Managing the Open Abdomen: Selecting an Appropriate Treatment Strategy.

Significance: The laparotomy is a common surgical procedure with a wide range of indications. Ideally, once the goals of surgery were achieved, the incision edges could then be approximated and the abdomen primarily closed. However, in some circumstances, it may be impossible to achieve primary closure, and instead the abdomen is intentionally left open. This review discusses the indications and objectives for the open abdomen (OA), summarizes the most common techniques for temporary abdominal closure, and illustrates treatment algorithms grounded in the current recommendations from specialty experts. Recent Advances: Still a relatively young technique, multiple strategies, and technologies have emerged to manage the OA. So too have the recommendations evolved, based on updated classifications that take wound characteristics into account. Recent studies have also brought greater clarity on recommendations for managing infection and malnutrition to support improved clinical outcomes. Critical Issues: The status of the OA can change rapidly depending on the patient's condition, the wound quality, and many other factors. Thus, there is a significant need for comprehensive treatment strategies that can be adapted to these developing circumstances. Future Directions: Treatment recommendations should be continuously updated as new technologies are introduced and old techniques fall out of use.

Colon perforation with severe peritonitis caused by erotic toy insertion and treated using vacuum-assisted closure: A case report.

BACKGROUND: Colorectal foreign bodies are commonly encountered during surgery. They are frequently observed in men 20 to 90 years of age and have bimodal age distribution. Surgical management is necessary for cases of rectal perforation. However, surgical site infections are the most common complications after colorectal surgery. CASE SUMMARY: We discuss a case of rectal perforation in a patient who presented to our hospital 2 d after its occurrence. The perforation occurred as a result of the patient inserting a sex toy in his rectum. Severe peritonitis was attributable to delayed presentation. CONCLUSION: Vacuum-assisted closure was performed to treat the wound, which healed well after therapy. No complications were noted.

Early wound healing at 1 week postoperatively in periodontal tissue regeneration therapy: enamel matrix derivative versus recombinant human fibroblast growth factor.

PURPOSE: Recombinant human fibroblast growth factor-2 (rhFGF-2) has demonstrated positive effects on wound healing at 2 weeks after periodontal surgery relative to enamel matrix derivative (EMD). However, the effects at earlier postoperative stages have not been reported. This retrospective study compared the early wound healing outcomes 1 week after surgery using the modified papilla preservation technique (mPPT) with either EMD or rhFGF-2 therapy. METHODS: We compiled a list of all mPPT sites treated with EMD or rhFGF-2 during the survey period (September 2011 to March 2022). Early wound healing was assessed using the early wound healing score (EHS) and the modified early wound healing index (mEHI). Inter-rater reliability for the EHS and mEHI was established using intraclass correlation coefficients. Factors influencing mPPT were identified by analyzing the correlation coefficients between the EHS items, mEHI items, and potential influencing factors. After adjusting for factors impacting EHS, mEHI, and mPPT, we compared the EHS and mEHI between EMD and rhFGF-2 groups. RESULTS: In total, 72 sites were evaluated. The scores for incision line, step, and dehiscence were significantly higher in those receiving rhFGF-2 (n=42) compared to those treated with EMD (n=30). The EHS item scores did not differ significantly between groups. Among patients aged ≥50 years, but not those <50 years, significantly higher step and dehiscence scores were found in the rhFGF-2 group than the EMD group (P<0.01). Additionally, for patients exhibiting a clinical attachment level (CAL) ≥8 mm, the step score was significantly higher in the rhFGF-2 group than in the EMD group (P<0.05), but this trend was not reflected in those with a CAL <8 mm. CONCLUSIONS: In this study, early wound closure at mPPT sites was more effectively achieved with rhFGF-2 than with EMD. Nevertheless, biochemical assessments are required to compare the re-epithelialization effects of these therapies.

Management of a complicated colonexposed sacrococcygeal wound after pelvic exenteration: a case report.

DECLARATION OF INTEREST: This work was supported by the Naval Medical University and the University of Shanghai for Science and Technology Joint Projects (2020-RZ04), the Innovative Clinical Research Program of Shanghai Changzheng Hospital (2020YLCYJ-Y16), and the academic project of Naval Medical University (2022QN073). The authors have no conflicts of interest to declare.

Effectiveness of vacuum-assisted wound closure and mesh-mediated fascial traction in open abdomen management.

