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1.
Wound Manag Prev ; 66(5): 38-45, 2020 05.
Article in English | MEDLINE | ID: mdl-32401733

ABSTRACT

Treating postoperative abdominal wound dehiscence following abdominal surgery using negative pressure wound therapy (NPWT) has shown promising results. PURPOSE: A study was conducted to evaluate the efficacy of NPWT for fascial closure/cutaneous cover compared to non-NPWT treatment using petrolatum gauze and a Bogota bag in patients with postoperative laparotomy wound dehiscence. METHODS: A single center, prospective, nonrandomized pilot study was conducted. Using convenience sampling methods, consecutive patients on 6 different surgical units who were at least 18 years of age and who developed postoperative abdominal wound dehiscence following elective and emergency laparotomy from January 2017 to December 2018 were recruited. NPWT dressing with polyvinyl white foam sponge or loosely packed, saline-soaked petrolatum gauze followed by Bogota bag application were used and compared. Baseline patient demographics and history were collected, and patients were followed for an average of 6 months after surgery. Number of days until first signs of granulation tissue appearance, time until complete granulation tissue cover/fascial surgical closure, and hospital discharge were compared. Categorical variables (gender, comorbidities, presence or absence of stoma, exposure to prior radiotherapy) were expressed as proportions and analyzed using chi-squared test or Fischer's exact test. Continuous variables such as age, body mass index, albumin, postoperative hospital stay, and number of days required for decision for fascial closure were expressed as Mean ± standard deviation and analyzed using an independent t test or Mann Whitney U test based on whether the data followed normal distribution. Postoperative day of wound dehiscence, the number of days for the appearance of granulation tissue, and the number of NPWT placements required also were assessed using Mean ± standard deviation and analyzed using an independent t test. A P value <.05 was considered significant. RESULTS: Sixty (60) patients were included, but 4 in NPWT group and 10 in the non-NPWT group could not complete the study, leaving 26 patients in NPWT group and 20 patients in non-NPWT group. Demographic and surgical variables were not significantly different. Patients in both groups achieved complete wound coverage by surgical closure or healing by secondary intention. Days until first signs of granulation tissue (2.92 vs. 6.65; P <.001), number of days until fascial closure (15.50 vs. 29.50; P <.001), and length of postoperative hospital stay (24.30 vs. 37.90; P <.001) were significantly less in NPWT group. Two (2) patients (7.6%) in the NPWT developed a fistula during the 6-month follow-up period. No fistulas developed in the control group, and no intra-abdominal abscesses, ventral hernias, or wound dehiscence were reported in either group. CONCLUSION: Time until first signs of granulation tissue appearance and complete granulation tissue coverage was significantly shorter in the NPWT group, but time until definitive closure was not evaluated. Randomized, controlled clinical studies to compare definitive time to wound closure and long-term follow up to evaluate long-term complication rates, including the risk of developing fistulas, are warranted.


Subject(s)
Abdominal Wound Closure Techniques/instrumentation , Negative-Pressure Wound Therapy/instrumentation , Abdominal Wound Closure Techniques/standards , Adult , Bandages/standards , Female , Humans , India , Male , Middle Aged , Negative-Pressure Wound Therapy/methods , Negative-Pressure Wound Therapy/standards , Petrolatum/therapeutic use , Pilot Projects , Postoperative Complications/prevention & control , Postoperative Complications/therapy , Prospective Studies
3.
Hernia ; 24(4): 839-843, 2020 08.
Article in English | MEDLINE | ID: mdl-31254134

ABSTRACT

BACKGROUND: Small steps wound closure of midline laparotomy has been reported to decrease the incidence of incisional hernia development in two randomized controlled trials. The aim of the present study was to evaluate the effect of implementing the small steps wound closure technique in clinical practice with regards to the development of incisional ventral hernia (IVH) and surgical site infections (SSI) in clinical practice. METHODS: Implementation of the small steps wound closure technique using the small tissue bites technique as the standard closure technique for abdominal midline incisions in our clinical practice was done in March 2015. For this study, all patients from June 2013 until June 2016 with a midline laparotomy, either long or small in case of specimen extraction in laparoscopic surgery, in either elective or emergency setting were included. Conventional large bite wound closure was compared to small steps wound closure with regards to the development of SSI, IVH as well as burst abdomen. RESULTS: A total of 327 patients were included. The small steps suture technique was used in 136 (42%) of the patients, whereas the conventional large bites suture technique was used in 191 patients (58%). A total of 54 patients in the large bites group developed SSI (28%) compared to 23 (17%) patients in the small steps group (p = 0.02). A total number of 10 patients (7%) developed IVH in the small steps group compared to 27 patients (14%) in the large bites group (p = 0.08). CONCLUSION: Implementation of small bites wound closure of abdominal midline incisions in clinical practice was correlated with a reduction in surgical site infections.


