were performed by a midline incision and the grafts were placed at the midline, in the intraperitoneal space. For arterial anastomosis, we used internal iliac, right common iliac and both the right external iliac and inferior mesenteric artery in 4, 4 and 1 case(s), respectively. For venous anastomosis, we used vena cava, common iliac and external iliac veins in 3, 5 and 1 case(s), respectively. During the follow up period (38 months), 6 grafts (66.6%) were functioning. None of the graft rejections were due to surgical complications. Wound dehiscence occurred in two patients. No other surgical complications including infection, lymphocele or hemorrhage were observed. Conclusion: Third kidney transplantation is a field that has not been fully explored. The rate of complications seems to be not much higher than the first transplantation. Defining a standard protocol seems necessary. [source] PILONIDAL DISEASE IN SINGAPORE: CLINICAL FEATURES AND MANAGEMENTANZ JOURNAL OF SURGERY, Issue 3 2000H. C. Lee Background: Pilonidal disease has not been well documented in Asian people. The aims of the present study were to investigate any variations in the clinical features and effectiveness of various surgical treatments in such a population. Methods: A prospectively collected computerized database of 61 consecutive patients admitted to a specialist colorectal unit over a 9-year period was studied. The five methods of surgical treatment used during this period (incision and drainage; laying open; marsupialization; primary closure; and the flap procedure) were compared. Results: There were 38 men and 23 women with a mean age of 27 ± 1.02 years. Pilonidal disease was significantly more common among the Indian people (52.5% of patients) than the other ethnic races in the Singaporean community (P < 0.001). Chronic discharging sinuses were the most common presentation (93.4%). There were no differences between the various surgical techniques employed with regard to the time required for wound healing (mean: 48 ± 21 days) and recurrence rates (4/61, 6.6%). Wound dehiscence after primary wound closure (10%) and flap procedures (42%) meant that the overall healing rate was not faster than when the wound was just laid open. Furthermore, flap procedures required a longer hospitalization than other procedures (P = 0.005). Conclusion: Pilonidal disease was more common among Indian people, the more hirsute among the Singaporean population. Primary closure and flap procedure did not improve overall wound healing because of dehiscence. [source] Lateral Wedge Resection: A Simple Technique for Repairing Involutional Lower Eyelid EntropionDERMATOLOGIC SURGERY, Issue 9 2010IGAL LEIBOVITCH MD BACKGROUND Lower lid involutional entropion is a common eyelid pathology affecting the elderly population. Most of the reported surgical techniques are mainly based on a lateral tarsal strip anchored to the orbital rim. OBJECTIVES To report the surgical outcome using a simple single-stitch lateral wedge technique to repair involutional lower entropion. METHODS This single-surgeon, retrospective, noncomparative cases series included all patients with involutional lower eyelid entropion who were operated on using the lateral wedge technique. RESULTS Fifty-eight eyelids of 52 patients (46 unilateral, 6 bilateral; 27 men, 25 women; age, mean 67±10; range 50,85) underwent surgical repair. Immediate resolution of entropion and associated ocular symptoms was achieved in 55 eyelids (94.9%). One case had postoperative ectropion that completely resolved spontaneously after 4 weeks, and one had wound dehiscence that healed completely without any intervention. Another patient had residual entropion that resolved after an additional surgical repair. No other cases of recurrence were noted during a mean follow-up period of 16 months (range 6,24 months). CONCLUSION This minimally invasive single-stitch lateral wedge technique is a simple and effective procedure for repairing involutional lower eyelid entropion and is associated with low recurrence and complication rates. Igal Leibovitch, MD, has indicated no significant interest with commercial supporters. [source] Contribution of Dermatologic Surgery in WarDERMATOLOGIC SURGERY, Issue 1 2010MAJOR J. SCOTT HENNING DO BACKGROUND Despite the large contribution by dermatology to military readiness, there have been no published reports regarding dermatologic surgery or skin cancer in the combat environment. OBJECTIVE To outline the contribution of dermatologic surgery, including skin cancer and benign tumors, to deployed service men and women in Operation