PURPOSE: To determine the effectiveness of vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) in patients undergoing open abdomen management (OAM). METHODS: Data from cases with OAM for at least five days who were admitted to our institution between January 2011 and December 2020 were included. We compared the patient's age, sex, medical history, indication for initial surgery, APACHE II scores, indication for OAM, operative time, intraoperative blood loss, intraoperative transfusion, success of primary fascial closure (rectus fascial closure and bilateral anterior rectus abdominis sheath turnover flap method), success of planned ventral hernia, duration of OAM, and in-hospital mortality between patients undergoing VAWCM (VAWCM cases, n = 27) and vacuum-assisted wound closure (VAWC) alone (VAWC cases, n = 25). RESULTS: VAWCM cases had a significantly higher success rate of primary fascial closure (70% vs. 36%, p = 0.030) and lower in-hospital mortality (26% vs. 72%, p = 0.002) than VAWC cases. A multivariate logistic regression analysis showed that VAWCM was an independent factor influencing in-hospital mortality (odds ratio, 0.14; 95% confidence interval: 0.04-0.53; p = 0.004). CONCLUSION: VAWCM is associated with an increased rate of successful primary fascial closure and may reduce in-hospital mortality.

Sutura em Polia Retificada para síntese de feridas de pele tensionadas / Rectified Pulley Suture for the synthesis of tensioned skin wounds

Introdução: A síntese de feridas de pele tensionadas é uma área que tem sido alvo de estudos para o desenvolvimento de técnicas de sutura que sejam capazes de realizar o fechamento primário dessas feridas com alívio de tensão, garantindo uma cicatrização adequada e evitando complicações como deiscência, edema, sangramento e infecção. Método: Esta pesquisa tratou-se de um estudo piloto, sendo a primeira apresentação da técnica de Sutura em Polia Retificada para síntese de feridas de pele tensionadas através do acompanhamento prospectivo, duplo-cego, de uma série de casos de 8 pacientes randomicamente admitidos no centro cirúrgico de um hospital de alta complexidade de uma cidade de médio porte. Resultados: A Sutura em Polia Retificada é uma técnica versátil e apta para lidar com feridas de pele tensionadas, uma vez que no intraoperatório conseguiu fechar por primeira intenção lesões de até 6,5 centímetros e de diferentes regiões tensionadas sem necessidade do uso de técnicas mais complexas, como retalhos, enxertos, zetaplastia e fechamento por segunda intenção. Além disso, no pós-operatório, houve redução dos escores da POSAS, indicando um processo de cicatrização satisfatório tanto para os observadores quanto para o paciente. É imprescindível mencionar, também, que o desfecho mais temido no seguimento dos pacientes com feridas tensionadas submetidos a fechamento primário - a deiscência - foi completamente evitado. Conclusão: A técnica é simples, confiável, segura e reprodutível, com curta curva de aprendizagem, de forma que a Sutura em Polia Retificada pode ser considerada como uma nova ferramenta a ser integrada ao arsenal cirúrgico.

Introduction: The synthesis of tensioned skin wounds is an area that has been the subject of studies for the development of suturing techniques that are capable of performing the primary closure of these wounds with tension relief, ensuring adequate healing, and avoiding complications such as dehiscence, edema, bleeding, and infection. Method: This research was a pilot study, being the first presentation of the Rectified Pulley Suture technique for the synthesis of tensioned skin wounds through prospective, double-blind monitoring of a series of cases of 8 patients randomly admitted to the surgical center of a high-complexity hospital in a mediumsized city. Results: Rectified Pulley Suture is a versatile technique suitable for dealing with tensioned skin wounds, since intraoperatively it was able to close, by first intention, lesions measuring up to 6.5 centimeters and in different tensioned regions without the need for the use of more extensive techniques. complex, such as flaps, grafts, Z-plasty, and secondary intention closure. Furthermore, post-operatively, there was a reduction in POSAS scores, indicating a satisfactory healing process for both observers and the patient. It is also essential to mention that the most feared outcome in the follow-up of patients with tension wounds undergoing primary closure - dehiscence - was completely avoided. Conclusion: The technique is simple, reliable, safe, and reproducible, with a short learning curve, so the Rectified Pulley Suture can be considered a new tool to be integrated into the surgical arsenal.

Meshing around: high-risk hernias and infected mesh.

