Management of complex surgical wounds of the back: identifying an evidence-based approach

Background@#Postoperative dehiscence and surgical site infection after spinal surgery can carry serious morbidity. Multidisciplinary involvement of plastic surgery is essential to minimizing morbidity and achieving definitive closure. However, a standardized approach is lacking. The aim of this study was to identify effective reconstructive interventions for the basis of an evidence-based management protocol. @*Methods@#A retrospective review was performed at a single tertiary institution for 45 patients who required 53 reconstruction procedures with plastic surgery for wounds secondary to spinal surgery from 2010 to 2019. Statistical analysis was performed for demographics, comorbidities, and treatment methods. Primary outcomes were postoperative complications, including dehiscence, seroma, and infection. The secondary outcome was time to healing. @*Results@#The overall complication rate was 32%, with dehiscence occurring in 17%, seroma in 15% and infection in 11% of cases. Median follow-up was 10 months (interquartile range, 4–23). Use of antibiotic beads did not affect rate of infection occurrence after wound closure (P=0.146). Use of incisional negative pressure wound therapy (iNPWT) was significant for reduced time to healing (P=0.001). Patients treated without iNPWT healed at median of 67.5 days while the patients who received iNPWT healed in 33 days. Demographics and comorbidities between these two groups were similar. @*Conclusions@#This data provides groundwork for an evidence-based approach to soft tissue reconstruction and management of dehiscence after spinal surgery. Timely involvement of plastic surgery in high-risk patients and utilization of evidence-based interventions such as iNPWT are essential for improving outcomes in this population.

Social media, purpose, and use of it: A community-based cross-sectional study in a rural area of a developing nation (India)

Background: Over the past two decades, the world has witnessed drastic progress in the field of communication. Social media are the collective of online communications channels dedicated to community-based input, interaction, content-sharing, and collaboration. Objectives: The objectives of the study were to determine the prevalence of social media use, pattern, and purpose of use and usefulness for conveying health education. Materials and Methods: The current study was undertaken; in a rural community of Punjab province of India from September 2018 to February 2019. Participants were interviewed using a pre-designed, pre-tested structured interview schedule. Results: The total number of participants in the study was 4000. Six hundred eighteen (15.5%) had a smartphone and among them, nearly 90% were using internet. The proportion of male participants (22.9%) using smartphone was significantly higher than female. Seven hundred and forty-two (18.5%) had heard of any form of social media, in which WhatsApp (13.1%) was the most common. The prevalence of the use of social media among the participants was 13.5% (n = 542). Friendship and entertainment were the major purposes for using of social media. Nearly 80% of the social media users think that it should be used more for health education, but only 11.8% of the users thought that the government was using this platform very successfully. Young, male, educated, employed, and business class was using significantly more social media for communication. Conclusions: Media is changing as well as health care and medicine, so time has come to consider one of the cost-effective and popular media to solve complex and diverse problems of health and disease.

Bilateral Duplication of Renal Arteries.

Routine dissection of a male cadaver revealed the presence of bilateral double renal arteries. On the right side the accessory renal artery originated from the abdominal aorta just above the main renal artery. On the left side the accessory renal artery originated from the abdominal aorta about 1 cm above the main renal artery. Knowledge of the variations of renal vascular anatomy has importance in exploration and treatment of renal trauma, renal transplantation, renal artery embolization, surgery for abdominal aortic aneurysm and conservative or radical renal surgery.

Antenatal Detection of Renal Malformations.

Our aim was to study the incidence and outcome of antenatally detected renal malformations in rural Maharashtra. Among 7365 deliveries conducted during the study period, antenatal screening for renal malformations was done in 6682 (90.7 %) deliveries. Renal malformations were detected in 35 fetuses on antenatal screening. Postnatal investigations confirmed renal malformations in 27 babies (77.1%), giving an incidence of 0.4% among liveborn babies. Seven babies were operated and 2 were awaiting surgery (33.3%). Two patients expired and another two were lost to follow-up. The outcome was satisfactory in other patients. Antenatal screening was a useful tool in diagnosing renal malformations.