Sutura em Polia Retificada para síntese de feridas de pele tensionadas / Rectified Pulley Suture for the synthesis of tensioned skin wounds

Introdução: A síntese de feridas de pele tensionadas é uma área que tem sido alvo de estudos para o desenvolvimento de técnicas de sutura que sejam capazes de realizar o fechamento primário dessas feridas com alívio de tensão, garantindo uma cicatrização adequada e evitando complicações como deiscência, edema, sangramento e infecção. Método: Esta pesquisa tratou-se de um estudo piloto, sendo a primeira apresentação da técnica de Sutura em Polia Retificada para síntese de feridas de pele tensionadas através do acompanhamento prospectivo, duplo-cego, de uma série de casos de 8 pacientes randomicamente admitidos no centro cirúrgico de um hospital de alta complexidade de uma cidade de médio porte. Resultados: A Sutura em Polia Retificada é uma técnica versátil e apta para lidar com feridas de pele tensionadas, uma vez que no intraoperatório conseguiu fechar por primeira intenção lesões de até 6,5 centímetros e de diferentes regiões tensionadas sem necessidade do uso de técnicas mais complexas, como retalhos, enxertos, zetaplastia e fechamento por segunda intenção. Além disso, no pós-operatório, houve redução dos escores da POSAS, indicando um processo de cicatrização satisfatório tanto para os observadores quanto para o paciente. É imprescindível mencionar, também, que o desfecho mais temido no seguimento dos pacientes com feridas tensionadas submetidos a fechamento primário - a deiscência - foi completamente evitado. Conclusão: A técnica é simples, confiável, segura e reprodutível, com curta curva de aprendizagem, de forma que a Sutura em Polia Retificada pode ser considerada como uma nova ferramenta a ser integrada ao arsenal cirúrgico.

Introduction: The synthesis of tensioned skin wounds is an area that has been the subject of studies for the development of suturing techniques that are capable of performing the primary closure of these wounds with tension relief, ensuring adequate healing, and avoiding complications such as dehiscence, edema, bleeding, and infection. Method: This research was a pilot study, being the first presentation of the Rectified Pulley Suture technique for the synthesis of tensioned skin wounds through prospective, double-blind monitoring of a series of cases of 8 patients randomly admitted to the surgical center of a high-complexity hospital in a mediumsized city. Results: Rectified Pulley Suture is a versatile technique suitable for dealing with tensioned skin wounds, since intraoperatively it was able to close, by first intention, lesions measuring up to 6.5 centimeters and in different tensioned regions without the need for the use of more extensive techniques. complex, such as flaps, grafts, Z-plasty, and secondary intention closure. Furthermore, post-operatively, there was a reduction in POSAS scores, indicating a satisfactory healing process for both observers and the patient. It is also essential to mention that the most feared outcome in the follow-up of patients with tension wounds undergoing primary closure - dehiscence - was completely avoided. Conclusion: The technique is simple, reliable, safe, and reproducible, with a short learning curve, so the Rectified Pulley Suture can be considered a new tool to be integrated into the surgical arsenal.

Terapia E-VAC como tratamiento de complicaciones en cirugía gastrointestinal en centro de referencia de gastroenterología en Colombia: Serie de casos

Las fístulas y dehiscencias anastomóticas postoperatorias gastrointestinales se presentan de forma frecuente y muchas son manejadas quirúrgicamente, sin embargo, las intervenciones endoscópicas han mostrado mejorar desenlaces de curación y tiempo de estancia hospitalaria. Se describe la experiencia de la terapia de cierre asistida por vacío (E-VAC), en el manejo de fístulas y dehiscencias anastomóticas postoperatorias, en un centro de referencia gastrointestinal en Colombia. Se realizó un estudio serie de casos en pacientes con dehiscencia de anastomosis y fístula a diferentes niveles del tracto digestivo, tratados mediante E-VAC, por el servicio de gastroenterología de la clínica universitaria Colombia, en Bogotá, durante un periodo comprendido de febrero 2019 y noviembre 2021. Se describieron variables sociodemográficas, clínicas y quirúrgicas. Se describen 6 casos, 4 de tracto digestivo inferior y 2 de tracto digestivo superior. El 83% fueron hombres, la edad media fue de 51,8 años (+/-17,5). La indicación de E-VAC fue fístula anastomótica colorrectal en el 66%, siendo la ubicación anatómica más frecuente la anastomosis colorrectal (66%), con menor frecuencia a nivel de los cardias (16%) y esófago (16%). El tamaño del defecto se describió entre el 20 y el 80% en pacientes sometidos a terapia E-VAC, siendo el tiempo promedio de hospitalización 22.5 días con un número de recambios promedio de siete por paciente. Las fugas y fístulas anastomóticas son complicaciones potencialmente mortales en pacientes llevados a intervenciones quirúrgicas gastrointestinales, en las que la terapia E-VAC ha mostrado ser eficaz y segura, promoviendo el cierre del defecto y el drenaje de colecciones presentes, igualmente disminuyendo el tiempo de estancia hospitalaria.