Open laparotomy carries a risk up to 20% for an incisional hernia, making repair one of the most common operations performed by general surgeons in the USA. Despite a multitude of mesh appliances and techniques, no size fits all, and there is continued debate on what is the best mesh type, especially in high-risk patients with contaminated hernias. Infected mesh carries a significant burden to the patient, the surgeon and overall healthcare costs with medical legal implications. A stepwise approach that involves optimization of patient comorbidities, patient selective choice of mesh and technique is imperative in mitigating outcomes and recurrence rates. This review will focus on the avoidance of mesh infection and the selection of mesh in patients with contaminated wounds.

The distance of insertion points from wound margins in interrupted and vertical mattress sutures influences the tensile load capacity: An in vitro experimental study.

AIM: To determine the tensile load capacity (TLC) and the tearing characteristics for interrupted and vertical mattress sutures with different insertion points from the wound margin, and the effect of the bite size when using vertical mattress sutures. MATERIALS AND METHODS: A total of 120 gingiva and lining mucosa samples obtained from pig jaws were divided into groups according to the suturing technique (interrupted and vertical mattress sutures), distance of the insertion points from the wound margin (margin, 1, 3, and 5 mm) and bite size (1, 3, and 5 mm). The TLC of the suture and the tearing characteristics were evaluated using a tensile tester device. RESULTS: The TLC was significantly higher for vertical mattress sutures than for interrupted sutures regardless of the distance of the insertion points from the wound margin (intergroup p < .001). This distance significantly influenced the TLC for vertical mattress sutures (p < .05) but not for interrupted sutures (p > .05). Testing the tearing characteristics revealed that no tissue tearing occurred in groups when the insertion points were more than 3 mm from the wound margin. CONCLUSION: The TLC is higher for vertical mattress sutures than for interrupted sutures, and it increases when the insertion points are farther from the wound margin.

Pharyngeal mucosal closure in total laryngectomy: comparison between vertical and T-shaped closure.

Objective: The objective of this study was to compare the outcomes vertical and T-shaped pharyngoplasty closure techniques after total laryngectomy (TL) and to evaluate the factors associated with the development of pharyngocutaneous fistula. Materials and methods: We performed a retrospective study that included patients with a histopathological diagnosis of laryngeal cancer that underwent TL between 2009 and 2021. Results: Fifty-seven patients were included in the study. A total of 14 patients underwent a vertical closure of the neopharynx (24.6%), while 43 patients underwent a T-shaped closure (74.4%). Pharyngocutaneous fistula was the most common complication, observed in 40.4% of cases (n = 23). No difference in the rate of complications was observed between groups, with the exception of tracheal dehiscence which was reduced in patients with T-shaped closure (n = 2, 4.7% vs. n = 5, 35.7%, p = 0.002). Diabetes mellitus was more frequently observed in patients withthe development of pharyngocutaneous fistula (n = 7, 30.4% vs. n = 3, 8.8%, p = 0.03). Conclusions: Although complicationswere lower in the T-shaped closure group, we could not establish the superiority of either technique.

Objetivo: Evaluar los desenlaces de la técnica vertical en comparación con la técnica en T para el cierre de faringoplastia posterior a una laringectomía total, y evaluar los factores asociados con el desarrollo de fístula faringocutánea. Método: Estudio retrospectivo de pacientes con diagnóstico de cancer de laringe a quienes se realizó laringectomía total como tratamiento, de 2009 a 2021. Resultados: Se incluyeron 57 pacientes. A 14 (24.6%) se les realizó una faringoplastia con cierre en T y a 43 (74.4%) un cierre vertical. La fístula faringocutánea fue la complicación más frecuente, presente en el 40.4% de los casos (n = 23). No se observaron diferencias en el desarrollo de complicaciones entre grupos, con excepción de la dehiscencia traqueal, la cual fue menos frecuente en el grupo de cierre en T (n = 2, 4.7% vs. n = 5, 35.7%; p = 0.002). La diabetes mellitus se asoció con el desarrollo de fístula faringocutánea (n = 7, 30.4% vs. n = 3, 8.8%; p = 0.03). Conclusiones: Aunque se observó una tendencia a una disminución de las complicaciones en el grupo de cierre en T, no se encontró superioridad de una técnica sobre otra.

Comparison between liquid skin adhesive and wound closure strip for skin closure after subcuticular suturing in single-port laparoscopic appendectomy: a single-center retrospective study in Korea.

