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Incision closure

Alexandros Mallios, William Jennings, Benoit Boura, Alessandro Costanzo, Myriam Combes
Skin necrosis overlying an arteriovenous fistula at the cannulation site is a common and potentially life-threatening problem, often associated with underlying aneurysm formation. Arteriovenous fistula-skin necrosis generally requires resection of surrounding skin margins and the underlying aneurysmal vessel wall, allowing repair with healthy tissue of the arteriovenous fistula in addition to closure of soft tissue and skin. In patients with insufficient fistula length, salvage of these arteriovenous fistulas may result in difficult or insurmountable cannulation issues leading to attempts at one-needle cannulation dialysis or, most often, catheter placement...
March 1, 2018: Journal of Vascular Access
Martin Dübbers, Elena Nikolaou, Hans Fuchs, Janina Fischer, Hakan Alakus, Jessica Leers, Christiane Bruns, Grigore Cernaianu
BACKGROUND: Transumbilical laparoscopic-assisted appendectomy (TULAA) is fast and cost-effective since no endoloops, staplers or wound protection devices are used. We analyzed the effects of TULAA as first approach for perforated (PA) and non-perforated (NPA) appendicitis in children. PATIENTS: We performed a retrospective analysis of 181 children for whom TULAA was the first approach for appendicitis between October 2010 and March 2016. METHODS: Morbidity, additional laparoscopic instrument insertion (AI), conversions to open extraumbilical appendectomy (OC), and complications were evaluated...
March 15, 2018: Klinische Pädiatrie
Qiang Wang, Jia-Xin Ye, Min Ge, Dong-Jin Wang
This study reviews our results and experience with cardiothoracic surgery via RVIAT over the past 15 years. This retrospective overview summarises our results, describing the early and late clinical outcomes of 1,126 patients, including 370 ASD closures, 488 VSD closures and 268 valve surgeries, at a single center between October 2001 and December 2015. The mean follow-up time was 52 ± 35 months (range 8-120 months). The mean incision length was 6 ± 2.22 cm (range 3.9-8.9 cm). No patient required conversion to median sternotomy...
March 12, 2018: Scientific Reports
Simon W Young, Mei Zhang, Grant A Moore, Rocco P Pitto, Henry D Clarke, Mark J Spangehl
BACKGROUND: In primary TKA, prophylaxis with low-dose vancomycin through intraosseous regional administration (IORA) achieves tissue concentrations six to 10 times higher than systemic administration and was shown to provide more effective prophylaxis in an animal model. However, in revision TKA, the presence of a tibial implant may compromise IORA injection, and tourniquet deflation during a prolonged procedure may lower tissue concentrations. QUESTIONS/PURPOSES: (1) Does low-dose IORA reliably provide equal or higher tissue concentrations of vancomycin compared with systemic IV administration in revision TKA? (2) Are tissue concentrations of vancomycin after IORA maintained for the duration of the revision TKA despite a period of tourniquet deflation? (3) Is there any difference in early postoperative (< 6 weeks) complications between IORA and systemic IV administration in revision TKA? METHODS: Twenty patients undergoing aseptic revision TKA were randomized to two groups...
January 2018: Clinical Orthopaedics and related Research
A Guiroy, A Sícoli, N Gonzalez Masanés, A Morales Ciancio, M Gagliardi, A Falavigna
Background: The paraspinal, posterolateral, or Wiltse approach is an old technique that observes the principles of an MIS procedure. The aim of this study was to provide a step-by-step description from the literature of the Wiltse paraspinal approach and analyze its main advantages and limitations. Methods: Here, we provide a step-by-step description of the Wiltse approach. Utilizing PubMed and Lilacs and the Mesh terms "Wiltse approach," "paraspinal approach," "muscle sparing approach," and "lumbar spine," we identified 10 papers...
2018: Surgical Neurology International
Maryam Rezapoor, Timothy L Tan, Mitchell G Maltenfort, Javad Parvizi
BACKGROUND: Iodophor-impregnated adhesive incise drapes are widely used during surgeries for reducing surgical site contamination. There is little evidence to support the latter belief. This study evaluated the efficacy of iodophor-impregnated adhesive drapes for reducing bacterial contamination and counts at the incision site during hip surgery. METHODS: In this prospective, randomized clinical trial, we enrolled 101 patients undergoing open joint preservation procedure of the hip...
