ABSTRACT
We wanted to evaluate the occurrence of wound dehiscence in class III and class IV wounds, that are contaminated, with an interrupted, far-near near-far technique (Smead Jones technique) of midline abdominal wound closure and study the occurrence of wound dehiscence in patients requiring laparotomy having high risk / co-morbid states. MethodsA total of 100 cases was selected and abdominal wound closure was done by Smead Jones technique using polypropylene suture No. 1. The Smead Jones sutures are double loop far-near, near-far applied to linea alba. All the patients were started on intravenous antibiotics. The wound was managed by daily antiseptic dressings. Postoperatively, the patients were followed up daily for 10 days and then once every 15 days up to 6 weeks to check for any disruption in suture line. ResultsAll patients were operated under general anaesthesia. The incision used was vertical midline. Majority of the cases were perforation peritonitis and intestinal obstruction (malignant or tubercular). Out of 100 patients, 76 patients had dirty wound, 10 had contaminated and 14 patients had clean contaminated wounds. Out of 100 patients, 2 patients had wound dehiscence. Dehiscence was observed on 7th post-operative day in one patient who was a case of perforation peritonitis due to duodenal ulcer perforation, who presented late in emergency after four days of symptoms. Secondary suturing was done after proper build up and was discharged on 16th post-operative day of his index surgery. ConclusionsFrom the present study, it can be concluded that the technique of closure of contaminated and dirty wounds is an important factor in the final outcome of the emergency laparotomy. In such cases burst abdomen can be reduced using Smead Jones (far-near near-far) interrupted technique of midline abdomen wound closure using non-absorbable polypropylene suture.
ABSTRACT
We wanted to assess and compare the morphological deviations of the cervical vertebral column and cranial base angle in three different facial types that is hypodivergent, normodivergent and hyperdivergent groups and elucidate the aetiology behind the associations as well as clinical implications of the results. MethodsThe study was conducted in the department of orthodontics wherein lateral cephalograms of 150 subjects in the age group of 18 - 25 years were taken and divided into three groups. The division of groups was made as per Steiner’s mandibular plane angle i.e. Hyperdivergent group (SN–MP angle >34 degrees) Normodivergent group (SN–MP angle 26- 34 degrees) Hypodivergent group (SN–MP angle < 26 degrees). Lateral cephalograms were traced and analysed to compare the variables by statistical analysis. Morphology of the cervical column was evaluated by visual inspection of the first 5 cervical vertebrae as they are normally seen on a standardized lateral skull radiograph. Characteristics of the cervical column were classified according to the method of Sandham. The cranial base angle was measured by the angle between nasion sella and sella basion (N-S-Ba) and then compared in the three groups. ResultsThe cranial base angle was increased significantly in the hyperdivergent group and decreased in the hypodivergent group when compared to the normodivergent group patients. However, no significant results were associated regarding the morphology of the cervical column in the three groups. ConclusionsAssociations between the cranial base angle and cervical column morphology plays a pivotal role in orthodontics in making the diagnosis of malocclusion and finding out the pattern of growth in vertical direction. A routine examination of the cervical vertebral column area for any deviation in the morphology should be done and checked. These registrations may prove useful in making the diagnosis and finding aetiology especially in the cases of severe skeletal malocclusions like severe open bite and deep bite and those with obstructive disorders like obstructive sleep apnoea or enlarged adenoids.
ABSTRACT
The aim of the present study was to examine as to whether any association can be found between the head posture and the craniofacial growth in the vertical direction.METHODSThe sample comprised of 150 subjects in the age group of 18 - 25 years and were further divided into three groups. These groups were classified into hypodivergent, normodivergent, and hyperdivergent according to the sella-nasion (SN) mandibular plane angle. The head posture was measured by calculating craniocervical and cervicohorizontal postural variables, recorded from the lateral cephalograms taken with the subjects standing with the head in the natural head position.RESULTSA clear pattern of association was found between the head posture and the vertical growth pattern. An extended head posture was seen in hyperdivergent group and flexion of the head was seen in hypodivergent group when compared to normodivergent cases (P<0.05, P<0.01). The findings were in agreement with the soft tissue stretching hypothesis according to which stronger forces are exerted on the facial skeleton whenever there is an increase in the tension in the soft tissue layer. When these forces are active for a long time during growth, they might restrict the growth of the maxilla and the mandible in forward direction and redirect it in a more caudal direction. Such a mechanism could explain the association between the extension of the head and the development of facial skeleton and in particular, the mandible.CONCLUSIONSThe cervical vertebral column area should be evaluated in routine cephalometric analysis and any deviation in the cervical column morphology and head posture should be registered. These registrations may prove useful when considering the diagnosis and evaluating the etiology, especially in patients with severe skeletal malocclusion and obstructive sleep apnea.