Iraqi Freedom. METHODS A retrospective chart review was performed of all dermatology visits at the 86th Combat Support Hospital, Ibn Sina, Iraq, between January 15, 2008 and July 15, 2008. RESULTS Two thousand six hundred ninety-six patients were seen in the combat dermatology clinic during the 6-month period reviewed; 8% (205/2,696) of the total visits were for skin cancer, and another 129 patients were treated for actinic keratosis. The specific diagnoses were basal cell carcinoma (n=70), in situ and invasive squamous cell carcinoma (n=68), mycosis fungoides (n=1), bowenoid papulosis (n=1), and in situ and invasive melanoma (n=9). Benign lesions and tumors accounted for 14% (357/2,696) of total patient visits. Three hundred seven surgeries were performed during the 6-month period (178 skin cancers and 129 benign lesions), and 20 patients were referred for Mohs micrographic surgery. The surgical complications included five postoperative wound infections (1 methicillin-resistant Staphylococcus aureus), one wound dehiscence, and seven allergic contact dermatitis. CONCLUSIONS To the authors' knowledge, this is the first publication regarding skin cancer and dermatologic surgery in the combat setting. This report outlines the important contribution of dermatologic surgery in the combat environment. The authors have indicated no significant interest with commercial supporters. [source] Prevention of lymphatic injuries in surgeryMICROSURGERY, Issue 4 2010Boccardo Francesco M.D. Background: The problem of prevention of lymphatic injuries in surgery is extremely important if we think about the frequency of both early complications such as lymphorrhea, lymphocele, wound dehiscence, and infections and late complications such as lymphangites and lymphedema. Nowadays, it is possible to identify risk patients and prevent these lesions or treat them at an early stage. This article helps to demonstrate how it is important to integrate diagnostic and clinical findings to better understand how to properly identify risk patients for lymphatic injuries and, therefore, when it is useful and proper to do prevention. Methods: Authors report their experiences in the prevention and treatment of lymphatic injuries after surgical operations and trauma. After an accurate diagnostic approach, prevention is based on different technical procedures among which microsurgical procedures. It is very important to follow-up the patient not only clinically but also by lymphoscintigraphy. Results and Conclusions: It was identified a protocol of prevention of secondary limb lymphedema that included, from the diagnostic point of view, lymphoscintigraphy and, as concerns therapy, it also recognized a role to early microsurgery. It is necessary to accurately follow-up the patient who has undergone an operation at risk for the appearance of lymphatic complications and, even better, to assess clinically and by lymphoscintigraphy the patient before surgical operation. © 2010 Wiley-Liss, Inc. Microsurgery, 2010. [source] Early Wound Complications in Advanced Head and Neck Cancer Treated With Surgery and Ir192 Brachytherapy,,THE LARYNGOSCOPE, Issue 1 2000Richard V. Smith MD Abstract Objectives: Brachytherapy, either as primary or adjuvant therapy, is increasingly used to treat head and neck cancer. Reports of complications from the use of brachytherapy as adjuvant therapy to surgical excision have been limited and primarily follow Iodine 125 (I125) therapy. Early complications include wound breakdown, infection, flap failure, and sepsis, and late complications may include osteoradionecrosis, bone marrow suppression, or carotid injuries. The authors sought to identify the early wound complications that follow adjuvant interstitial brachytherapy with iridium 192 (Ir192). Study Design: A retrospective chart review of all patients receiving adjuvant brachytherapy at a tertiary medical center over a 4-year period. Methods: Nine patients receiving Ir192 brachytherapy via afterloading catheters placed during surgical resection for close or microscopically positive margin control were evaluated. It was used during primary therapy in six patients and at salvage surgery in three. Early complications were defined as those occurring within 6 weeks of surgical therapy. Results: The overall complication rate was 55% (5/9), and included significant wound breakdown in two patients, minor wound dehiscence in three, and wound infection, bacteremia, and local tissue erosion in one patient each. All complications occurred in patients receiving flap reconstruction and one patient required further surgery