Gastrointestinal postoperative anastomotic leaks and fistulas occur frequently and many are managed surgically; however, endoscopic interventions have shown to improve healing outcomes and length of hospital stay. The experience of vacuum-assisted closure therapy (E-VAC) is described, in complications such as fistulasand postoperative anastomotic leaks, in a gastrointestinal reference center in Colombia. A case series study was carried out in patients with anastomotic leaks and fistulasat different levels of the digestive tract, treated by E-VAC, by the Gastroenterology Service in Colombia, during a period from February 2019 to November 2021. Sociodemographic, clinical and surgical variables were described. 6 cases are described, 4 from lower digestive tract and 2 from upper digestive tract. 83% were men; the mean age was 51.8 years (+/-17.5). The indication for E-VAC was colorectal anastomotic fistula in 66%; the most frequent anatomical location was near the anal region (66%), less frequently at the level of the cardia (16%) and esophagus (16%). The size of the defect was described between 20 and 80% in patients undergoing E-VAC therapy, with an average hospitalization length of stay of 22.5 days, with an average number of exchanges of seven per patient. Anastomotic leaks and fistulasare potentially fatal complications in gastrointestinal surgery. E-VAC therapy has shown to be effective and safe, promoting defect closure and drainage of collections present, also decreasing the length of hospital stay.

Dehiscencia de herida quirúrgica y exposición material de osteosíntesis. ¿Infección segura? / Surgical wound dehiscence and exposed hardware. Infection foretold?

Resumen: Introducción: la dehiscencia de herida quirúrgica con exposición de material de fijación interna es un grave problema en cirugía ortopédica y un factor importante de infección. Objetivo: descripción del caso inusual de un paciente adulto con dehiscencia de la herida quirúrgica y exposición completa de 20 cm de largo de una placa de cúbito tras seis años de la cirugía, sin signos de infección, consolidación ósea y reepitelización debajo de la placa y adherida al hueso. Caso clínico: hombre de 39 años que sufrió una fractura-luxación de Monteggia, abierta grado II y multifragmentaria. El paciente tenía historia de drogodependencia en tratamiento con metadona. Fue tratado con fijación interna del cúbito mediante una placa de reconstrucción larga. Postoperatoriamente, el paciente dejó de acudir para evaluación. A los seis años de la cirugía presentaba una completa exposición de la placa (20 cm de longitud), sin signos de infección y consolidación con malalineación de la fractura. Tras el retiro de la placa se observó epitelización espontánea adherida al lecho óseo cubital. La cobertura cutánea fue completa a los dos meses. Conclusión: aunque inusual, es posible la consolidación ósea y la ausencia de infección en una fractura abierta con exposición de larga evolución de una placa de antebrazo en el adulto.

Abstract: Introduction: surgical wound dehiscence with exposure of internal fixation material is a serious problem in orthopedic surgery and an important factor for infection. Objective: presentation of an unusual case of an adult patient with surgical wound dehiscence and complete exposure of 20 cm of the ulnar plate after six years of surgery, without infection signs, with bone healing and skin behind the plate. Case presentation: 39-year-old man with an open Gustilo II Monteggia fracture-dislocation multifracture. The patient had a history of drug dependence. He had an open reduction and internal fixation with an ulnar reconstruction plate. The patient did not have any follow-up. After six years of the surgery, there was a complete exposure of the plate (20 cm) without infection and healing of the fracture with misalignment. After removing the plate, we observed spontaneous epithelialization attached to the bone bed. Skin coverage was complete at two months. Conclusion: although unusual, bone consolidation without infection is possible in an open fracture with long-standing exposure to a forearm plate in the adult.

Analysis of risk factors of abdominal wound dehiscence after radical cystectomy

SUMMARY OBJECTIVE: Wound dehiscence is associated with high morbidity and mortality. This study aimed to analyze the risk factors and comorbidities in the patients undergoing radical cystectomy with early postoperative wound dehiscence. METHODS: In all, 539 patients with bladder cancer who underwent radical cystectomy and urinary diversion at a single center between January 2008 and January 2022 were included in the study. The data related to the demographics, medical history, and perioperative clinical features were reviewed. Univariate and multivariate regression analysis was performed to identify risk factors for wound dehiscence. RESULTS: The mean age of the patients was 64.2 years (22-91). The mean body mass index was 26.4 kg/m2 (18.7-35.4). Wound dehiscence was observed in 43 (7.9%) of 539 patients. The patients with wound dehiscence had significantly higher mean BMI (27.8 vs. 26.3, p=0.006), ASA scores (p=0.002), history of chronic obstructive pulmonary disease (30.2 vs. 14.3%, p=0.006), diabetes mellitus (44.2 vs. 17.9%, p=0.003), previous abdominal surgery (18.6 vs. 7.7%, p=0.014), and postoperative ileus (58.1 vs. 16.9%, p=0.006). In the multivariable regression model, diabetes mellitus (odds ratio [OR] 4.9, 95%CI 2.3-10.1; p<0.001), postoperative ileus (OR 8.1, 95%CI 4.1-16.5; p<0.001), and chronic obstructive pulmonary disease (OR 2.6, 95%CI 1.2-5.7; p=0.013) were independent predictors of abdominal wound dehiscence following radical cystectomy. CONCLUSION: Diabetes mellitus, chronic obstructive pulmonary disease, and postoperative ileus were strongly associated with abdominal wound dehiscence following radical cystectomy. Both potential preventive and therapeutic interventions may decrease the risk of wound dehiscence.