Subject(s)
Abdominal Wound Closure Techniques/standards , Surgical Wound Infection/etiology , Suture Techniques/standards , Wound Closure Techniques/standards , Aged , Female , Humans , Male
4.
Int J Surg ; 71: 110-116, 2019 Nov.
Article in English | MEDLINE | ID: mdl-31561005

ABSTRACT

PURPOSE: Incisional hernias after laparotomy are associated with significant morbidity and increased costs. Recent research on prevention of incisional hernia formation suggests that a laparotomy closure technique using a slowly absorbable monofilament suture with small fascial steps and bites in a continuous, single layer with a suture length to wound length (SL/WL) ratio of at least 4:1 is effective in lowering morbidity. Little is known about application of this evidence in daily practice. Therefore, a survey was performed among Dutch surgeons. METHODS: All members of the Dutch Surgical Society were invited to participate in a 24-question online survey on techniques and materials used for abdominal wall closure after midline laparotomy. Subgroup analysis was performed based on surgical subspecialty, type of hospital and experience. RESULTS: Response rate was 26% (402 respondents), representing 97% of all Dutch surgical departments. More than 90% of participants closed the abdominal wall in a single mass layer, using a slowly absorbable monofilament running suture The SL/WL ratio of >4:1 is practiced by only 35% of participants and preferred suture size was variable among participants. Risk factors for incisional hernia development were generally identified correctly but more than half of the participants were unaware of the incidence and time of occurrence of incisional hernia. Subgroup analysis found that gastrointestinal and oncologic surgeons preferred smaller diameter sutures and higher suture-length to wound-length ratios. Trauma, vascular and pediatric surgeons had lower estimates of incidence of incisional hernia than other subspecialties. Surgeons employed in academic hospitals were more likely to use small fascial steps and smaller suture sizes than their colleagues in non-academic hospitals. Correct estimates of incisional hernia incidence decreased when surgeons perform less than 10 laparotomies annually. CONCLUSION: Implementation of the latest evidence regarding closure techniques of the abdominal wall is not widespread. Only 35% of surgeons close the abdominal fascia using a suture length to wound length ratio of 4:1, which is recommended based on the latest evidence. Surgical trainees, gastrointestinal and oncological surgeons are most familiar with the recommended technique and use it in their daily practice. Efforts should be directed at improving spreading of this technique.


Subject(s)
Abdominal Wound Closure Techniques/standards , Guideline Adherence/statistics & numerical data , Incisional Hernia/etiology , Practice Patterns, Physicians'/statistics & numerical data , Surgeons/statistics & numerical data , Abdominal Wall/surgery , Abdominal Wound Closure Techniques/adverse effects , Adult , Female , Humans , Incidence , Incisional Hernia/epidemiology , Laparotomy/adverse effects , Laparotomy/standards , Male , Middle Aged , Risk Factors , Surveys and Questionnaires , Sutures/adverse effects
5.
Prenat Diagn ; 39(12): 1070-1079, 2019 11.
Article in English | MEDLINE | ID: mdl-31410858

ABSTRACT

OBJECTIVE: To determine the predictive value of the fetal omphalocele circumference/abdominal circumference (OC/AC) ratio for type of surgical closure and survival and to describe the trajectory of OC/AC ratio throughout gestation. METHODS: This cohort study included all live-born infants prenatally diagnosed with an omphalocele in our tertiary centre (2000-2017) with an intention to treat. The OC/AC ratio and liver position were determined using 2D ultrasound at three periods during gestation (11-16, 17-26, and/or 30-38 weeks). Primary outcome was type of closure; secondary outcome was survival. In the secondary analyses, the predictive value of the OC/AC-ratio trend for type of closure and survival was assessed. RESULTS: Primary closure was performed in 37/63 (59%) infants, and 54/63 (86%) survived. The OC/AC ratio was predictive for type of closure and survival in all periods. Optimal cut-off values for predicting closure decreased throughout gestation from 0.69 (11-16 weeks) to 0.63 (30-38 weeks). Repeated OC/AC-ratio measurements were available in 33 (73%) fetuses. The trend of the OC/AC ratio throughout gestation was not significantly associated with type of closure. All infants without liver herniation underwent primary closure. CONCLUSION: Type of omphalocele surgical closure and survival can be predicted prenatally on the basis of the OC/AC ratio and liver herniation independent of associated anomalies. LEARNING OBJECTIVE: The reader will be able to use the OC/AC ratio throughout gestation in all omphalocele cases for prediction of type of closure and survival and thus patient counselling.