to manage the complication. Complication rates were not associated with patient age, site, prior radiotherapy, timing of therapy, number of catheters, or dosimetry. Conclusions: The relatively high complication rate is acceptable, given the minor nature of most and the potential benefit of radiotherapy. Further study should be under-taken to identify those patients who will achieve maximum therapeutic benefit without prohibitive local complications. [source] Successful Management of Eviscerated Renal Allograft with Preservation of FunctionAMERICAN JOURNAL OF TRANSPLANTATION, Issue 5 2008H. Jeon Although most wound complications after renal transplantation are minor, the renal allograft, in its superficial and extraperitoneal location, is vulnerable to exposure if there is wound breakdown resulting in loss of overlying tissue. We describe a 66-year-old man who received a renal allograft from a deceased donor for end-stage renal disease (ESRD) secondary to polycystic kidney disease. His immediate posttransplant course was complicated by delayed graft function from acute tubular necrosis, reexploration for perigraft hematoma and subsequent wound dehiscence. After unsuccessful conservative wound care, the renal allograft became completely eviscerated due to fascial retraction of the dehisced wound. While the allograft was initially covered with a pedicled rectus femoris muscle flap, several local tissue rearrangements were required for definitive coverage. The allograft function was recovered after initial flap coverage and was subsequently maintained; follow-up more than 2 years after transplantation has demonstrated not only continued stable graft function but also complete healing of the dehiscent wound. [source] How safe is open abdominal aortic aneurysm surgery for octogenarians in New Zealand?ANZ JOURNAL OF SURGERY, Issue 5 2009Ian A. Thomson Abstract Background:, Abdominal aortic aneurysm (AAA) is an important cause of mortality for the aged, a group that has been denied surgery in the past for fear of peri-operative mortality. Is this attitude still justified? Methods:, Analysis of prospectively gathered data from a vascular database. Results:, 10.9% of all open AAA operations were in patients older than 79 years with an 8% mortality cate compared to 3% for younger patients. For fit elderly patients with ASA scores less than 3, mortality was just under 4%. Renal failure and wound dehiscence were more common in the elderly. Conclusion:, When endovascular repair is not possible in a fit elderly patient, open surgery can be performed with acceptable results. [source] Smoking is a major risk factor for wound dehiscence after midline abdominal incision; case,control studyANZ JOURNAL OF SURGERY, Issue 4 2009Saleh M. Abbas Abstract Background:, The incidence of acute fascial wound dehiscence (AFWD) after major abdominal operations is as high as 3%. AFWD is associated with mortality rates of 15,20%. Male gender, advanced age and numerous systemic factors including malignancy hypoproteinemia and steroid use have been associated with increased risk. The aim of the present study was to investigate the association between smoking prevalence and AFWD. Methods:, Middlemore Hospital records were retrieved from the 1997,2006 period for patients who had undergone midline abdominal surgery and developed AFWD. A return to the operating theatre for closure of the fascial dehiscence was required for study group inclusion. Each patient in the study group was matched to two control patients who had been admitted in the same year for surgery and who had a similar initial surgical intervention. Conditional logistic regression was used to calculate odds ratios with 95% confidence intervals, representing the risk of developing fascial wound dehiscence in smokers compared with the non-smoking group. Results:, There were 52 patients (32 male, 20 female) and 104 controls (64 male, 40 female). Median age for both groups was 63 years. A history of heavy tobacco use (,20 pack-years) was more prevalent in those who had AFWD (46%) compared with the control group (16%; P = 0.0002; odds ratio 3.7). Conclusions:, Smoking is associated with an increased incidence of acute fascial wound dehiscence following laparotomy. It is not known whether smoking is a causal or a surrogate factor. [source] Original Article: Randomised prospective study of abdominal wall closure in patients with gynaecological cancerAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2010Roberto BERRETTA Background:, Median laparotomy is the most common approach to the abdominopelvic cavity in patients