Purpose: This study was performed to evaluate the safety and feasibility of skin adhesives and to compare postoperative and cosmetic outcomes after wound closure in single-port laparoscopic appendectomy (SPLA) between skin adhesives and steri-strips. Methods: This was a single-center retrospective study. We included 22 and 47 patients in whom skin adhesive and steri-strips were used respectively, for skin closure after subcuticular suturing in SPLA between August 2014 and 2020. The patient scar assessment questionnaire (PSAQ) was completed postoperatively to assess postoperative cosmetic outcomes. Results: On the postoperative day, patients in whom skin adhesive was used had significantly lower numeric rating scores than in whom steri-strips were used (2.8 ± 0.8 vs. 3.9 ± 0.8, p < 0.001). The frequency of analgesic administration within 24 hours and between 24 and 48 hours after surgery was significantly lower in the skin adhesive group compared to the wound closure strip group (1.4 ± 0.8 vs. 2.7 ± 1.2, p = 0.013 and 0.2 ± 0.4 vs. 0.7 ± 0.9, p = 0.002, respectively). In the PSAQ, "satisfaction with appearance" and "satisfaction with symptoms" subitem scores were significantly lower in patients in whom skin adhesive was used (11.3 ± 3.0 vs. 15.1 ± 4.5, p = 0.006 and 6.5 ± 1.8 vs. 9.5 ± 3.3, p = 0.003), whereas, "appearance" and "consciousness" subitems revealed no statistically significant differences between the groups. Conclusion: Liquid skin adhesive closures seem to be safe and feasible and cause less postoperative pain, resulting in greater patient satisfaction with postoperative scars than wound closure strip closure after subcuticular suturing in SPLA.

Keystone Flap for Closure of Skin Cancer Defects on the Upper Extremity.

Background: We sought to examine the efficacy of the Keystone Design Perforator Island Flap (KDPIF) for the reconstruction of skin cancer excision defects isolated to the upper extremity. In particular, to examine the size of defects repaired and the complications associated with the keystone flap procedure isolated to the upper extremity. Methods: This is a retrospective chart review including all patients older than 18 years of age who received a KDPIF procedure between February 2013 and February 2019 for the oncologic reconstruction of skin cancer defects isolated to the upper extremities by a single surgeon. All procedures were done according to the original description by Behan. Results: A total of 32 patients, 18 (56%) male and 14 (44%) female, received 35 keystone flaps between February 2013 and February 2019. The mean age of the males and females was 70.5 and 79.7 years of age, respectively. Thirty-five lesions suspicious for cancer were excised and 14 (40%) basal cell carcinoma (BCC), 11 (31%) squamous cell carcinoma (SCC), 9 (26%) melanoma, and 1 (3%) actinic keratoses diagnoses were histopathologically determined. Skin defect excisions varied from 3.53 cm2 to 31.42 cm2. No intraoperative or postoperative complications occurred. Conclusions: The keystone flap is a successful versatile flap procedure with a low or absent complication rate for the reconstruction of skin cancer excision defects of various locations (eg arm, hand, elbow, forearm, shoulder, and wrist), cancer pathologies, and sizes on the upper extremity. When needed, a Doppler may successfully identify adequate perforating blood vessels for the relatively larger flaps.

Contexte: Nous avons cherché à connaître l'efficacité du lambeau en clé de voûte/îlot appelé « keystone design perforator island flap ¼ (KDPIF) pour la reconstruction de la peau après excision de cancers isolés du membre supérieur. Nous avons plus particulièrement examiné la dimension des tissus manquants et réparés, ainsi que les complications associées à la procédure KDPIF isolée au niveau du membre supérieur. Méthodes: Il s'agit d'une étude rétrospective de dossiers incluant tous les patients âgés de plus de 18 ans ayant bénéficié d'une procédure KDPIF entre février 2013 et février 2019 pour reconstruction oncologique de manques de substance isolés après excision de cancers de la peau du membre supérieur par un seul chirurgien. Toutes les procédures ont été exécutées selon la description originale de Behan. Résultats: Un total de trente-deux patients (18 hommes [56%] et 14 femmes [44%]) ont bénéficié de trente-cinq volets en clé de voûte entre février 2013 et février 2019. L'âge moyen des patients masculins était de 70.5 ans et celui des patientes féminines était de 79.7 ans. Trente-cinq lésions suspectes de cancer ont été excisées et les diagnostics ont été confirmés par l'histopathologie : 14 (40%) carcinomes basocellulaires, 11 (31%) carcinomes spinocellulaires (à cellules squameuses), 9 (26%) mélanomes et 1 (3%) kératose actinique. La surface de peau manquante due à l'excision était comprise entre 3.53 cm2 et 31.42 cm2. Aucune complication peropératoire ou postopératoire n'est survenue. Conclusions: Le volet en clé de voûte KDPIF est une procédure versatile efficace ayant un taux de complication faible ou nul pour la reconstruction pour manque de peau après excision de cancer cutané à divers emplacements (bras, main, coude, avant-bras, épaule, poignet), des pathologies cancéreuses et des tailles variables sur le membre supérieur. Quand cela est nécessaire, un examen Doppler peut identifier avec succès les vaisseaux sanguins perforants pour les volets relativement plus grands.