A CLINICAL STUDY OF ABDOMINAL WOUND DEHISCENCE

INTRODUCTION:-AWD (abdominal wound dehiscence) is a word that is widely used to describe the separation of different layers of an abdominal wound before it has healed completely. Acute laparotomy wound failure and burst abdomen are two more words that are used interchangeably. Wound dehiscence happens when a wound does not develop the necessary strength to withstand the demands exerted on it. Dehiscence happens when sutures are disrupted by external pressures, absorbable sutures dissolve too quickly, or tight sutures rip through tissues due to excessive strain. AWD has been a long-standing problem for which no surgical unit has offered a complete solution (i.e. none of the surgical units worldwide has reported 0 percent failure rate). However, numerous institutes around the world have been successful in achieving and maintaining failure rates considerably below 1%. These ?gures, on the other hand, do not deter researchers from continuing their efforts to solve the problem. In the last ten years, there have been a slew of publications attempting to explain how to solve this problem. The goal of this study is to assess the prevalence of abdominal wound dehiscence in relation to various risk factors, co-morbidities, and treatment options. The study aimed at ?nding out the AIM:- prevalence of abdominal wound dehiscence with respect to demographic factors, nature of preceding surgery and different risk factors and also to study the effective management of abdominal wound dehiscence. An Observational study METHODS:- on 60 patients comprising all patients admitted to Silchar medical College and Hospital a tertiary care center in Assam within the study period of 1st January 2021 to 31st July 2021 with diagnosed abdominal wound Dehiscence after undergoing surgical interventions. :-The majority of the patients in this study were between the ages of 41 and 50. Majority were male. RESULTS 81.67% were operated as emergency surgery. 66.67% have undergone procedures which are classi?ed as contaminated. (80%) were operated with mid line incision. 58% patients with peritonitis due to hollow viscus perforation. 58.33% had hypoalbuminemia. Malnutrition, DM, HT, pulmonary diseases, anemia etc. are important risk factors for wound dehiscence. CONCLUSION:-Because of the poor blood supply at Linea Alba, individuals who had a midline laparotomy had a higher risk of wound dehiscence than those who had a paramedian laparotomy. Wound dehiscence is more likely in people with a BMI greater than 25, compared to those with a BMI less than 25. In this study wound dehiscence is mainly associated with complications like hypoproteinemia and pulmonary complications and anaemia.

Prevalence of complicated surgical wounds and related factors among adults hospitalized in public hospitals / Prevalencia de heridas operatorias complicadas y sus factores asociados en adultos hospitalizados en instituciones públicas de salud / Prevalência de ferida operatória complicada e fatores associados em adultos internados em hospitais públicos

ABSTRACT Objective: To estimate the prevalence of complicated surgical wounds and its related factors in hospitalized adults. Method: In this cross-sectional study, information from 251 patients hospitalized in seven public hospitals in Manaus, Brazil, and at risk of suffering surgical site complications after undergoing surgery was analyzed. Data were collected via interviews, physical examinations, and a medical record review from March to June 2015. Prevalence rate was estimated as the ratio between individuals with complications and patients at risk. To explore associated variables, individuals with and without complications were compared via 5% significant logistic regression and bivariate analyses. This study was approved by a research ethics committee. Results: Overall, 15 patients (6%) showed complicated surgical wounds. General hospitalization (p < 0.003), presence of ecchymosis, (p < 0.001), and men (p = 0.047) increased patients' probability of developing complications in 13.9, 10.1, and 8.2 times, respectively. Conclusion: Assessing the prevalence of complicated surgical wounds and its associated factors in adults contributes to their epidemiological understanding, highlighting prevention targets and making data available for scientific comparisons.

RESUMEN Objetivo: Estimar la prevalencia de herida quirúrgica complicada y sus factores asociados en adultos hospitalizados. Método: Estudio transversal, aprobado por el comité de ética. Se analizaron los datos de 251 pacientes, sometidos a cirugía y con riesgo de complicación del sitio quirúrgico, hospitalizados en siete hospitales públicos de Manaos (Brasil); la recolección de datos se dio por entrevistas, examen físico y revisión de historias clínicas, en el periodo de marzo a junio de 2015. La tasa de prevalencia se calculó como la razón entre los individuos con complicaciones y los pacientes de riesgo. Para explorar las variables asociadas, se compararon individuos con y sin complicaciones mediante análisis bivariado y regresión logística, con un nivel de significancia del 5%. Resultados: Fue identificada herida operatoria complicada en quince pacientes (6%). La presencia de equimosis (p < 0,001), ajustada por sexo masculino (p = 0,047) y la hospitalización en clínica general (p < 0,003) aumentaron en 10,1; 8,2 y 13,9 veces, respectivamente, la probabilidad de desarrollar complicaciones. Conclusión: La identificación de la prevalencia de herida quirúrgica complicada en adultos y sus factores asociados contribuye a su comprensión epidemiológica, destacando focos potenciales de prevención y proporcionando datos para la comparación científica.