with gynaecological tumours. Aims:, The primary endpoint of the study was to evaluate the onset of incisional hernia. The secondary endpoint was to evaluate the onset of infection, wound dehiscence, wound infection, and scar pain during the post-operative period. Methods:, A total of 191 patients were eligible for the study. They were divided into three groups. Group A underwent en bloc closure of the peritoneum and fascia with Premilene® suture, Group B en bloc closure of the peritoneum and fascia with Polydioxanone suture, and Group C separate closure of the peritoneum and fascia with single stitches of Ethibond suture. Statistical analysis was performed using the Statistical Software Package for Social Sciences 12.0. Results:, Group A and Group B comprised 63 patients, and Group C included 65 patients. The three groups proved homogeneous on statistical analysis (P > 0.05). The statistical analysis did not reveal significant differences between the different suture types and techniques with respect to the incidence of incisional hernia (P > 0.05). Conclusion:, In our study, the incidence of incisional hernia was 8%. Randomised patients were homogeneous for sample size and risk factors. No significant differences were found between suture types or techniques. Currently, there is no suture material or technique that can be considered superior to others. When possible, we believe that the best way to prevent incisional hernia is to preserve the integrity of the abdominal wall using minimally invasive techniques. [source] Is mechanical bowel preparation necessary in patients undergoing cystectomy and urinary diversion?BJU INTERNATIONAL, Issue 9 2002M. Shafii Objective,To compare the surgical outcome in patients with or with no bowel preparation before cystectomy and ileal conduit urinary diversion, specifically assessing local and systemic complications. Patients and methods,All patients undergoing cystectomy and ileal conduit urinary diversion between January 1991 and December 1999 were assessed retrospectively. Twenty-two receive no bowel preparation (group 1) and were compared with 64 who had (group 2). Patients had similar demographic characteristics, stage and grade of tumour. Patients in group 2 received a standard 4-day bowel preparation and group 1 received no lavage or enemas. All patients underwent a standard iliac and obturator lymph node dissection, and cystoprostatectomy or anterior exenteration and ileal conduit urinary diversion. All patients received intraoperative metronidazole and gentamicin intravenously, and two further doses after surgery. Results,Deaths after surgery were comparable in the two groups (two in group 1 and four in group 2) and the incidence of wound infection was similar (three and seven, respectively). There were no significant differences between the respective groups for fistula and anastomotic dehiscence (two and six) or sepsis (three and six). Group 2 had a higher incidence of wound dehiscence (one) than in group 1 (none). The incidence of prolonged postoperative ileus was lower in group 1 (one vs 12), as was the length of hospital stay (31.6 days vs 22.8 days). Conclusions,Bowel preparation had no advantage for the surgical outcome but it increased the length of hospital stay. [source] Prospective study of skin surgery in smokers vs. nonsmokersBRITISH JOURNAL OF DERMATOLOGY, Issue 2 2009A.J. Dixon Summary Background, Smoking may increase complications following minor surgery leading many clinicians to urge patients to refrain from smoking before and after surgery. Objective, To study the association between smoking and complications following skin surgery. Methods, In a 5-year prospective observational study 7224 lesions were excised on 4197 patients. Patients were not instructed regarding smoking. All complications were recorded. Results, A total of 439 smokers (10·5%) underwent 646 procedures (9%), 3758 nonsmokers (89·5%) underwent 6578 procedures (91%). Smokers were younger (55 ± 16 years) than nonsmokers (66 ± 17 years) (P < 0·001). Infection incidence was not significantly different, 1·9% (12/646) in smokers compared with 2·2% (146/6578) in nonsmokers (P = 0·55). There were two bleeds with smokers (0·3%) vs. 50 in nonsmokers (0·8%) (P = 0·2). The incidence of wound dehiscence in nonsmokers (three) was not different from nonsmokers (21) (P = 0·54). However, the incidence of scar contour distortion in smokers (three) was greater than in nonsmokers (two) (odds ratio 15·3; 95% confidence interval 2·5,92). Total complication incidence was similar, 3·6% in smokers vs. 4·0% in nonsmokers (P = 0·58). Out