ABSTRACT
BACKGROUND AND PURPOSE: wound complications after infrainguinal bypass surgery occur frequently and may jeopardise an underlying graft. The purpose of this study was to investigate the role of suture material in the occurrence of wound complications. METHODS: prospective randomised trial. 170 consecutive patients underwent femoro-popliteal or femoro-tibial bypass surgery and were randomised between wound closure with continuous polyamide sutures (Ethilon) or with skin staples. RESULTS: ten patients were excluded because of re-intervention or death within 2 weeks after operation. The wound was closed with a continuous polyamide suture (Ethilon) in 77 patients and with metallic skin staples in 83 patients. The groups were comparable in age, use of corticosteroids, occurrence of diabetes mellitus and operation time. Skin closing time was significantly shorter in the staples group (6.4 min versus 2.7 min, p<0.001). Overall, there were no significant differences between continuous polyamide sutures and metallic skin staples in superficial infections (8% versus 2%), deep infections (1% versus 1%), serous leakage or haematoma. CONCLUSION: we found no significant differences in the incidence of wound complications in infrainguinal bypass surgery comparing continuous polyamide (Ethilon) and skin staples. The time needed for wound closure was significantly reduced using metallic staples, but this had no effect on the total operation time. Choices of closing materials should be guided by surgeon's preference.
Subject(s)
Inguinal Canal/surgery , Nylons , Surgical Staplers , Surgical Wound Infection/surgery , Aged , Chi-Square Distribution , Female , Femoral Artery/surgery , Humans , Male , Popliteal Artery/surgery , Prospective Studies , Treatment Outcome , Wound Healing/physiologyABSTRACT
Thirty-nine patients with unstable pelvic fractures were analysed retrospectively. The mean age of the group was 41 years (range 15-77). Of these cases 35 had sustained high energy trauma. The mean Hospital Trauma Index-Injury Severity Score of the population was 32 (16-66). Nine cases were haemodynamically unstable on admission. The type of unstable pelvic fracture was classified according to Tile. Sixteen patients had a type B fracture and 23 had a vertical instability (type C) fracture. In two patients, an open fracture was seen. Directly associated injuries were diagnosed in 11 patients, of which eight showed damage of the urogenital system, three of the rectum and three of the peripheral nerve system. In seven cases the fracture was treated non-operatively; in the remaining 32 patients the pelvic ring was stabilized operatively. Additional therapy for hypovolaemic shock due to pelvic bleeding was necessary in six cases. The overall mortality in this series was 13 per cent. Early and aggressive resuscitation and standardized treatment in well-equipped and staffed injury centres is mandatory in these severely traumatized patients to achieve optimal results and to minimize the risk of fatal outcome.
Subject(s)
Fractures, Bone/classification , Multiple Trauma/therapy , Pelvic Bones/injuries , Accidental Falls , Accidents, Occupational , Accidents, Traffic , Adolescent , Adult , Aged , Blood Transfusion , Clinical Protocols , Female , Fracture Fixation, Internal , Fractures, Bone/etiology , Fractures, Bone/surgery , Humans , Male , Middle Aged , Multiple Trauma/etiology , Multiple Trauma/surgery , Retrospective StudiesABSTRACT
Compound unstable pelvic ring fractures should be considered a major trauma, with very high morbidity and mortality rates. Two case reports illustrate the life-threatening character. Associated injuries, specific diagnostic tests as well as methods of treatment are discussed. In both cases the result was survival with a prolonged period of rehabilitation and permanent functional impairment.