RESUMO Objetivo: Estimar a prevalência de Ferida Operatória Complicada e seus fatores associados, em adultos hospitalizados. Método: Estudo transversal, aprovado por comitê de ética. Foram analisadas informações de 251 pacientes submetidos à cirurgia e com risco de complicação do sítio cirúrgico, internados em sete hospitais públicos em Manaus (Brasil); cujos dados foram coletados por meio de entrevista, exame físico e revisão de prontuários, no período de março a junho de 2015. A taxa de prevalência foi calculada como a razão entre os indivíduos com complicação e os pacientes em risco. Para exploração de variáveis associadas, foram comparados indivíduos com e sem complicação por meio de análises bivariadas e regressão logística, com significância de 5%. Resultados: 15 pacientes (6%) apresentaram ferida operatória complicada. A presença de equimose (p < 0,001), ajustada pelo sexo masculino (p = 0,047) e a internação na clínica geral (p < 0,003) aumentaram a probabilidade de desenvolver a complicação em 10,1; 8,2 e 13,9 vezes, respectivamente. Conclusão A identificação da prevalência da ferida operatória complicada em adultos e seus fatores associados contribuem para a sua compreensão epidemiológica, destacando alvos de prevenção e disponibilizando dados para comparação científica.

Comparación entre suturas para cierre profundo y superficial en reemplazo total de rodilla: seguimiento a un año / A comparison of sutures for deep and superficial wound closure in total knee arthroplasty: One-year follow-up

Introducción Aunque diferentes materiales y técnicas se han desarrollado para el cierre superficial y profundo en reemplazo total de rodilla (RTR), no hay evidencia que permita dar recomendaciones respecto a una técnica especifica que disminuya complicaciones postoperatorias de la herida. El propósito de este estudio es comparar el uso de dos técnicas de cierre profundo (Sutura barbada vs. Sutura absorbible trenzada) y superficial (grapas vs. sutura de polipropileno) en RTR. Materiales y métodos Estudio observacional retrospectivo en 240 pacientes. Se excluyeron pacientes con antecedente de cirugía abierta previa de rodilla, RTR previo por lesiones tumorales o artrofibrosis. Seguimiento mínimo de 1 año. Resultados Se usaron grapas en 176 pacientes y Prolene® en 64 pacientes. El cierre profundo se realizó con Stratafix® en 164 pacientes y con Vicryl® en 75 pacientes. Encontramos complicaciones relacionadas con la herida y la funcionalidad al año de seguimiento. La infección superficial para el cierre con prolene presento un HR de 2.6 con un intervalo de confianza (IC) de 95%=1.1-6.2; p=0.029 y en el cierre profundo encontramos un HR a favor del Vicryl® de 0.22, IC 95%=0.96-5.8; p=0.05. Conclusiones Este estudio demostró un incremento significativo de la incidencia de infección superficial después de un RTR cuando el cierre profundo se realiza con suturas barbadas y el cierre superficial se realiza con sutura de polipropileno. Sin embargo, no se presentaron diferencias significativas en otras complicaciones relacionadas con la herida y en la funcionalidad postoperatoria con las diferentes técnicas de cierre superficial y profundo evaluadas.

Introduction Different materials and techniques have been developed for superficial and deep closure in total knee replacement (TKR), but there is no solid evidence that allows to recommend a specific technique that decreases the surgical post-operative complications. The purpose of this study is to compare the use of two deep closure techniques (barbed suture vs. braided absorbable suture) and superficial (staples vs. polypropylene suture) in TKR. Materials and methods An observational retrospective study was carried out in 240 patients. Those individuals were excluded with previous open knee surgery, arthrofibrosis, patients who underwent TKR due to tumor lesions or a follow up for less than one year. Results The skin was closed in 176 patients with staples and in 64 patients with Prolene®. Deep closure was performed with Stratafix® in 164 patients and with Vicryl® in 75 patients. Also, complications related to the wound and functionality were recorded in the first postoperative year. Superficial infection for closure with prolene presented an HR in favor of 2.6 with a confidence interval (CI) of 95%=1.1­6.2; p=0.029 and in deep closure a HR in favor of Vicryl® of 0.22, 95% CI=0.96­5.8; p=0.05 Conclusions This study demonstrated a significant increase in the incidence of superficial infection after TKR when deep closure is performed with barbed sutures and superficial closure with polypropylene suture. However, there were no significant differences in other complications related with the wound neither postoperative functionality with the different superficial and deep closure techniques that were evaluated.

Rotura vaginal y evisceración relacionadas a úlcera de contacto por útero prolapsado: reporte de caso / Vaginal rupture and evisceration related to contact ulcer due to prolapsed uterus: case report

RESUMEN La evisceración vaginal se presenta en 0,36% a 0,96% de las pacientes postoperadas de histerectomía. La causa más frecuente es la dehiscencia de la cúpula vaginal, con mayor riesgo en la histerectomía laparoscópica en relación a la de abordaje abierto. Se describe el caso de una mujer de 63 años con historia de prolapso total de útero, sin antecedente quirúrgico, que ingresó a emergencia por evisceración vaginal. La rotura ocurrió en la pared vaginal posterior, en donde se había formado una úlcera por roce. Se realizó laparotomía para reducir el intestino y reparar el desgarro de la pared vaginal. La corrección del prolapso se practicó ocho meses después con resultados satisfactorios. El tipo de cirugía reparadora depende del tipo y viabilidad de la víscera herniada y se puede realizar por vía vaginal, abdominal o combinada, mediante laparotomía o laparoscopia.