Subject(s)
Abdominal Cavity/pathology , Abdominal Wound Closure Techniques , Hernia, Umbilical/diagnosis , Hernia, Umbilical/surgery , Viscera/pathology , Abdominal Cavity/diagnostic imaging , Abdominal Wound Closure Techniques/adverse effects , Abdominal Wound Closure Techniques/classification , Abdominal Wound Closure Techniques/standards , Cohort Studies , Female , Fetal Development/physiology , Gestational Age , Hernia, Umbilical/mortality , Hernia, Umbilical/pathology , Humans , Infant, Newborn , Male , Organ Size , Predictive Value of Tests , Pregnancy , Pregnancy Trimester, Third/physiology , Prognosis , Reproducibility of Results , Survival Analysis , Ultrasonography, Prenatal/methods , Ultrasonography, Prenatal/standards , Viscera/diagnostic imaging , Waist Circumference/physiology
7.
Plast Surg Nurs ; 39(2): 41-43, 2019.
Article in English | MEDLINE | ID: mdl-31136556

ABSTRACT

Given their high rate of complications, radical surgical procedures of anorectal and gynecological tumors require a reliable and individualized reconstruction. The latter is influenced by the frequent indication of adjuvant chemo/radiotherapy that they present. We describe the case of a patient with medical history of vulvar carcinoma that required radical surgery and bilateral inguinal lymphadenectomy. Because of the stage of the tumor, the application of postoperative radiotherapy was clinically indicated; however, after surgery, the patient developed bilateral inguinal ulcers that made postoperative radiotherapy application impossible. Using a radical surgical approach in combination with postoperative radiotherapy increases survival in patients with these types of tumors. Therefore, delaying its use because of wound complications or inadequate reconstruction cannot be justified. The pedicled abdominal rectus flap is an excellent option for this purpose in patients with moderate- to large-sized defects.


Subject(s)
Inguinal Canal/surgery , Surgical Flaps/surgery , Vulvar Neoplasms/surgery , Abdominal Wound Closure Techniques/standards , Adult , Female , Humans , Radiotherapy/methods , Plastic Surgery Procedures/methods , Plastic Surgery Procedures/standards , Rectus Abdominis/surgery , Treatment Outcome
8.
J Trauma Acute Care Surg ; 86(4): 670-678, 2019 04.
Article in English | MEDLINE | ID: mdl-30562327

ABSTRACT

BACKGROUND: To standardize care and promote early fascial closure among patients undergoing emergent laparotomy and temporary abdominal closure (TAC), we developed a protocol addressing patient selection, operative technique, resuscitation strategies, and critical care provisions. We hypothesized that primary fascial closure rates would increase following protocol implementation with no difference in complication rates. STUDY DESIGN: We performed a retrospective cohort analysis of 138 adult trauma and emergency general surgery patients who underwent emergent laparotomy and TAC, comparing protocol patients (n = 60) to recent historic controls (n = 78) who would have met protocol inclusion criteria. The protocol includes low-volume 3% hypertonic saline resuscitation, judicious wound vacuum fluid replacement, and early relaparotomy with sequential fascial closure. Demographics, baseline characteristics, illness severity, resuscitation course, operative management, and outcomes were compared. The primary outcome was fascial closure. RESULTS: Baseline characteristics, including age, American Society of Anesthesiologists class, and postoperative lactate levels, were similar between groups. Within 48 hours of initial laparotomy and TAC, protocol patients received significantly lower total intravenous fluid resuscitation volumes (9.7 vs. 11.4 L, p = 0.044) and exhibited higher serum osmolarity (303 vs. 293 mOsm/kg, p = 0.001). The interval between abdominal operations was significantly shorter following protocol implementation (28.2 vs. 32.2 hours, p = 0.027). The incidence of primary fascial closure was significantly higher in the protocol group (93% vs. 81%, p = 0.045, number needed to treat = 8.3). Complication rates were similar between groups. CONCLUSIONS: Protocol implementation was associated with lower crystalloid resuscitation volumes, a transient hyperosmolar state, shorter intervals between operations, and higher fascial closure rates with no difference in complications. LEVEL OF EVIDENCE: Therapeutic study, level IV.