February 2, 2018: Journal of Arthroplasty
Zi-Jian Li, Min-Wei Zhao, Lin Zeng
Background: Total knee arthroplasty (TKA) is the most frequently performed procedure in treating advanced knee osteoarthritis. Excessive perioperative blood loss can sometimes lead to postoperative anemia. Tranexamic acid (TXA) is a potent fibrinolysis inhibitor which has been extensively used at the surgical incision and closure to lower overall blood loss in adult reconstruction surgery. Our previous study suggested that about two-thirds of the total blood loss (TBL) came from hidden blood loss (HBL) on postoperative days 1 and 2...
March 20, 2018: Chinese Medical Journal
Glenn Isaacson, Jonathan A Harounian
Objectives: To evaluate the success of pediatric endoscopic and endoscopically assisted transcanal cartilage inlay tympanoplasty. Methods: Retrospective review of single surgeon experience. Results: During a 3 year period, 30 children underwent 31 endoscopic or endoscopically assisted transcanal tympanoplasties by the senior surgeon using tragal cartilage/perichondrial inlay grafts. There were 22 boys and 8 girls, ranging in age from 3.5 to 17 years (median 6 years)...
September 2017: World Journal of Otorhinolaryngology—Head and Neck Surgery
Kensuke Yamauchi, Shinnosuke Nogami, Yoshihiro Kataoka, Shigeto Koyama, Bernd Lethaus, Tetsu Takahashi
The objective of this study was to present a novel procedure for cortical bone repositioning (CBR) that maintains a secure space under the periosteum by replacement of the lateral cortex via fixation, employing titanium screws. Seven systemically healthy patients presenting with horizontal alveolar bone defects in radiographs and CT images were enrolled for CBR technique for horizontal alveolar bone augmentation. A lateral cortical bone block was cut in the defects and freed from the original bony surface. A screw was inserted into the block, and the block was placed laterally to allow fixation...
March 7, 2018: International Journal of Periodontics & Restorative Dentistry
Hahn-Sol Bae, Mu-Young Lee, Ji-Ung Park
RATIONAL: Burns at the site of the return electrode (i.e., grounding pad) are possible effects of electrosurgery. Despite this knowledge, however, ignorance or negligence with regards to proper handling of the grounding pads still often occurs. Burn injuries can be easily prevented by taking the necessary precautions; thus, during plastic surgery, careful attention should to be paid. PATIENT CONCERNS: A 38-year-old female patient was admitted to our ward to be performed augmentation mammoplasty...
January 2018: Medicine (Baltimore)
Quoc Tran, Ryo Mizumoto, Daniel Mehanna
INTRODUCTION: Subcutaneous emphysema (SE) is a frequent and often self-limiting complication of tube thoracostomy or other cardiothoracic procedures. On rare occasions, severe and extensive surgical emphysema marked by palpable cutaneous tension, dysphagia, dysphonia, palpebral closure or associated with pneumoperitoneum, airway compromise, "tension phenomenon" and respiratory failure require treatment. PRESENTATION OF CASE: A 67 year old lady presented with a large spontaneous pneumothorax on the background of end-stage chronic obstructive pulmonary disease (COPD) and newly diagnosed lung cancer, developed extensive surgical emphysema following insertion of a chest drain...
February 9, 2018: International Journal of Surgery Case Reports
David Peleg, Ronan Said Ahmad, Steven L Warsof, Naama Marcus-Braun, Yael Sciaky-Tamir, Inbar Ben Shachar
BACKGROUND: Knotless barbed sutures are monofilament sutures with barbs cut into them. These sutures self-anchor, maintaining tissue approximation without the need for surgical knots. OBJECTIVE: The hypothesis of this study was that knotless barbed suture could be used on the myometrium to close the hysterotomy at cesarean delivery. The objective was to compare uterine closure time, need for additional sutures, and blood loss between this and a conventional suture...
March 2018: American Journal of Obstetrics and Gynecology
G M Cooney, A Kiernan, D C Winter, C K Simms
BACKGROUND: Suturing techniques for midline abdominal wall incisions vary between surgeons. This study uses a biomechanical abdominal model to assess tissue stretch using different suturing techniques for midline laparotomy closure. METHODS: Deformation tests were performed on the linea alba of 48 porcine abdominal walls. Each pattern was tested three times at pressures ranging from 0 to 20 kPa using different continuous suturing techniques and a control. RESULTS: There was a sevenfold improvement when the best performing bite separation and bite width ([5, 16] mm) was compared with the most poorly performing combination ([15, 4] mm)...