ABSTRACT Vaginal evisceration occurs in 0.36% to 0.96% of postoperative hysterectomy patients. The most frequent cause is vaginal vault dehiscence, with a higher risk in laparoscopic hysterectomy than in open approach. We describe the case of a 63-yearold woman with a history of total prolapse of the uterus, with no surgical history, who was admitted to the emergency room for vaginal evisceration. The rupture occurred in the posterior vaginal wall, where a friction ulcer had formed. Laparotomy was performed to reduce the bowel and repair the tear in the vaginal wall. Correction of the prolapse was done eight months later with satisfactory results. The type of reparative surgery depends on the type and viability of the herniated viscus and can be performed vaginally, abdominal or combined, by laparotomy or laparoscopy.

Dehiscencia de cúpula vaginal y evisceración posquirúrgica: reporte de caso / Vaginal vault dehiscence and postoperative evisceration: case report

RESUMEN La dehiscencia de cúpula vaginal es la separación precoz de la incisión vaginal suturada, que en el 70% de los casos se manifiesta con una evisceración de asas intestinales a través del conducto vaginal. Dentro de sus factores de riesgo, destacan la edad y alteraciones en el lugar postoperatorio de histerectomía. El diagnóstico se realiza mediante un adecuado examen físico, y el tratamiento, netamente quirúrgico, involucra el regresar las vísceras intestinales y corregir la dehiscencia. Describimos el caso de una mujer de 50 años, que presentó dehiscencia de la cúpula vaginal con evisceración de una porción de íleon distal, a quien se le practicó tratamiento quirúrgico y farmacológico.

ABSTRACT Vaginal cuff dehiscence is the premature separation of the sutured vaginal incision, which in 70% of the cases manifests with evisceration of intestinal loops through the vaginal canal. Among its risk factors, age and alterations in the postoperative hysterectomy site stand out. The diagnosis is made by means of an adequate physical examination and the treatment, purely surgical, involves the return of the intestinal viscera and correction of the dehiscence. We describe the case of a 50-year-old woman who presented dehiscence of the vaginal vault with evisceration of a portion of the distal ileum, who underwent surgical and pharmacological treatment.

Recidiva de cicatriz queloide en pacientes tratados con resección quirúrgica más radioterapia / Keloid scar recurrence in patients treated with surgical resection plus radiotherapy

INTRODUCCIÓN. El proceso de cicatrización puede derivar en anomalías, que afectan el aspecto estético y funcional de la zona afectada; la combinación de tratamientos ha permi-tido resultados favorables. OBJETIVOS. Describir los factores que se dan en las recidivas de cicatriz queloide en pacientes tratados con resección quirúrgica más radioterapia. MA-TERIALES Y MÉTODOS. Estudio observacional, descriptivo y retrospectivo. Población de 2 960 Historias Clínicas, se tomó muestra de 100. Criterios de inclusión: diagnóstico de cicatriz queloide, edad de 12 a 75 años, combinación de tratamiento quirúrgico y radiotera-pia. Criterios de exclusión: edades fuera del rango, tratamiento diferente, en la Unidad de Plástica y Reconstructiva del Hospital de Especialidades Carlos Andrade Marín durante el período enero 2013 a diciembre 2019. Los datos fueron tomados del sistema AS400, el análisis se realizó en el programa estadístico International Business Machines Statistical Package for the Social Sciences, versión 22. RESULTADOS. La localización frecuente fue en el pabellón auricular con 83% (83; 100), de estos el 57% (57; 100) fueron poste-rior a perforación; la recidiva se presentó en el 24% (24; 100) y la principal complicación en los pacientes fue Radiodermitis. DISCUSIÓN. La evidencia científica guardó relación con el estudio referente a técnica, sexo, localización del queloide, causa y complicación. CONCLUSIÓN. Se pudo describir los factores que se dieron en las recidivas de cicatriz queloide en pacientes tratados con resección quirúrgica más radioterapia.

INTRODUCTION. The healing process can lead to anomalies, which affect the aesthe-tic and functional appearance of the affected area; the combination of treatments have allowed favorable results. OBJECTIVES. Describe the factors that occur in keloid scar recurrences in patients treated with surgical resection plus radiotherapy. MATERIALS AND METHODS. Observational, descriptive and retrospective study. Population of 2 960 Clini-cal Histories, a sample of 100 was taken. Inclusion criteria: diagnosis of keloid scar, age 12 to 75 years, combination of surgical treatment and radiotherapy. Exclusion criteria: ages outside the range, different treatment, in the Plastic and Reconstructive Unit of the Carlos Andrade Marín Specialty Hospital during the period January 2013 to December 2019. The data were taken from the AS400 system, the analysis was carried out in the program Sta-tistical International Business Machines Statistical Package for the Social Sciences, ver-sion 22. RESULTS. The frequent location was in the auricle with 83% (83; 100), of these 57% (57; 100) were after perforation; recurrence occurred in 24% (24; 100) and the main complication in patients was Radiodermatitis. DISCUSSION. The scientific evidence was related to the study referring to technique, sex, location of the keloid, cause and compli-cation. CONCLUSION. It was possible to describe the factors that occurred in keloid scar recurrences in patients treated with surgical resection plus radiotherapy.

Assessment of Wound Dehiscence in Smead Jones (Far - Near Near - Far) Technique of Midline Abdominal Wound Closure - An Observational Study

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.