Subject(s)
Abdominal Wound Closure Techniques/standards , Emergency Service, Hospital , Intraoperative Complications/prevention & control , Laparotomy/standards , Postoperative Complications/prevention & control , Wounds and Injuries/surgery , Adult , Aged , Cohort Studies , Critical Care/standards , Fasciotomy/standards , Female , Humans , Injury Severity Score , Intraoperative Complications/etiology , Male , Middle Aged , Patient Selection , Postoperative Complications/etiology , Reoperation/standards , Resuscitation/standards , Retrospective Studies
9.
World J Emerg Surg ; 13: 7, 2018.
Article in English | MEDLINE | ID: mdl-29434652

ABSTRACT

Damage control resuscitation may lead to postoperative intra-abdominal hypertension or abdominal compartment syndrome. These conditions may result in a vicious, self-perpetuating cycle leading to severe physiologic derangements and multiorgan failure unless interrupted by abdominal (surgical or other) decompression. Further, in some clinical situations, the abdomen cannot be closed due to the visceral edema, the inability to control the compelling source of infection or the necessity to re-explore (as a "planned second-look" laparotomy) or complete previously initiated damage control procedures or in cases of abdominal wall disruption. The open abdomen in trauma and non-trauma patients has been proposed to be effective in preventing or treating deranged physiology in patients with severe injuries or critical illness when no other perceived options exist. Its use, however, remains controversial as it is resource consuming and represents a non-anatomic situation with the potential for severe adverse effects. Its use, therefore, should only be considered in patients who would most benefit from it. Abdominal fascia-to-fascia closure should be done as soon as the patient can physiologically tolerate it. All precautions to minimize complications should be implemented.


Subject(s)
Abdominal Wound Closure Techniques/standards , Guidelines as Topic , Prophylactic Surgical Procedures/methods , Abdomen/blood supply , Abdomen/physiopathology , Abdominal Cavity/blood supply , Abdominal Cavity/surgery , Abdominal Wound Closure Techniques/adverse effects , Humans , Intra-Abdominal Hypertension/complications , Intra-Abdominal Hypertension/prevention & control , Negative-Pressure Wound Therapy/methods , Postoperative Complications/prevention & control , Prophylactic Surgical Procedures/standards , Resuscitation/methods
10.
World J Emerg Surg ; 12: 39, 2017.
Article in English | MEDLINE | ID: mdl-28814969

ABSTRACT

The open abdomen (OA) is defined as intentional decision to leave the fascial edges of the abdomen un-approximated after laparotomy (laparostomy). The abdominal contents are potentially exposed and therefore must be protected with a temporary coverage, which is referred to as temporal abdominal closure (TAC). OA use remains widely debated with many specific details deserving detailed assessment and clarification. To date, in patients with intra-abdominal emergencies, the OA has not been formally endorsed for routine utilization; although, utilization is seemingly increasing. Therefore, the World Society of Emergency Surgery (WSES), Abdominal Compartment Society (WSACS) and the Donegal Research Academy united a worldwide group of experts in an international consensus conference to review and thereafter propose the basis for evidence-directed utilization of OA management in non-trauma emergency surgery and critically ill patients. In addition to utilization recommendations, questions with insufficient evidence urgently requiring future study were identified.


Subject(s)
Abdominal Wound Closure Techniques/standards , Consensus , Abdominal Wound Closure Techniques/trends , Critical Illness , Humans , Lower Body Negative Pressure/methods , Pancreatitis/surgery
11.
J Wound Ostomy Continence Nurs ; 44(3): 293-298, 2017.
Article in English | MEDLINE | ID: mdl-28472817

ABSTRACT

BACKGROUND: A 54-year-old morbidly obese woman with a small bowel obstruction and large ventral hernia was admitted to hospital. She underwent an exploratory laparotomy, lysis of adhesions, and ventral hernia repair with mesh placement. She subsequently developed an enteroatmospheric fistula; several months of hospital care was required to effectively manage the wound and contain effluent from the fistula. METHODS: Several approaches were used to manage output from the fistula during her hospital course. She was initially discharged to a skilled nursing facility where a fistula management pouch was used for several months to encompass the wound and contain effluent, but this method ultimately proved ineffective. The fistula was then isolated using a collapsible enteroatmospheric fistula isolation device and an ostomy appliance to contain effluent. CONCLUSION: The application of the collapsible enteroatmospheric fistula isolation and effluent containment devices in conjunction with negative-pressure wound therapy produced positive patient outcomes; it improved patient satisfaction with fistula management, promoted wound healing, and diminished cost.


