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Delayed primary skin closure

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https://www.readbyqxmd.com/read/27844118/the-cost-of-infection-in-severe-open-tibial-fractures-treated-with-a-free-flap
#1
Ulrik Kähler Olesen, Nicolas Jones Pedersen, Henrik Eckardt, Line Lykke-Meyer, Christian Thorsten Bonde, Upender Martin Singh, Martin McNally
PURPOSE: Open tibial fractures needing soft tissue cover are challenging injuries. Infection risk is high, making treatment difficult and expensive. Delayed skin closure has been shown to increase the infection rate in several studies. We aimed at calculating the direct and indirect cost of treatment, and to determine the effect of delayed skin closure on this cost. METHODS: We reviewed all records of patients treated with a free flap in our institution for an open tibial fracture from 2002 to 2013...
November 14, 2016: International Orthopaedics
https://www.readbyqxmd.com/read/27836205/effectiveness-of-cyanoacrylate-microbial-sealant-in-the-reduction-of-surgical-site-infection-in-gynecologic-oncology-procedures-a-phase-iii-single-institution-prospective-randomized-trial
#2
Eric D Thomas, Elizabeth K Nugent, Matthew C MacAllister, Katherine M Moxley, Lisa Landrum, Joan L Walker, D S McMeekin, Robert S Mannel, Gerald McGwin, Kathleen N Moore
OBJECTIVES: Surgery is a cornerstone for patients with gynecologic malignancies. Surgical site infections (SSI) remain a source of post-operative morbidity. Consequences range from escalated costs, delay in adjuvant therapy, and increased morbidity. Our primary objective was to evaluate the effectiveness of a cyanoacrylate microbial sealant (CMS) to reduce post-operative SSI following laparotomy for suspected gynecologic malignancy. METHODS: Patients were randomized using a 1:1 allocation to receive either standard skin preparation or standard preparation with CMS and stratified by BMI...
November 8, 2016: Gynecologic Oncology
https://www.readbyqxmd.com/read/27524532/use-of-the-bogota-bag-for-closure-of-open-abdominal-wound-after-exploratory-laparotomy-our-experience-at-mayo-hospital-lahore
#3
Yar Muhammad, Khalid Masood Gondal, Umair Ahmed Khan
OBJECTIVE: To assess the efficacy of Bogota bag for closure of open abdominal wounds after laparotomy where the primary closure cannot be achieved and other closure techniques are not available. METHODS: The descriptive study was conducted at Mayo Hospital, Lahore, Pakistan, from September 2011 to February2015, and comprised patients who underwent laparotomy and peritoneal cavities and who could not be closed primarily because of various reasons like traumatic loss and oedematous gut...
August 2016: JPMA. the Journal of the Pakistan Medical Association
https://www.readbyqxmd.com/read/27363660/negative-pressure-therapy-is-effective-in-abdominal-incision-closure
#4
Nathan W Kugler, Thomas W Carver, Jasmeet S Paul
BACKGROUND: CDC wound classification demonstrates surgical site infection (SSI) occurs in 15%-30% of contaminated (class III) and >30% of dirty-infected (class IV) wounds. Several techniques have been used to decrease SSI rates in midline laparotomy incisions; however, no technique has shown superiority. Evidence suggests incisional negative pressure wound therapy (INPWT) can decrease wound complications, but no literature exists regarding INPWT for high-risk laparotomy incisions. We sought to analyze the efficacy of INPWT in the management of high-risk midline laparotomy incisions...
June 15, 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/27351470/melanoma-extirpation-with-immediate-reconstruction-the-oncologic-safety-and-cost-savings-of-single-stage-treatment
#5
Irena Karanetz, Sharon Stanley, Denis Knobel, Benjamin D Smith, Nicholas Bastidas, Mansoor Beg, Armen K Kasabian, Neil Tanna
BACKGROUND: The timing of reconstruction following melanoma extirpation remains controversial, with some advocating definitive reconstruction only when the results of permanent pathologic evaluation are available. The authors evaluated oncologic safety and cost benefit of single-stage neoplasm extirpation with immediate reconstruction. METHODS: The authors reviewed all patients treated with biopsy-proven melanoma followed by immediate reconstruction during a 3-year period (January of 2011 to December of 2013)...
