Intraoperative Wound Lavage System for Deep Neck Infection: A Retrospective Cohort Study.

Introduction Multiple solutions are currently used to cleanse a deep neck infection (DNI), and a variety of devices are available to deliver wound irrigation solutions. An essential difference between these devices is the pressure that the irrigation solution exerts over the wound tissue. Objective To compare low-pressure and high-pressure irrigation delivery systems for wound cleansing in DNI. Methods we designed a retrospective cohort study and reviewed the medical records of patients operated on due to DNI from June 2016 to December 2017 at our institution. One cohort included patients treated with an intraoperative irrigation method that exerts low pressure over the irrigated tissue, and the other cohort, to a system capable of generating higher pressure. The Pearson Chi-squared test was used to analyze the data. Results A total of 42 patients whose ages ranged from 16 months to 72 years were included. The low-pressure irrigation system was used in 18 patients, and the high-pressure system was used in 24 patients. No statistical differences were observed regarding the irrigation methods, the complexity of the DNI, and the overall outcomes. Conclusions The present is the first study in which low- and high-pressure systems for wound lavage were evaluated in the treatment of DNI. When comparing these methods, we did not find one to be superior to the other; however, the additional cost associated with the high-pressure devices may not justify their in head and neck procedures.

Intraoperative Wound Lavage System for Deep Neck Infection: A Retrospective Cohort Study

Abstract Introduction Multiple solutions are currently used to cleanse a deep neck infection (DNI), and a variety of devices are available to deliver wound irrigation solutions. An essential difference between these devices is the pressure that the irrigation solution exerts over the wound tissue. Objective To compare low-pressure and high-pressure irrigation delivery systems for wound cleansing in DNI. Methods we designed a retrospective cohort study and reviewed the medical records of patients operated on due to DNI from June 2016 to December 2017 at our institution. One cohort included patients treated with an intraoperative irrigation method that exerts low pressure over the irrigated tissue, and the other cohort, to a system capable of generating higher pressure. The Pearson Chi-squared test was used to analyze the data. Results A total of 42 patients whose ages ranged from 16 months to 72 years were included. The low-pressure irrigation system was used in 18 patients, and the high-pressure system was used in 24 patients. No statistical differences were observed regarding the irrigation methods, the complexity of the DNI, and the overall outcomes. Conclusions The present is the first study in which low- and high-pressure systems for wound lavage were evaluated in the treatment of DNI. When comparing these methods, we did not find one to be superior to the other; however, the additional cost associated with the high-pressure devices may not justify their in head and neck procedures.

Tracheostomy Outcomes on Trauma Patients.

Objective: Tracheostomies are performed in trauma patients for multiple purposes. Approaches to the procedure are usually directed by individual expertise and local preferences. Though generally safe, a tracheostomy can cause serious complications. This study aims to identify complications associated with tracheostomies performed at the level I Trauma Center of the Puerto Rico Medical Center (PRMC) to have an advanced foundation to develop and implement guidelines to improve patient outcomes. Study Design: A retrospective cross-sectional study. Setting: Level I Trauma Center of the PRMC. Methods: Medical charts of 113 trauma adult patients that underwent tracheostomy at the PRMC from 2018 to 2020 were reviewed. Data collected included patient demographics, surgical approach, initial tracheostomy tube size (ITTS), intubation period, and flexible laryngoscopic findings. Complications occurring during and after tracheostomy were documented. The unadjusted relationship of the independent variables and outcome measures was assessed using χ 2 and Fisher's test for categorical variables and the Wilcoxon-Mann-Whitney rank-sum test for continuous ones. Results: Abnormal airway findings detected on flexible laryngoscopic examination were reported in 30 patients in the open tracheostomy (OT) group and 43 patients in the percutaneous tracheostomy group (p = 0.007). Peristomal granulation tissue was reported in 10 patients with an ITTS 8, while in only 1 patient with an ITTS 6 (p = 0.026). Conclusion: This study showed several key findings in our cohort. The OT surgical approach was associated with fewer long-term complications when compared to the percutaneous approach. Also, a statistically significant difference in peristomal granulation tissue findings was found between the ITTS, ITTS-6 and ITTS-8, the smaller size being associated with fewer abnormal findings.

Incidental Tracheocele as an Unusual Presentation of Pneumomediastinum in the Trauma Setting.

BACKGROUND Tracheocele are rarely encountered air cysts formed due to tracheal wall outpouching through a weak vantage point. The majority are acquired in the adult population and are associated with conditions that weaken the tracheal wall. Most tracheoceles are diagnosed incidentally since many are asymptomatic or present with nonspecific symptoms. Multidetector computed tomography (MDCT) scans are the most common imaging modality for diagnosis of silent tracheal cysts. Tracheocele have been very rarely documented in the trauma setting; therefore, in the setting of multiple body trauma diagnosis can be challenging. CASE REPORT We report a case of an acquired tracheocele after a high-impact blunt thoracic trauma with an admission diagnosis of suspected tracheal perforation. MDCT of the neck and chest demonstrated an irregularly multicystic-shaped air collection at the right posterolateral trachea upon evaluation. Flexible laryngoscopy and bronchoscopy results were unremarkable. CONCLUSIONS Tracheocele are rare and asymptomatic pseudo-diverticulum of the tracheal wall. Many are diagnosed incidentally with imaging studies for other conditions. Nevertheless, in the trauma setting its diagnosis can be challenging and misleading. Consideration of conditions such as tracheocele is important to prevent any unwarranted treatment modalities.

Late-Onset Metastatic Renal Cell Carcinoma to the Thyroid Gland: An Unusual Airway Emergency.

BACKGROUND Thyroid malignant lesions mostly present as an anterior neck mass with or without compressive symptoms. Infrequently, metastases from extra-thyroid neoplasms migrate to the thyroid gland. These lesions most commonly arise from renal cell carcinoma (RCC), which is the primary kidney malignancy in adults. This case parallels one of the longest latency periods described in the literature from a primary RCC with metastasis to the thyroid gland (TG). CASE REPORT We report a case of an 88-year-old female patient with past medical history of RCC resected 25 years earlier, who presented to the Emergency Department with a large left anterior neck mass causing dyspnea and stridor due to intra-tracheal extension. The airway symptoms progressed rapidly, and she required emergent management to secure the airway in the operating room. CONCLUSIONS This case reports a rare instance in which RCC metastasis presented with intra-tracheal extension causing airway compromise and the need for emergent airway management. It is the first time that use of cold instruments has been documented to excise RCC's intra-luminal tracheal lesion to secure the airway in an emergent case in a safe manner. With this surgical approach, the airway is secured by endotracheal intubation after excision of an intra-luminal tracheal lesion, with the benefit of avoiding awake tracheostomy in a patient with a distorted neck anatomy. Also, this case reinforces that metastatic RCC to the thyroid gland can occur 25 years after initial diagnosis. For this reason, we advocate lifelong monitoring in patients with the diagnosis of RCC.