A prospective study of assessment of prognostic factors in early and late wound dehiscence in midline vertical incision

Background: Wound dehiscence is separation of some or all layers of incision. It may be partial or complete. It is called as complete when all layers of the abdominal wall have been separated with or without evisceration of viscous. The study aims to find out and record the prognostic factors for wound dehiscence in vertical midline laparotomy.Methods: This was a prospective study in 1400 laparotomies that developed wound dehiscence operated in Gandhi Medical College, Bhopal from august 2017 to august 2019. All the patients with burst abdomen operated during emergency or elective setting by midline vertical laparotomy were included.Results: Wound dehiscence was most common in 51-60 years age group (26%). Majority patients were males (62%). Emergency laparotomy showed maximum incidence (71%). Bursts were seen mostly during 6th to 10th postoperative day. 78% patients presented as partial wound dehiscence and remaining as complete wound dehiscence. 46% presented as early wound dehiscence (7 days).Conclusions: Post laparotomy wound dehiscence has multifactor etiology. Respiratory infections, anemia, and hypoproteinaemia are the contributing factors. Improper haemostasis during surgery and poor surgical technique are the predisposing factors.

Study of negative pressure wound therapy in management of abdominal wound dehiscence

Background: Postlaparotomy Abdominal wound dehiscence (AWD) occurs in 0.25% to3%. Many technique are being used to manage AWD like surgical revision with open dressing/closed irrigation, temporary covering with ‘Bagota bag’, saline soak gause dressing, absorbable/permanent mesh. Negative-pressure wound therapy (NPWT) is a recent modality of treatment of wound. It involves controlled application of sub atmospheric pressure to local wound environment, using sealed wound dressing connected to vacuum pump. This study aimed at finding the effectiveness of negative pressure wound therapy in management of abdominal wound dehiscence over conventional methods of wound management.Methods: This was hospital based non randomised comparative prospective interventional study carried between July 2017 to November 2019, includes all patients admitted in GMCH, Nagpur Hospital having post laparotomy AWD, excluding the patients having enter ocutaneous fistula and patient not giving consent for VAC application. Total n=60 cases were included in study. Out of 60, 30 were taken as cases in whom intervention was done by applying vaccum assisted closure (VAC) therapy and 30 were control.Results: All 60 patients had undergone laparotomy of this patients 30 patients was applied NPWT and efficacy plotted on the parameter of, wound sepsis, wound contraction, length of hospital stay and extension of time therapy. It was found that 90% patients had negative c/s post VAC dressing, compared to 26% in post ns dressing, there was MWC of 0.86 cm in post VAC patients compared to 0.14 cm in post NS dressing, MHS was 18.9 days in cases and was 28 days in controls,13 patients had complete fascial closure in cases whereas none in controls.Conclusions: NPWT significantly reduces the hospital stay of patients, it causes faster and higher degree of wound contraction, reduces wound sepsis thereby reducing morbidity of patients.

Ações de enfermagem podem prevenir deiscência em ferida operatória? / Can nursing actions prevent surgical wound dehiscence? / ¿Pueden las acciones de enfermería prevenir la dehiscencia de la herida operatoria?

Objetivo: Identificar na literatura científica intervenções de enfermagem úteis para a prevenção de Deiscências em Feridas Cirúrgicas. Método: Trata-se de uma revisão integrativa da literatura, norteada pela pergunta: Há ações de enfermagem que possam contribuir para prevenção de deiscência em ferida operatória? Realizou-se a busca no período de março de 2019, incluindo artigos publicados a partir do ano de 1990 até 2018. Para a seleção dos artigos foram utilizadas as seguintes bases de dados e/ou portais: National Library of Medicine (PubMed); Web of Science; Scopus Info Site (Scopus); Literatura Latino-Americana e do Caribe em Ciência da Saúde (LILACS) e Cumulative Index to Nursing and Allied Health Literature (CINHAL). Resultados: A busca resultou em 64 artigos, excluíram-se quatro por estarem duplicados e 40 por não atenderem aos critérios de inclusão (24 por serem sobre tratamento, 13 pela natureza do artigo, dois por não estarem disponíveis e um por ser em francês). Vinte artigos foram avaliados na íntegra e 14 foram excluídos por não responderem à questão norteadora desta revisão. Dessa maneira, ao fim desse processo de análise, foram selecionados seis artigos que responderam aos critérios de inclusão e constituíram a amostra final. Conclusão: Houve pouca produção da enfermagem sobre o tema. As principais ações de enfermagem para prevenção de deiscência em feridas cirúrgicas estão associadas à prevenção de infecções de sítio cirúrgico e à indicação e à utilização de terapia de cobertura a vácuo.

Objective: To identify useful nursing interventions for preventing Surgical Wound Dehiscence in scientific literature. Method: This is an integrative literature review, guided by the question: are there nursing actions that can contribute to the prevention of surgical wound dehiscence? The search was carried out in March 2019, including articles published from 1990 to 2018. We used the following databases and/or portals to select the articles: National Library of Medicine (PubMed); Web of Science; Scopus Info Site (Scopus); Latin American and Caribbean Health Sciences Literature (LILACS), and Cumulative Index to Nursing and Allied Health Literature (CINHAL). Results: The search resulted in 64 articles. We excluded four of them for being duplicates, and another 40 that did not meet the inclusion criteria (24 were about treatment, 13 due to the nature of the article, two were not available, and one was in French). Twenty articles were fully evaluated, and 14 were excluded because they did not answer the guiding question of this review. Thus, at the end of this analysis process, we selected six articles that met the inclusion criteria and constituted the final sample. Conclusion: The nursing production on the subject was scarce. The main nursing actions for preventing surgical wound dehiscence are associated with the prevention of surgical site infections and the indication and use of negative pressure wound therapy.