Subject(s)
Intestinal Fistula/therapy , Negative-Pressure Wound Therapy/methods , Postoperative Complications/nursing , Wound Healing , Abdominal Wound Closure Techniques/nursing , Abdominal Wound Closure Techniques/standards , Female , Home Health Nursing/methods , Home Health Nursing/standards , Humans , Laparotomy/adverse effects , Middle Aged , Negative-Pressure Wound Therapy/standards , Obesity, Morbid/complications , Obesity, Morbid/nursing , Ostomy/instrumentation , Parenteral Nutrition, Total/nursing
12.
Chirurg ; 87(9): 744-750, 2016 Sep.
Article in German | MEDLINE | ID: mdl-27495164

ABSTRACT

The 1­year incisional hernia rate of 9-30 % has been tolerated for decades. Even in the 1970s and 1980s there was evidence that supported reducing suture tension. Recently, the traditional 4:1 relationship between suture and wound length, which has been passed on for years, has been questioned. After first experimental and clinical data suggested an advantage by reducing the width and interval of stitches by 50 %, the prospective randomized STITCH study has now provided evidence by significantly lowering the 1­year hernia rate from 21 % to 13 %. For surgeons this means less of a revolution and more of an innovative evolution of a long-established technique. Before introduction of the technique quality assurance must be carried out with documentation of performance indicators (e.g. number of stitches, length of thread incorporated and wound length).


Subject(s)
Abdominal Wound Closure Techniques/education , Education, Medical, Continuing , Abdominal Wound Closure Techniques/standards , Humans , Incisional Hernia/prevention & control , Prospective Studies , Quality Assurance, Health Care/standards , Randomized Controlled Trials as Topic , Subcutaneous Tissue/surgery , Suture Techniques/education
13.
Khirurgiia (Mosk) ; (7): 30-35, 2016.
Article in Russian | MEDLINE | ID: mdl-27459485

ABSTRACT

AIM: to improve the results of advanced peritonitis management. MATERIAL AND METHODS: 743 patients with advanced peritonitis were studied. Patients were divided into 2 groups depending on treatment strategy. RESULTS: Programmed relaparotomy combined with removable draining musculoaponeurotic seams during laparotomy closure decreased mortality from 47.8±2.7% to 24.1±2.3% (p<0.001) and provided 4-fold reduction of postoperative suppuration incidence (p<0.001). Refusal from removable draining musculoaponeurotic seams and use of only cutaneous seams in persistent abdominal hypertension were associated with further decrease of mortality to 15.8±2.7% (p<0.05). CONCLUSION: Programmed relaparotomy combined with removable draining musculoaponeurotic seams are advisable for advanced peritonitis management. Laparotomy closure with only cutaneous seams is indicated in case of persistent abdominal hypertension. Large eventration always requires abdominal wall repair. APACHE-III scale scores have significant prognostic value in patients with advanced peritonitis.


Subject(s)
Abdominal Wound Closure Techniques/standards , Laparotomy , Multiple Organ Failure , Peritoneal Lavage , Peritonitis/surgery , Postoperative Complications , Reoperation , Sepsis , Adult , Aged , Female , Humans , Laparotomy/adverse effects , Laparotomy/methods , Male , Middle Aged , Multiple Organ Failure/etiology , Multiple Organ Failure/mortality , Multiple Organ Failure/prevention & control , Outcome and Process Assessment, Health Care , Peritoneal Lavage/adverse effects , Peritoneal Lavage/methods , Peritonitis/diagnosis , Peritonitis/mortality , Peritonitis/physiopathology , Postoperative Complications/mortality , Postoperative Complications/prevention & control , Prognosis , Reoperation/adverse effects , Reoperation/methods , Reoperation/mortality , Retrospective Studies , Russia/epidemiology , Sepsis/etiology , Sepsis/mortality , Sepsis/prevention & control
14.
Chirurg ; 87(9): 737-743, 2016 Sep.
Article in German | MEDLINE | ID: mdl-27392763