Negative pressure device used in pediatric patients with Hostile abdomen. Case series. / Dispositivo de presión negativa empleado en pacientes pediátricos con abdomen hostil: serie de casos.

INTRODUCTION: Hostile abdomen is a surgical condition characterized by loss of space between organs and structures in the abdomen. Negative pressure therapy use has been widely described in adults; the case is not the same for pediatric patients. The goal of this study is to present short-term results of negative pressure therapy use in pediatric patients with hostile abdomen due to different etiologies. MATERIAL AND METHODS: Pediatric hostile abdomen patients (< 18 years) who were treated Negative pressure therapy using ABTHERA were identified and retrospectively reviewed. RESULTS: 7 patients were included in this study. Median age was 16 (range: 9-17 yo). 5 (71.4%) were male and 2 (28.6%) females. 3 (43%) had significant past medical/surgical history (Systemic Lupus Erythematosus, complicated appendectomy and ventriculoperitoneal-shunt). The device was set at a continuous pressure ranging from -50 to -125 mmHg. Pre and post-surgical findings were reported using Bjork's classification. Devices were replaced every 4-7 days (median 5 days). Total amount of replacements was 1-4 (median 3). 5 (71.4%) patients required invasive mechanical ventilation during use of Negative pressure therapy based on clinical status. 4 (57%) patients received enteral nutrition. 1 (14%) patient required re-intervention posterior to definitive closure due to retroperitoneal abscess development. Outcome, evaluated by (oral tolerance, bowel movement and absence of pain), was favorable in all patients. CONCLUSION: Negative pressure therapy devices generate favorable results in hostile abdomen in pediatric population but further information is needed to assess pressure settings and device replacement frequency.

INTRODUCCION: El abdomen hostil es una patología quirúrgica caracterizada por una pérdida de espacio entre los órganos y estructuras del abdomen. La terapia de presión negativa se ha descrito de manera extensa en adultos, pero no así en pacientes pediátricos. El objetivo de este estudio es presentar los resultados a corto plazo de la terapia de presión negativa en pacientes pediátricos con abdomen hostil debido a distintas etiologías. MATERIAL Y METODOS: Identificación y análisis retrospectivo de los pacientes pediátricos con abdomen hostil (< 18 años) tratados con terapia de presión negativa ABTHERA. RESULTADOS: Se incluyó a 7 pacientes. La mediana de edad fue de 16 años (rango: 9-17). 5 (71,4%) eran niños y 2 (28,6%) niñas. 3 (43%) presentaban antecedentes médico-quirúrgicos de interés (lupus eritematoso sistémico, apendicectomía complicada y derivación ventriculoperitoneal). El dispositivo se empleó a presión constante, entre ­50 y ­125 mmHg. Los hallazgos preoperatorios y postoperatorios se notificaron mediante la clasificación de Bjork. Los dispositivos se sustituyeron cada 4-7 días (mediana de 5 días). La cantidad total de reemplazos fue de 1-4 (mediana de 3). 5 (71,4%) pacientes precisaron ventilación mecánica invasiva durante la terapia de presión negativa debido al estado clínico. 4 (57%) pacientes recibieron nutrición enteral. 1 (14%) paciente requirió reintervención posterior al cierre definitivo por el desarrollo de un absceso retroperitoneal. El resultado, evaluado en base a la tolerancia oral, el movimiento intestinal y la ausencia de dolor, fue favorable en todos los pacientes. CONCLUSION: Los dispositivos de terapia de presión negativa aportan resultados favorables en los pacientes pediátricos con abdomen hostil, aunque se necesita más información para evaluar los ajustes de presión y la frecuencia de reemplazo del dispositivo.