Objetivo: identificar en la literatura científica intervenciones de enfermería útiles para la prevención de la dehiscencia en heridas quirúrgicas. Método: Esta es una revisión de literatura integradora, guiada por la pregunta: ¿Existen acciones de enfermería que puedan contribuir a la prevención de la dehiscencia en las heridas quirúrgicas? La búsqueda se realizó en el período de marzo de 2019, incluidos los artículos publicados de 1990 a 2018. Para la selección de artículos, se utilizaron las siguientes bases de datos y/o portales: National library of Medicine (PubMed); Web of Science; Scopus Info Site (Scopus); Literatura latinoamericana y caribeña de ciencias de la salud (LILACS) y Cumulative Index to Nursing and Allied Health Literature (CINHAL). Resultados: La búsqueda resultó en 64 artículos, se excluyeron cuatro duplicados, 40 artículos por no cumplir con los criterios de inclusión (24 sobre el tratamiento, 13 por la naturaleza del artículo, dos por no estar disponibles y uno por estar en francés), y 20 los artículos fueron evaluados en su totalidad y 14 fueron excluidos porque no respondieron la pregunta guía de esta revisión. Por lo tanto, al final de este proceso de análisis, se seleccionaron seis artículos que cumplían los criterios de inclusión y constituían la muestra final. Conclusión: hubo poca producción de enfermería sobre el tema. Las principales acciones de enfermería para prevenir la dehiscencia en las heridas quirúrgicas están asociadas con la prevención de infecciones del sitio quirúrgico y la indicación y el uso de la terapia de cobertura con vacío.

Effectiveness of Early Versus Late Dressing Removal in Contaminated and Clean Surgical Wounds

Aim: This study was conducted to assess the effectiveness of early versus late dressing removal in contaminated and clean surgical wounds. Study design: A Prospective non-randomized study. Place and duration: In the Surgical Unit of AllamaIqbal Teaching Hospital, Sialkot from March 2018 to March 2019. Method: Sixty patients age eighteen or above (planned surgery and emergency surgery) were enrolled in the study, admitted in hospital and operated. All surgical wounds met the criteria of contaminated and clean surgical wounds. Thirty patients were included in each group with early and late dressing removal. In the early removal group, within 48 hours, the surgical dressing was removed and in the late group 48 hours after surgical intervention. The incidence of deep and superficial surgical site (SSI) infection was studied in these two groups. Additional subordinate factors such as dehiscence of wound incidence and secondary suturing were too assessed. Results: Thirty patients were included in each group with early and late dressing removal for final scrutiny. The occurrence of superficial surgical sight infection was lower expressively in the early dressing removal group. The time required for full recovery (days) (8.60-10.70; p=0.734) was shorter considerably in the early dressing removal group. In the early dressing removal group, there was the significantly shorter postoperative hospital stay (days) (10.50 vs. 15.0; p ≤ 0.001). Conclusion: Early dressing removal considerably decreases the superficial SSIs incidence in contaminated and clean surgical wounds. It also considerably decreases the time of full wound healing and facilitates short hospital stay as compared to late dressing removal.

Comparison of efficacy of large tissue bites versus small tissue bites for midline abdominal wound closure

Background: Incisional hernia is common complication after median laparotomy, with reported incidence varying between 2% and 20%. For prevention of incisional hernia, many clinical trials and meta-analyses have demonstrated that mass closure technique with simple running suture is good option to close midline incision. An attempt was made in this study to compare efficacy of large tissue bites vs small tissue bites for midline abdominal wound closure.Methods: Three hundred thirty patients admitted for midline laparotomy were randomized into Group A, and Group B. Group A, and Group B patients underwent abdominal closure by small bites technique, and large bites technique respectively. Patients were followed at 7th postoperative day, 1 month, 6 months, and 12 months. Primary outcome measures were incidence of incisional hernia, incidence of postoperative complications like post-operative pain, surgical site infections, wound dehiscence whereas, secondary outcome measure was fascial closure time. Inter-group comparison of categorical, and continuous variables was done using Chi-square test/Fisher’s exact test and unpaired ‘t’ test respectively.Results: Incidence of incisional hernia was significantly higher in large bites suture technique compared to small bites suture technique at 12 months follow up. Mean time required for fascial closure time was significantly higher in small bite group compared to large bite group. There was no statistically significant difference in postoperative pain, surgical site infections, and wound dehiscence among the two groups.Conclusions: The rate of incisional hernia was lower in small bites technique compared with large bites technique in midline abdominal incisions.

