Deep sternal wound infections: Evidence for prevention, treatment, and reconstructive surgery

Median sternotomy is the most popular approach in cardiac surgery. Post-sternotomy wound complications are rare, but the occurrence of a deep sternal wound infection (DSWI) is a catastrophic event associated with higher morbidity and mortality, longer hospital stays, and increased costs. A literature review was performed by searching PubMed from January 1996 to August 2017 according to the guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The following keywords were used in various combinations: DSWI, post-sternotomy complication, and sternal reconstruction. Thirty-nine papers were included in our qualitative analysis, in which each aspect of the DSWI-related care process was analyzed and compared to the actual standard of care. Plastic surgeons are often involved too late in such clinical scenarios, when previous empirical treatments have failed and a definitive reconstruction is needed. The aim of this comprehensive review was to create an up-to-date operative flowchart to prevent and properly treat sternal wound infection complications after median sternotomy.

Role of Endoscopy in the Management of Boerhaave Syndrome

Boerhaave syndrome (BS) is a spontaneous esophageal perforation which carries high mortality. Surgical treatment is well established, but the development of interventional endoscopy has proposed new therapies. We expose our experience in a Gastrointestinal and Endoscopy Unit. With a retrospective, observational, open-label, single center, consecutive case series. All patients diagnosed with BS who were managed in our center were included. Treated conservatively, endoscopically or surgically, according to their clinical condition and lesion presentation. Fourteen patients were included. Ten were treated with primary surgery. One conservatively. In total, 7/14 patients required an endoscopic treatment. All required metallic stents deployment, 3 cases over-the-scope-clips concomitantly and one case a novel technique an internal drain. 6/7 cases endoscopically treated achieved complete esophageal healing. In conclusion, endoscopy is an useful tool at all stages BS management: difficult diagnosis, primary treatment in selected patients and as salvage when surgery fails. With mortality rates and outcomes comparables to surgery.

Precisão da instalação de implantes com guias cirúrgicos obtidos por estereolitografia / On the accuracy of stereolithographic-guided dental implant placement: a clinical study

O presente estudo in vivo propôs avaliar a precisão de instalação de 23 implantes sem retalhos empregando guias cirúrgicos obtidos por estereolitografia em quatro pacientes com maxilas totalmente desdentadas. Após duplo escaneamento com tomografia computadorizada tipo cone-beam, o planejamento pré-cirúrgico foi realizado com o programa Procera. Depois da cirurgia, realizou-se a comparação entre as posições dos implantes planejados e executados através de tomografia computadorizada pós-operatória. Para comparação da posição e dos longos eixos das imagens dos implantes foram eleitos três pontos em cada implante planejado e executado: no centro do limite coronário (D1), no centro da porção central (D2), no centro do limite apical (D3). Assim, as distâncias e o ângulo (A1) formado entre os longos eixos dos implantes planejados e executados foram numericamente calculados. De acordo com a análise tomográfica, os implantes executados em relação aos implantes planejados apresentaram desvios médios de 0,72 mm para a posição D1; 0,98 mm para a posição D2; 1,45 mm para a posição D3; 1,92 graus para o ângulo A1. Concluiu-se que houve desempenho adequado para a utilização de protocolos de cirurgia guiada baseados no método empregado em associação com guias cirúrgicos produzidos pelo processo de estereolitografia. A transferência do planejamento protético-cirúrgico para o campo operatório foi considerada satisfatória, visto que viabilizou a instalação de implantes dentários nas situações propostas...

The aim of this in vivo study was to evaluate the placement accuracy of 23 dental implants with fl apless surgery using stereolithographic guides in four completely edentulous maxillary patients. After double scanning with cone beam computerized tomography (CBCT), the presurgical planning was performed using appropriate software (Procera). After surgery, executed and planned implant positions were compared using CBCT superimposing. Measurements were made at the center of three pre-selected points: coronal (D1), central (D2), and apical (D3) portions. Thus, the distances among points and the angle (A1) formed between the long axes of the planned/executed implants were calculated. Mean deviations were as the following: 0.72 mm at D1, 0.98 mm at D2, and 1.45 mm at D3 positions. The mean angular deviaton (A1) was 1.92 degrees. It was concluded that there was adequate performance with surgical guides produced by stereolithographic process. The transfer of prosthetic-surgical planning for the surgical area was considered satisfactory, since it allowed for implant placement in proposed situations...