March 2018: British Journal of Surgery
Sacha Salzberg, Maximillian Emmert
Left atrial appendage closure was originally described by Madden in 1949 who was the first to perform appendix amputation. This was a very invasive procedure with poor outcome, but preformed for stroke prevention. Much later, it was James Cox whom described the Cox-Maze procedure, which included multiple incisions to create a maze like pathway for the electrical impulse to go undisturbed from the sinus node down to the atrio-ventricular node. Since then cardiac surgeons stopped focusing on the left atrial appendage and went on about seemingly more important things...
December 2017: Journal of Atrial Fibrillation
Selvakumari Ulagesan, Kamatchi Sankaranarayanan, Amutha Kuppusamy
A peptide might be an exciting biomaterial or template for the development of novel wound-healing agents. In this report, it was isolated from the terrestrial snail Cryptozona bistrialis by enzymatic digestion and was evaluated for its in vitro wound-healing activity in NIH/3T3 mouse fibroblasts cell line and in vivo wound-healing activity in normal and diabetic-induced Wistar albino rats. The C. bistrialis protein was digested by the papain enzyme, and 21.79 kDa peptide (Cb-peptide) was purified by reversed-phase high-performance liquid chromatography and identified by MALDI (matrix-assisted laser desorption/ionization)-TOF analysis...
February 26, 2018: International Wound Journal
Sergio Henrique Bastos Damous, George Felipe Bezerra Darce, Renato Silveira Leal, Adilson Rodrigues Costa, Pedro Henrique Alves Ferreira, Celso de Oliveira Bernini, Edivaldo Massazo Utiyama
INTRODUCTION: Severe injuries of the pancreatic head and duodenum in haemodynamically unstable patients are complex management. The purpose of this study is to report a case of complex pancreatic trauma induced by gunshot and managed with surgical approaches at three different times. PRESENTATION OF CASE: Exploratory laparotomy was indicated after initial emergency room care, with findings of cloudy blood-tinged fluid and blood clots on the mesentery near the hepatic angle, on the region of the 2nd portion of the duodenum and at the pancreatic head...
February 15, 2018: International Journal of Surgery Case Reports
Andy C Kiser, Thomas G Caranasos, Mark D Peterson, David M Holzhey, Philipp Kiefer, L Wiley Nifong, Michael A Borger
OBJECTIVE: Recently, the PARTNER 2A trial reported results of transcatheter aortic valve replacement versus surgical aortic valve replacement in 2032 intermediate-risk patients at 2 years. Two hundred thirty-six patients (24%) required an access route other than transfemoral. Compared with transfemoral and surgical aortic valve replacement, nontransfemoral transcatheter aortic valve replacement was associated with a numerically higher rate of death and disabling stroke at 30 days. This underscores the need for a better alternative surgical approach for patients with marginal femoral access...
February 17, 2018: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Mouen A Khashab, Petros C Benias, Lee L Swanstrom
Peroral endoscopic myotomy (POEM) is an advanced endoscopic procedure classically performed for the treatment of achalasia. The procedure is based on principles of submucosal endoscopy and is comprised of a mucosal incision, submucosal tunneling, myotomy and mucosal closure. Multiple published studies that collectively include more than 6000 patients reported clinical success in more than 80-90% of patients. Recent literature also suggested durability of response over a medium-term follow-up. POEM is associated with a low rate of adverse events when performed by experienced operators...
February 15, 2018: Gastroenterology
Eijiro Echizen, Kei Miyata, Ken Yamashita, Takeshi Mikami, Eichi Narimatsu, Nobuhiro Mikuni
BACKGROUND: Neurosurgical intervention for a patient with an extensive scalp burn is rare, but it might be associated with the high risk of surgical site infection. CASE DESCRIPTION: An 80-year-old man had a severe and extensive scalp burn. A chronic subdural hematoma (CSDH) was observed on a head CT for the assessment of bacteremia during treatment in the intensive care unit. To evaluate whether the CSDH might underlie his prolonged fever and sepsis pathology, we urgently evacuated the hematoma using one burr hole...
February 13, 2018: World Neurosurgery
Bethany J Slater, Saundra Kay, Steven S Rothenberg
OBJECTIVE: Laparoscopic anorectoplasty (LARRP) for the treatment of select anorectal malformations has gained popularity due to enhanced visualization of the fistula and the ability to place the rectum within the sphincter complex while minimizing division of muscles and the perineal incision. However, given the technical challenges and reported complications of ligation, a number of techniques have been described, including using clips, suture ligation, endoloops, or division without closure...
February 15, 2018: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
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