July 2016: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/27129759/wound-hygiene-practices-after-total-knee-arthroplasty-does-it%C3%A2-matter
#6
Anthony L Yu, David C Alfieri, Kristen N Bartucci, Adam M Holzmeister, Harold W Rees
BACKGROUND: Current literature is limited with regard to standardized postoperative surgical site hygiene after total knee arthroplasty (TKA). With little guidance from the literature, the timing of permissible postoperative cleaning is a decision made by the individual surgeon using anecdotal evidence. A standardized wound care regimen is of particular interest to minimize the risk of infection. METHODS: To examine what species of bacteria recolonize the surgical site postoperatively, a randomized controlled trial was performed of 16 TKA patients who were allowed to shower at 2 days postoperatively and of 16 patients who were asked to wait until 2 weeks postoperatively before showering after TKA...
October 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27106143/comparison-between-primary-closure-and-skin-grafts-of-the-free-fibula-osteocutaneous-flap-donor-site
#7
Masaya Akashi, Kazunobu Hashikawa, Hiroyuki Takasu, Kazuhiro Watanabe, Junya Kusumoto, Akiko Sakakibara, Takumi Hasegawa, Tsutomu Minamikawa, Takahide Komori
PURPOSE: This study aimed to compare the size of skin paddles, the postoperative course, and donor site complications between primary closure and skin grafts of the free fibula flap donor site. METHODS: Thirty-five consecutive patients were enrolled. Medical records were retrospectively reviewed for risk factors for delayed healing, size of skin paddles, time to resumption of gait with a mobility aid and self-ambulation, early donor site morbidity, and late donor site complaints...
September 2016: Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/27076995/keratinocyte-secreted-heat-shock-protein-90alpha-leading-wound-reepithelialization-and-closure
#8
Ayesha Bhatia, Kathryn O'Brien, Mei Chen, David T Woodley, Wei Li
Significance: Delayed and nonhealing wounds pose a health, economic, and social problem worldwide. For decades, the conventional wisdom pointed to growth factors as the driving force of wound healing and granted them a center stage for therapeutic development. To date, few have obtained US FDA approvals or shown clinical effectiveness and safety. Critical Issue: Wound closure is the initial and most critical step during wound healing. Closing chronic wounds to shut down continued infection is the primary and likely the only achievable goal at the clinic in the foreseeable future...
April 1, 2016: Advances in Wound Care
https://www.readbyqxmd.com/read/27038863/soft-tissue-reconstruction-and-flap-coverage-for-revision-total-knee-arthroplasty
#9
REVIEW
Allison J Rao, Steven J Kempton, Brandon J Erickson, Brett R Levine, Venkat K Rao
BACKGROUND: Total knee arthroplasty is a successful operation for treatment of arthritis. However, devastating wound complications and infections can compromise the knee joint, particularly in revision situations. METHODS: Soft tissue loss associated with poor wound healing and multiple operations can necessitate the need for reconstruction for wound closure and protection of the prosthesis. RESULTS: Coverage options range from simple closure methods to complex reconstruction, including delayed primary closure, healing by secondary intention, vacuum-assisted closure, skin grafting, local flap coverage, and distant microsurgical tissue transfer...
July 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27022814/isolated-fournier-s-gangrene-of-the-penis
#10
A O Obi
To share experience on the presentation and management of 4 cases of isolated penile Fournier's gangrene. Clinical and demographic data of four patients with isolated penile Fournier's gangrene seen over an 8-year period (January 2006-December 2013) were reviewed. All patients had intravenous fluid resuscitation, emergency surgical debridement, and broad-spectrum intravenous antibiotics. Fournier's gangrene of the penis was, respectively, due to long segment anterior urethral stricture, penile edema from poorly controlled congestive cardiac failure, penile abrasion from oral sex and idiopathic...