International Delphi Study on Wound Closure and Dressing Management in Joint Arthroplasty: Part 1: Total Knee Arthroplasty.

BACKGROUND: The purpose of this modified Delphi study was to obtain consensus on wound closure and dressing management in total knee arthroplasty (TKA). METHODS: The Delphi panel included 20 orthopaedic surgeons from Europe and North America. There were 26 statements identified using a targeted literature review. Consensus was developed for the statements with up to three rounds of anonymous voting per topic. Panelists ranked their agreement with each statement on a five-point Likert scale. An a priori threshold of ≥ 75% was required for consensus. RESULTS: All 26 statements achieved consensus after three rounds of anonymous voting. Wound closure-related interventions that were recommended for use in TKA included: 1) closing in semi-flexion versus extension (superior range of motion); 2) using aspirin for venous thromboembolism prophylaxis over other agents (reduces wound complications); 3) barbed sutures over non-barbed sutures (lower wound complications, better cosmetic appearances, shorter closing times, and overall cost savings); 4) mesh-adhesives over other skin closure methods (lower wound complications, higher patient satisfaction scores, lower rates of readmission); 5) silver-impregnated dressings over standard dressings (lower wound complications, decreased infections, fewer dressing changes); 6) in high-risk patients, negative pressure wound therapy over other dressings (lower wound complications, decreased reoperations, fewer dressing changes); and 7) using triclosan-coated over non-antimicrobial-coated sutures (lower risks of surgical site infection). CONCLUSIONS: Using a modified Delphi approach, the panel achieved consensus on 26 statements pertaining to wound closure and dressing management in TKA. This study forms the basis for identifying critical evidence supported by clinical practice for wound management to help reduce variability, advance standardization, and ultimately improve outcomes during TKA. The results presented here can serve as the foundation for knowledge, education, and improved clinical outcomes for surgeons performing TKAs.

Dispositivo de presión negativa empleado en pacientes pediátricos con abdomen hostil: serie de casos / Negative pressure device used in pediatric patients with hostile abdomen. Case series

Introducción: El abdomen hostil es una patología quirúrgica caracterizada por una pérdida de espacio entre los órganos y estructuras del abdomen. La terapia de presión negativa se ha descrito de manera extensa en adultos, pero no así en pacientes pediátricos. El objetivo de este estudio es presentar los resultados a corto plazo de la terapia de presión negativa en pacientes pediátricos con abdomen hostil debido a distintas etiologías. Material y métodos: Identificación y análisis retrospectivo de los pacientes pediátricos con abdomen hostil (< 18 años) tratados con terapia de presión negativa ABTHERA. Resultados: Se incluyó a 7 pacientes. La mediana de edad fue de 16 años (rango: 9-17). 5 (71,4%) eran niños y 2 (28,6%) niñas. 3 (43%) presentaban antecedentes médico-quirúrgicos de interés (lupus eritematoso sistémico, apendicectomía complicada y derivación ventriculoperitoneal). El dispositivo se empleó a presión constante, entre–50 y –125 mmHg. Los hallazgos preoperatorios y postoperatoriosse notificaron mediante la clasificación de Bjork. Los dispositivos sesustituyeron cada 4-7 días (mediana de 5 días). La cantidad total dereemplazos fue de 1-4 (mediana de 3). 5 (71,4%) pacientes precisaronventilación mecánica invasiva durante la terapia de presión negativadebido al estado clínico. 4 (57%) pacientes recibieron nutrición enteral.1 (14%) paciente requirió reintervención posterior al cierre definitivopor el desarrollo de un absceso retroperitoneal. El resultado, evaluadoen base a la tolerancia oral, el movimiento intestinal y la ausencia dedolor, fue favorable en todos los pacientes.Conclusión: Los dispositivos de terapia de presión negativa aportanresultados favorables en los pacientes pediátricos con abdomen hostil,aunque se necesita más información para evaluar los ajustes de presióny la frecuencia de reemplazo del dispositivo.(AU)