ABSTRACT

BACKGROUND: The most frequent complications following midline abdominal laparotomy include incisional hernias, which develop in 10-15 % of patients and surgical site infections in 15-25 % of cases; however, the risk of these complications can be reduced by the surgical technique and the use of special suture materials. In 2010, the INLINE meta-analysis performed by the Study Centre of the German Society of Surgery (SDGC) revealed that a continuous suture technique using slowly absorbable suture material resulted in the lowest risk of developing postoperative incisional hernia after elective midline laparotomy. OBJECTIVE: The aim of this study was to perform a systematic literature search to identify all randomized controlled trials (RCTs) that have been published since 2010 concerning conventional abdominal wall closure in order to update the 2010 INLINE meta-analysis and summarize current evidence. MATERIAL AND METHODS: On 28 January 2016, a systematic literature search was performed in MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL). All RCTs dealing with abdominal wall closure after midline laparotomy were identified and included for further analysis. RESULTS: Since 2010 a total of 9 RCTs comparing different techniques of abdominal wall closure have been published. Three monocentric RCTs comparing different suture materials, showed no significant differences to the INLINE meta-analysis regarding incisional hernia development; therefore, slowly absorbable sutures using a continuous suture technique are still recommended for abdominal wall closure in elective cases. Furthermore, six RCTs were identified which investigated antimicrobial suture materials but failed to show an overall advantage for Triclosan-coated suture material with respect to surgical site infections. CONCLUSION: Current evidence shows that slowly absorbable monofilament suture material using a continuous suture technique provides the best results with regard to incisional hernia rates after elective midline laparotomy. Triclosan-coated sutures cannot be recommended as a standard suture material as they failed to reduce surgical site infections. For emergency laparotomies no evidence exists to recommend a specific kind of suture technique or a special suture material.


Subject(s)
Abdominal Wound Closure Techniques/standards , Incisional Hernia/etiology , Incisional Hernia/prevention & control , Surgical Wound Infection/etiology , Surgical Wound Infection/prevention & control , Suture Techniques/standards , Humans , Randomized Controlled Trials as Topic , Sutures/standards
15.
Crit Care ; 20(1): 164, 2016 May 28.
Article in English | MEDLINE | ID: mdl-27233244

ABSTRACT

BACKGROUND: Patients with an open abdomen (OA) treated with temporary abdominal closure (TAC) need multiple surgical procedures throughout the hospital stay with repeated changes of the vacuum-assisted closure device (VAC changes). The aim of this study was to examine if using the intensive care unit (ICU) for dressing changes in OA patients was safe regarding bloodstream infections (BSI) and survival. Secondary aims were to evaluate saved time, personnel, and costs. METHODS: All patients treated with OA in the ICU from October 2006 to June 2014 were included. Data were retrospectively obtained from registered procedure codes, clinical and administrative patients' records and the OR, ICU, anesthesia and microbiology databases. Outcomes were 30-, 60- and 90-day survival, BSI, time used and saved personnel costs. RESULTS: A total of 113 patients underwent 960 surgical procedures including 443 VAC changes as a single procedure, of which 165 (37 %) were performed in the ICU. Nine patients died before the first scheduled dressing change and six patients were closed at the first scheduled surgery after established OA, leaving 98 patients for further analysis. The mean duration for the surgical team performing a VAC change in the ICU was 63.4 (60.4-66.4) minutes and in the OR 98.2 (94.6-101.8) minutes (p < 0.001). The mean duration for the anesthesia team in the OR was 115.5 minutes, while this team was not used in the ICU. Personnel costs were reduced by €682 per procedure when using the ICU. Forty-two patients had all the VAC changes done in the OR (VAC-OR), 22 in the ICU (VAC-ICU) and 34 in both OR and ICU (VAC-OR/ICU). BSI was diagnosed in eight (19 %) of the VAC-OR patients, seven (32 %) of the VAC-ICU and eight (24 %) of the VAC-OR/ICU (p = 0.509). Thirty-five patients (83 %) survived 30 days in the VAC-OR group, 17 in the VAC-ICU group (77 %) and 28 (82 %) in the VAC-OR/ICU group (p = 0.844). CONCLUSIONS: VAC change for OA in the ICU saved time for the OR team and the anesthesia team compared to using the OR, and it reduced personnel costs. Importantly, the use of ICU for OA dressing change seemed to be as safe as using the OR.