A Prospective Study to Evaluate the Post-Operative Wound Dehiscence Rate after Midline Laparotomy for Emergency or Elective Surgery: An Hospital Based Study

Background: The present study was undertaken to assess theproportion of Burst abdomen in post midline laparotomypatients, using Interrupted X suture versus Continuous suturetechnique in sheath closure.Materials & Methods: A comparative prospective hospitalbased study done on 50 patients reporting to the Surgery dept.,RVRS Medical College and attached groups of MahatmaGandhi Hospital, Bhilwara, Rajasthan. After taking writteninformed consent and were equally divided into all cases eachin the study group (interrupted X suture) and control group(continuous suture). All the patients scheduled to undergo amidline laparotomy for emergency or elective reasons. Patientsyounger than 18 years of age, patients who had undergone aprevious laparotomy for any condition (or had a incisionalhernia or burst abdomen at presentation) and patients whorequired a re – exploration in post op course were excludedfrom the present study.Results: Our study showed that the mean age of patients was45 years in both groups. Male to female ratio was 2.5:1 ininterrupted X-suture group and 1.5:1 in continuous suturegroup. The 40% dirty wound was found in interrupted X-suturegroup and 32% continuous suture group. Because interruptedsuture use more in dirty wound during patients selection. Thewound infection, dehiscence and incisional hernia were mostlyoccurred in continuous suture group as compared tointerrupted X-suture group.Conclusion: We concluded that the wound infection,dehiscence and incisional hernia were mostly occurred incontinuous suture group as compared to interrupted X-suturegroup in our study.

Management of transvaginal bowel evisceration secondary to vaginal cuff dehiscence following hysterectomy: Case report and review of the literature / Manejo de evisceración intestinal transvaginal secundaria a dehiscencia de la cúpula vaginal posterior a histerectomía: reporte de caso y revisión de la literatura

ABSTRACT Objetives: To report a case of transvaginal bowel evisceration following total abdominal hysterectomy, and to conduct a review of the literature on its diagnosis and treatment. Materials and methods: A 48-year-old female patient who presented to a high complexity institution with transvaginal bowel evisceration lasting 10 hours. Laparotomy was performed in order to reduce the evisceration and repair the vaginal vault defect. A search was conducted in Medline via PubMed, Embase, Elsevier, Medigraphic, Wolters Kluwer Health and UpToDate using the terms "vaginal vault dehiscence," "transvaginal bowel evisceration," "dehiscence following hysterectomy," "hysterectomy complications," and using a snowball search strategy based on the studies identified, both in English and Spanish. Results: Fourteen studies were included. The diagnosis of transvaginal evisceration is primarily clinical with the observed bulging of the abdominal content through the vagina. It may also be associated with signs of peritonitis or bowel obstruction. Initial management must be an attempt at vaginal packing and prophylactic antibiotics. Several surgical techniques have been described for vaginal vault correction and reinforcement of dehiscence closure. Conclusions: Transvaginal evisceration is considered a surgical emergency. Further studies assessing the safety and effectiveness of the various management interventions are required.

RESUMEN Objetivos: reportar un caso de evisceración intestinal transvaginal posterior a histerectomía abdominal total y realizar una revisión de la literatura sobre su diagnóstico y tratamiento. Materiales y métodos: se presenta el caso de una paciente de 48 años que consulta a una institución de alta complejidad por evisceración intestinal transvaginal de 10 horas de evolución, se realiza laparotomía para reducción de la evisceración y reparación del defecto de cúpula vaginal. Se hace una búsqueda en Medline vía PubMed, Embase, Elsevier, Medigraphic, Wolters Kluwer Health y UpToDate con los términos: "dehiscencia de cúpula vaginal", "evisceración intestinal transvaginal", "dehiscencia posterior a histerectomía", "complicaciones histerectomía", y en bola de nieve a partir de los estudios identificados, en idiomas inglés y español. Resultados: se incluyeron 14 estudios. El diagnóstico de la evisceración transvaginal es eminentemente clínico al observar salida de contenido abdominal por vagina, se puede asociar a signos de peritonitis u obstrucción intestinal. Su manejo inicial debe intentar el empaquetamiento vaginal y la profilaxis antibiótica Se han descrito varias técnicas quirúrgicas para corregir el defecto de la cúpula vaginal y reforzar el cierre de la dehiscencia de la cúpula. Conclusiones: la evisceración transvaginal se considera una urgencia quirúrgica. Se requieren más estudios que evalúen la seguridad y la efectividad de las diferentes intervenciones para el manejo.

Calcaneal fractures: a management dilemma-minimally invasive approach for intra and extra articular calcaneal fractures

Background: Calcaneal fractures which constitutes 2% of total fractures are frequent and very debilitating if not treated properly. Calcaneal fractures generally affect younger population leading to significant man-days loss(around 2-5 years3) and in-turn leading significant economic burden on the society. The goal of treatment for calcaneal fractures is elimination of pain and restoration of normal foot shape, biomechanics, and walking ability. Wound related complications are common with open surgeries. After open reduction internal fixation with perimeter plates for displaced calcaneal fractures, wound edge necrosis is commonly observed with the extended lateral approach. Because of such high incidence of wound complications in open reduction of calcaneum fractures, minimally invasive approach takes priority over open reduction of these fractures.Methods: The study aimed to evaluate the results of minimally invasive approach for calcaneal fractures. To reduce the operative complications, 30 patients were treated with minimally invasive methods in both extra articular and intra-articular calcaneal fractures and the results were evaluated. All patients were evaluated clinically , functionally and radiologically 3D- CT reconstruction images.Results: All cases were followed up for 2 years at specified intervals. The outcome measures were evaluated by AOFAS scores10 with excellent result in 13 cases and good to fair results in the rest. Operated patients had no wound infection, no skin necrosis, 5 patients had mild subtalar arthrosis and 3 patients complained slight difficulty in wearing shoes. None of them have any gait abnormalities.Conclusions: Our study suggests that the minimally invasive methods will reduce the operative complication rates. The minimally invasive surgical intervention in an expert hand can yield better results with less complication rates.