Introduction: Hostile abdomen is a surgical condition characterized by loss of space between organs and structures in the abdomen. Negative pressure therapy use has been widely described in adults; the case is not the same for pediatric patients. The goal of this study is to present short-term results of negative pressure therapy use in pediatric patients with hostile abdomen due to different etiologies. Materials and methods: Pediatric hostile abdomen patients (< 18 years) who were treated Negative pressure therapy using ABTHERA were identified and retrospectively reviewed. Results: 7 patients were included in this study. Median age was 16 (range: 9-17 yo). 5 (71.4%) were male and 2 (28.6%) females. 3 (43%) had significant past medical/surgical history (Systemic Lupus Erythematosus, complicated appendectomy and ventriculoperitonealshunt). The device was set at a continuous pressure ranging from –50 to –125 mmHg. Pre and post-surgical findings were reported using Bjork’s classification. Devices were replaced every 4-7 days (median 5 days). Total amount of replacements was 1-4 (median 3). 5 (71.4%) patients required invasive mechanical ventilation during use of Negative pressure therapy based on clinical status. 4 (57%) patients received enteral nutrition. 1 (14%) patient required re-intervention posterior to definitive closure due to retroperitoneal abscess development. Outcome, evaluated by (oral tolerance, bowel movement and absence of pain), was favorable in all patients. Conclusion: Negative pressure therapy devices generate favorable results in hostile abdomen in pediatric population but further information is needed to assess pressure settings and device replacement frequency.(AU)

Results of prophylactic simple fasciocutaneous advancement in the initial management of acute ankle fractures with high risk of operative wound complication.

Ankle fracture is the third most prevalent fracture in older adults. Wound dehiscence is the most frequent complication. Our objective is to determine the operative wound complication rate in patients with unstable ankle fracture in whom a prophylactic simple fasciocutaneous advancement was used. METHODS: Prospective registry of patients with unstable ankle fracture, in whom a prophylactic fasciocutaneous advancement was performed between August 2020 and July 2021. Demographic variables, time spent in performing the flap, cost of osteosynthesis, minor and major complications of the surgical wound, readmission or reoperation were registered. RESULTS: 42 older adults with ankle fracture were included. Median age 69 (60-94). 31% diabetics and 21.5% active smokers. A 40% trimalleolar fracture pattern. There were 7% of superficial complications of the surgical wound. No major complications, no reoperations. CONCLUSIONS: Prophylactic fasciocutaneous advancement at the beginning of traumatological surgery is technically simple, reproducible, cheap and with low complications. LEVEL OF EVIDENCE: Level IV, cross-sectional study.

Sistema de presión negativa como tratamiento de la venta torácica: informe de caso / Negative pressure system as a thoracic window treatment: a case report

Introducción: Se presenta un caso clínico de sistema de presión negativa como tratamiento de ventana torácica derecha, realizado en la clínica de heridas. Se describe el tiempo y proceso de cicatrización, desde la llegada del paciente hasta la cicatrización total. Caso: Hombre de 24 años, postoperado de toracotomía, se le colocó terapia de presión negativa inicial a -75mmHg con intensidad media y modalidad continua; se aplicó esponja blanca para proteger el pulmón expuesto y esponja de plata, con tres cambios cada siete días. Posteriormente, se realizaron diez cambios de esponjas cada cuatro días, identificando disminución de las dimensiones de la ventana torácica. En la semana once inició tratamiento con terapia húmeda y fibrina rica en plaquetas, la cual se colocó en el lecho de la herida, aplicándose una vez por semana durante un mes. A partir de la semana quince se realizó curación diaria con aplicación de sulfadiazina de plata. El paciente fue dado de alta en la semana veinte con la herida 100% epitelizada. Conclusiones: El uso de la terapia de presión negativa acelera el proceso de curación, reduce las complicaciones y la carga bacteriana del tejido, debido a que la esponja de plata actúa como barrera antimicrobiana.

Introduction: A clinical case of negative pressure system as a right thoracic window treatment, performed in the wound clinic, is presented. The time and healing process from patient arrival to complete healing is described. Case: A 24-year-old man, postoperative thoracotomy, was placed on negative pressure therapy at -75mmHg with medium intensity and continuous mode; white sponge was applied to protect the exposed lung and silver sponge, with three changes every seven days. Subsequently, ten sponge changes were performed every four days, identifying a decrease in the dimensions of the thoracic window. In week eleven, the patient started treatment with wet therapy and platelet-rich fibrin, which was placed in the wound bed and applied once a week for a month. From week fifteen onwards, daily healing was performed with silver sulfadiazine application. The patient was discharged at week twenty with the wound 100% epithelialized. Conclusions: The use of negative pressure therapy accelerates the healing process, reduces complications and tissue bacterial load, due to the silver sponge acting as an antimicrobial barrier.