Subject(s)
Abdominal Cavity/surgery , Abdominal Wound Closure Techniques/nursing , Bandages/standards , Negative-Pressure Wound Therapy/standards , Time Factors , Abdominal Wound Closure Techniques/standards , Adult , Aged , Aged, 80 and over , Compartment Syndromes/nursing , Compartment Syndromes/prevention & control , Female , Humans , Intensive Care Units , Male , Middle Aged , Negative-Pressure Wound Therapy/methods , Negative-Pressure Wound Therapy/mortality , Retrospective Studies
16.
BMC Vet Res ; 12: 58, 2016 Mar 19.
Article in English | MEDLINE | ID: mdl-26995736

ABSTRACT

BACKGROUND: Defects in the abdominal wall of horses have high relapse rate. This is mainly in lateral eventrations and hernias caused by trauma from kicks of other horses or installation structures. The eventration region normally becomes swollen and there may be complications due to intestinal loop incarceration. The surgical treatment, consisting of reconstruction of the abdominal wall, frequently require biological or synthetic materials for the reinforcement of the suture line and tension support. Therefore, several studies have reported new materials for the repair of the abdominal wall, with the aim of improving the integration among adjacent tissues and reducing risks and complications such as rejection and infection. This report describes for the first time the use of a regular polypropylene mesh reinforced with polyester buttons for the herniorrhaphy. CASE PRESENTATION: A male, three-year-old, Appaloosa with 500 Kg presented to our hospital with a 10 days history of an increased volume on the left ventro-lateral region of the abdomen. During the physical examination, a deventration following traumatic rupture of the abdominal wall was diagnosed via ultrasonography. Then, the equine was anesthetized and moved to surgery for correction of the eventration which was performed according to conventional technique described in literature. Two days later, an eventration relapse was observed and confirmed via ultrasonography. After that, a second surgical intervention was performed using polyester buttons and polypropylene mesh. After the second surgical procedure, no complications related to eventration were observed either intra or postoperatively. After that, a recheck was performed thirty days later where satisfactory wound healing and total recovery were observed. CONCLUSION: The use of polypropylene mesh reinforced with polyester buttons is an effective technique for the repair of traumatic eventration in horses. This technique provides effective reinforcement against the abdominal tension and was a good option for reconstruction of lacerated muscles in cases of equine post-traumatic eventration, including relapsing cases.


Subject(s)
Abdominal Injuries/surgery , Abdominal Injuries/therapy , Abdominal Wound Closure Techniques/veterinary , Polyesters/therapeutic use , Polypropylenes/therapeutic use , Suture Techniques/veterinary , Abdominal Injuries/diagnostic imaging , Abdominal Wall/diagnostic imaging , Abdominal Wall/surgery , Abdominal Wound Closure Techniques/standards , Animals , Horses , Male , Treatment Outcome , Ultrasonography/veterinary
17.
Am J Surg ; 211(6): 1077-83, 2016 Jun.
Article in English | MEDLINE | ID: mdl-26850135

ABSTRACT

BACKGROUND: Prevention of surgical site infections (SSIs) can improve surgical quality through reductions in morbidity and cost. We sought to determine whether the abdominal closure protocol, in isolation, decreases SSI at an academic teaching hospital. METHODS: Adult patients undergoing laparotomy were prospectively randomized to an abdominal closure protocol, which includes unused sterile instruments and equipment at fascial closure, or usual care. A 30-day SSI rates were compared. General surgery, colorectal, urology, or gynecologic oncology patients undergoing anticipated wound classification II cases were eligible. RESULTS: Overall SSI rates were 11.6% in patients randomized to protocol closure vs 12.4% for usual care (total n = 233; P = .85). The abdominal closure protocol and usual care groups had similar rates of superficial (4.5% vs 4.1%; P = .9), deep (.9% vs 0%, P = .3), organ-space SSI rates (6.2% vs 8.3%, P = .55), and wound dehiscence (2.7% vs 5.3%; P = .24). CONCLUSIONS: An abdominal closure protocol did not decrease the rate of SSI and is likely not a key intervention for SSI reduction.


