ABSTRACT
OBJECTIVE: Saphenous vein harvesting can be associated with wound complications, incision pain, infection, and poor cosmetic outcome. The objective of our study is to determine the difference in wound complication and infection rates between two saphenous vein harvesting techniques, long incision versus multiple short interrupted incisions (tunneling) for coronary artery bypass grafting at the King Abdullah University Hospital - Jordan. METHODS: Retrospectively we analyzed data from 1,050 consecutive elective coronary artery bypass procedures performed from May 5, 2003, to December 31, 2007, in our institution. Saphenectomy using traditional Long incision vein harvesting (Group 1) performed in six hundred and fifty patients (n=650), while saphenectomy using multiple incisions with small skin bridges - tunneling (Group 2) performed in four hundred patients (n=400). Saphenectomy performed by the cardiac surgery assistant or main cardiac surgeon. Inflammation, dehiscence, cellulites, lymphangitis, drainage, necrosis, or abscess necessitating dressing, antibiotics or debridement before complete healing without eschar were defined as wound complications. There was no statistical difference in preoperative risk factors in both groups. Test results were considered significant when P<0.05. RESULTS: Leg wound complications observed more in traditional long incision vein harvesting technique (P=0.0005). Female gender, obesity, diabetes are associated with an increased incidence of wound problems (P<0.05). CONCLUSIONS: Saphenous vein harvest using saphenous vein tunneling was associated with fewer wound complications than the traditional longitudinal method.
OBJETIVO: A exérese da veia safena pode estar associada a complicações da ferida, dor da incisão, infecção e resultado cosmético ruim. O objetivo deste estudo é determinar a diferença de complicações da ferida e as taxas de infecção entre as duas técnicas de exérese de veia safena, incisão longa versus múltiplas incisões curtas separadas (tunneling) para a revascularização do miocárdio no Hospital Universitário King Abdullah, Jordânia. MÉTODOS: Analisamos, retrospectivamente, os dados de 1.050 procedimentos eletivos consecutivos de revascularização do miocárdio realizados no período de 5 de maio de 2003 a 31 de dezembro de 2007, em nossa instituição. Safenectomia utilizando exérese tradicional por incisões contínuas (Grupo 1) foi realizada em seiscentos e cinquenta pacientes (n=650), enquanto a safenectomia utilizando múltiplas incisões com pequenos patchs de pele - tunelização (Grupo 2) foi empregada em quatrocentos (n=400). Safenectomia foi realizada pelo assistente ou pelo cirurgião cardíaco principal. Reação inflamatória, deiscência, celulites, linfangite, drenagem, necrose ou abscesso que necessitasse curativo, antibióticos ou desbridamento antes da cicatrização completa sem escara foram definidos como complicações da ferida. Não houve diferença estatística entre os grupos com relação aos fatores de risco pré-operatório em ambos os grupos. Os resultados dos testes foram considerados significativos quando P <0,05. RESULTADOS: As complicações da ferida foram observadas com maior frequência nos pacientes submetidos à técnica tradicional de exérese por incisão contínua (P = 0,0005). Sexo feminino, obesidade e diabetes estão associados a aumento da incidência de complicações na ferida (P <0,05). CONCLUSÕES: A exérese da veia safena utilizando tunelização foi associada a menores complicações da ferida do que o tradicional método longitudinal.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Coronary Artery Bypass/adverse effects , Leg/microbiology , Saphenous Vein/surgery , Surgical Wound Infection/etiology , Tissue and Organ Harvesting/methods , Coronary Artery Bypass/methods , Jordan , Retrospective Studies , Tissue and Organ Harvesting/adverse effectsABSTRACT
We report the case of a one-day-old newborn infant, female, birth weight 1900 g, gestational age 36 weeks presenting with necrotizing fasciitis caused by E. coli and Morganella morganii. The newborn was allowed to fall into the toilet bowl during a domestic delivery. The initial lesion was observed at 24 hours of life on the left leg at the site of the venipuncture for the administration of hypertonic glucose solution. Despite early treatment, a rapid progression occurred resulting in a fatal outcome. We call attention to the risk presented by this serious complication in newborns with a contaminated delivery, and highlight the site of the lesion and causal agents
Subject(s)
Humans , Female , Infant, Newborn , Fasciitis, Necrotizing/microbiology , Home Childbirth , Escherichia coli , Fatal Outcome , Leg/microbiology , Leg/pathology , Morganella morganiiABSTRACT
Three morphological varieties of hyperkeratotic and verrucous skin lesions on the anterior aspect of ankle joints in patients with leprosy are described: (i) verrucous lesions with thread-like horny projections similar to filiform warts; (ii) irregular compact hyperkeratotic lesions with deep fissures in between; and (iii) hyperkeratotic lesions with linear fissures corresponding to the transverse creases on the anterior aspect of the ankle. Chemical cautery was useful for the treatment of the first two varieties, and a potent topical corticosteroid with salicylic acid was useful for the third.