Feasibility of an improved knotless method of chest drain wound closure:a prospective cohort clinical trial.

OBJECTIVE: Chest tube management plays a key role in minimising erioperative period. We have improved the knotless method to chest tube wounds. In this article, we demonstrate the clinical bility and safety of this method. METHOD: From 13 October 2018-3 January 2019, patients were ecutively included in our study at the First Affiliated Hospital of n Medical University, Dalian, China. They were separated into approximately equally sized groups-the knotless group and the entional group. Our improved knotless method was performed ose the chest tube wounds of patients in the knotless group, and onventional method using the pre-existing U-shaped string to the chest tube wounds of patients in the conventional group. Patient clinical information, tube-related complications, retreatment s and cosmetic scores were compared between the groups. RESULTS: The cohort comprised 102 patients; 47 in the knotless group and 55 in the conventional group. There were no statistically significant differences in patient clinical information or tube-related complications between the two groups (p>0.05; both comparisons). In the knotless group, retreatment times were shorter (p<0.001) and cosmetic scores were higher (p<0.001). CONCLUSION: This study showed that our new knotless method is safe and has wide clinical feasibility. The new method also improved patient cosmetic scores. Furthermore, it decreased the patients' economic burdens.

Surgical site infection in skin surgery-An observational study.

BACKGROUND: Surgical site infection (SSI) has a significant impact on patients' morbidity and aesthetic results. OBJECTIVE: To identify risk factors for SSI in dermatologic surgery. PATIENTS AND METHODS: This prospective, single-centre, observational study was performed between August 2020 and May 2021. Patients that presented for dermatologic surgery were included and monitored for the occurrence of SSI. For statistical analysis, we used a mixed effects logistic regression model. RESULTS: Overall, 767 patients with 1272 surgical wounds were included in the analysis. The incidence of SSI was 6.1%. Significant risk factors for wound infection were defect size over 10cm2 (OR 3.64, 95% confidence interval [CI] 1.80-7.35), surgery of cutaneous malignancy (OR 2.96, CI 1.41-6.24), postoperative bleeding (OR 4.63, CI 1.58-13.53), delayed defect closure by local skin flap (OR 2.67, CI 1.13-6.34) and localisation of surgery to the ear (OR 7.75, CI 2.07-28.99). Wound localisation in the lower extremities showed a trend towards significance (OR 3.16, CI 0.90-11.09). Patient-related factors, such as gender, age, diabetes, or immunosuppression, did not show a statistically significant association with postoperative infection. CONCLUSION: Large defects, surgery of cutaneous malignancy, postoperative bleeding, and delayed flap closure increase the risk for SSI. High-risk locations are the ears and lower extremities.

Various Applications of Purse-String Suture and Its Cosmetic Outcome in Cutaneous Surgical Defects.

BACKGROUND: Purse-string suture is a simple technique to reduce wound size and to achieve complete or partial closure of skin defects. OBJECTIVE: To classify situations in which purse-string sutures can be utilized and to assess the long-term size reduction and cosmetic outcome of the final scar. METHODS: Patients (93 from Severance hospital and 12 from Gangnam Severance hospital) in whom purse-string sutures were used between January 2015 and December 2019 were retrospectively reviewed. Wound site, final reconstruction method, repair duration, final wound size, and Vancouver scar scale were assessed. RESULTS: A total of 105 patients were reviewed. Lesions were located on the trunk (48 [45.7%]), limbs (32 [30.5%]), and face (25 [23.8%]). Mean ratio of wound length/primary defect length was 0.79±0.30. Multilayered purse-string suture showed the shortest duration from excision to final repair (p<0.001) and most effectively minimized the scar size (scar to defect size ratio 0.67±0.23, p=0.002). The average Vancouver scar scale measured at the latest follow-up visit at least 6 months postoperatively was 1.62, and the risk of hypertrophic scarring was 8.6%. There was no significant difference in the Vancouver scar scale and the risk of hypertrophic scarring between the different surgical method groups. CONCLUSION: Purse-string sutures can be utilized in many stages of reconstruction to effectively reduce scar size without compromising the final cosmetic outcome.