Subject(s)
Abdominal Wound Closure Techniques/standards , Genital Neoplasms, Female/surgery , Surgical Wound Infection/prevention & control , Wound Healing/physiology , Abdomen/surgery , Abdominal Wound Closure Techniques/trends , Adult , Aged , Colorectal Neoplasms/surgery , Colorectal Surgery/adverse effects , Colorectal Surgery/methods , Female , Gynecologic Surgical Procedures/adverse effects , Gynecologic Surgical Procedures/methods , Humans , Laparotomy/adverse effects , Laparotomy/methods , Logistic Models , Male , Middle Aged , Multivariate Analysis , Prospective Studies , Quality Improvement , Risk Assessment , Treatment Outcome , Urologic Surgical Procedures/adverse effects , Urologic Surgical Procedures/methods
18.
Zentralbl Chir ; 136(6): 564-7, 2011 Dec.
Article in German | MEDLINE | ID: mdl-22086773

ABSTRACT

The most common complications after abdominal surgery - wound infections and the development of incisional hernia - are associated with the opening and closing of the abdominal wall. Depending on the selection of patients, wound infection rates of up to 19 % and hernia rates of up to 38 % are reported. Based on a summary of the actual literature, the abdominal wall should be closed with continuous slowly absorbable sutures with a suture length to wound length ratio of over 4 using small stitches. While antiseptic suture material may help to reduce wound infections after abdominal incision, preventing the development of incisional hernia is still a unsolved problem. As there is still no standard surgical technique for abdominal wall closure, surgeons should pay greater attention to the standardisation and documentation of techniques and wound care.


Subject(s)
Abdominal Wound Closure Techniques , Hernia, Abdominal/surgery , Postoperative Complications/surgery , Surgical Wound Dehiscence/surgery , Surgical Wound Infection/surgery , Abdominal Wound Closure Techniques/standards , Critical Pathways/standards , Evidence-Based Medicine/standards , Germany , Humans , Quality Assurance, Health Care/standards , Reoperation/standards , Suture Techniques/standards , Sutures/standards
19.
Cir Pediatr ; 24(2): 109-11, 2011 Apr.
Article in Spanish | MEDLINE | ID: mdl-22097659

ABSTRACT

UNLABELLED: INTRODUCION AND AIM: The enterostomy used in the treatment of Necrotizing Enterocolitis (NEC) causes many complications before and after its closure. The aim of this study was to examine the complications of closure aiming at determining the best timing for this operation. PATIENTS AND METHOD: Retrospective review patients (p) below 1500 g with NEC in whom the enterostomy was closed in the last seven years. P were divided into two groups: PC (planned closure after uncomplicated postoperative period) and CC (advanced closure due to stomal--excessive looses--or to parenteral nutrition complications--septicemia, liver dysfunction-). We compared the age at closure, time of enterostomy, weight gain and complications. RESULTS: Out of a total of 25 p requiring surgical treatment for NEC, 16 from the PC group and 9 from the CC group were included. The mean age at the moment of the closure were, respectively, 129 + 65 vs. 204 +/- 121 days (p < 0.05). Weight at closure was 2665 +/- 841 vs. 4665 +/- 2076 g (p < 0.05); the mean time with the enterostomy was 105 +/- 64 vs. 187 +/- 116 d (p < 0.05), and the weight gain was 1779 +/- 859 vs. 3693 +/- 2155 g (p < 0.05). After stomal closure, 7/16 p of the CC group (43%) and 2/9 of the PC group (22%) required reoperation due to severe complications (ns). In 4 of them, three of the CC group and one of the PC group, a new enterostomy was performed. CONCLUSIONS: In p with enterostomy-related complications, closure has often to be advanced and it is performed in deficient nutritional conditions. Severe complications after enterostomy closure required reoperation in 43% of the CC group and in 22% of the PC group. Although there was no statistically significant difference, the trend indicates an augmented risk in CC group. The timing for enterostomy closure should be chosen individually. At the time of indicating the closure, the high risk of complications, should be taken into account particularly in preterms with enterostomy-related problems.


Subject(s)
Abdominal Wound Closure Techniques/standards , Enterocolitis, Necrotizing/surgery , Enterostomy/standards , Humans , Infant, Newborn , Retrospective Studies , Time Factors
20.
Khirurgiia (Mosk) ; (5): 56-60, 2011.
Article in Russian | MEDLINE | ID: mdl-21666583
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