of 2371 flaps there were 14 (0·6%) cases of end-flap necrosis but smokers were not at increased risk. The case,control analysis compared each smoker with two nonsmokers matched for age, sex, postal code and outdoor occupational exposure. This again demonstrated no difference in infection, scar complication, bleed, dehiscence, end-flap necrosis or total complication incidence. Conclusions, Smokers and nonsmokers suffer skin surgery complications similarly. The increased risk of contour distortion identified was difficult to interpret. Advice to cease smoking in the short term to improve outcomes with skin cancer surgery is not supported by these data. [source] Multiple synchronous colonic anastomoses: are they safe?COLORECTAL DISEASE, Issue 2 2010S. D. Holubar Abstract Objective, To evaluate short-term outcomes after construction of synchronous colonic anastomoses without fecal diversion. Method, Using a prospective procedural database, all adult general surgery patients who underwent two synchronous segmental colon resections and anastomoses without ostomy at our institution from 1992,2007 were identified. Demographics, operative techniques, and 30-day outcomes are reported. Results are number (percent) of patients or median (interquartile range). Results, Over 15 years, 69 patients underwent double colonic anastomoses [40 males, age 63 (45,76) years, BMI 25.3 (22.9,28.7) kg/m2]. Multiple colonic anastomoses were performed in one of every 201 colectomies during the study period (0.5%). The operation was an emergency in two (3%) cases; most cases were clean-contaminated 56 (81%). Ten (17%) cases were laparoscopic-assisted with a 44% conversion rate. Length of stay was seven (5,10) days. Overall 30-day morbidity was 36% including nine (13%) surgical site infections, two (2.9%) intra-abdominal abscesses requiring percutaneous drainage, and one (1.4%) wound dehiscence. There were no anastomotic leaks or fistulas, and two patients (2.9%) died within 30 days from pulmonary sepsis and complications from a distal anastomotic hemorrhage, respectively. Conclusions, Synchronous colon anastomoses without fecal diversion do not appear to be associated with an increased risk of complications and can be safely constructed in selected patients. [source] Categorization of major and minor complications in the treatment of patients with resectable rectal cancer using short-term pre-operative radiotherapy and total mesorectal excision: a Delphi roundCOLORECTAL DISEASE, Issue 4 2006R. Bakx Abstract Background, To properly balance the benefit (reduction of local recurrence) of short-term pre-operative radiotherapy for resectable rectal cancer against its harm (complications), a consensus concerning the severity of complications is required. The aim of this study was to reach consensus regarding major and minor complications after short-term radiotherapy followed by total mesorectal excision in the treatment of rectal carcinoma, using the Delphi technique. Methods, A Delphi round was performed in cooperation with 21 colo-rectal surgeons from the Netherlands, United Kingdom and Sweden. The key-question was: ,Which of the predefined complications, caused or substantially aggravated by radiotherapy, are so important (major) that they might lead to the decision to abandon short-term pre-operative radiotherapy (5 × 5Gy) when treating patients with resectable rectal cancer (T1,3N0,2M0)?' Results, After three rounds, consensus was reached for 37 (68%) of 54 complications of which 13 were considered major and 24 considered minor. The following complications were considered to be major: mortality, anastomotic leakage managed by relaparotomy, anastomotic leakage resulting in persisting fistula, postoperative haemorrhage managed by relaparotomy, intra-abdominal abscess without healing tendency, sepsis, pulmonary embolism, myocardial infarction, compartment syndrome of the lower legs, long-term incontinence for solid stool, long-term problems with voiding, pelvic fracture with persisting pain, and neuropathy with persisting pain (legs). Three of 17 complications without consensus showed a tendency to be considered as major: perineal wound dehiscence managed by surgical treatment, small bowel obstruction leading to relaparotomy and long-term incontinence for liquid stool. Conclusion, The 13 major and three ,accepted as major' complications can be used to properly balance the benefit and harm of short-term pre-operative radiotherapy in resectable rectal cancer. This may eventually lead to improved treatment strategies for these patients. [source] | |||||||||||||||||||||||||