May 2016: Nigerian Journal of Clinical Practice
https://www.readbyqxmd.com/read/26986991/a-novel-approach-to-keloid-reconstruction-with-bilaminar-dermal-substitute-and-epidermal-skin-grafting
#11
Khang T Nguyen, Lauren Shikowitz, Armen K Kasabian, Nicholas Bastidas
BACKGROUND: Keloids represent a challenging problem. Surgical excision remains the definitive treatment for immediate lesion debulking, but recurrence rates are reported to be 45 to 100 percent. The authors present a staged reconstructive approach using a dermal regeneration substrate and epidermal grafting to minimize recurrence and donor-site morbidity. METHODS: Keloids were completely excised down to normal subcutaneous tissue or perichondrium. A bilaminar dermal regeneration matrix was approximated to the entire wound, with the silicone lamina oriented superficially...
July 2016: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/26826925/vacuum-assisted-closure-in-the-management-of-degloving-soft-tissue-injury-a-case-report
#12
Torsten Andres, Falk von Lübken, Benedikt Friemert, Gerhard Achatz
We report the case of a patient with an extensive degloving injury to his right foot involving severe subcutaneous soft tissue disruption and contamination. The initial treatment consisted of debridement, which was kept to a minimum, copious irrigation, primary wound closure at a few sites, and coverage of the remaining skin defects with vacuum-assisted closure (VAC) dressings. After a few weeks of VAC therapy for wound bed preparation, definitive coverage with a meshed skin graft was possible. Additional plastic surgical procedures were not required...
July 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/26721003/laparotomy-for-peritonitis-primary-or-delayed-primary-closure
#13
RANDOMIZED CONTROLLED TRIAL
Gul Nasib, Syed Inamullah Shah, Eitezaz Ahmad Bashir
BACKGROUND: Although literature does not provide a level-1 evidence to support either method of closure, various studies have shown a reduced frequency of superficial surgical site infection with delayed primary closure (DPC) as opposed to primary closure (PC). Nevertheless, PC is still preferred by most. surgeons to avoid a second procedure. This study was conducted with the objective to compare the frequency of wound infection and duration of hospitalization among patients undergoing primary and delayed primary closure of the skin wound following laparotomy for peritonitis...
July 2015: Journal of Ayub Medical College, Abbottabad: JAMC
https://www.readbyqxmd.com/read/26653950/delayed-abdominal-closure-after-congenital-diaphragmatic-hernia-repair
#14
Pablo Laje, Holly L Hedrick, Alan W Flake, N Scott Adzick, William H Peranteau
PURPOSE: We present our experience with CDH patients who required delayed abdominal closure following CDH repair. METHODS: A retrospective review of all CDH repairs from 2004 to 2014 was performed. RESULTS: 233 patients underwent CDH repair, of which 21 required delayed abdominal closure defined as the inability to close the abdominal fascia at the time of CDH repair. The incidence of delayed closure was higher in those undergoing CDH repair on ECMO vs...
February 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/26650578/delayed-wound-dehiscence-of-anterior-knee-incisions-in-patients-aged-20-years-and-younger-a-comparison-of-subcutaneous-skin-closure
#15
Christopher G Salib, June C Smith, Nicholas Siow, Scott J Luhmann
BACKGROUND: Delayed wound dehiscence (DWD) typically occurs 2 to 7 weeks postoperatively and is characterized by wound gapping and drainage at a surgical site which has initial normal wound healing. This wound problem clinically mimics deep surgical site infection and, after eventual skin healing, leaves a cosmetically unattractive widened, atrophic surgical scar. METHODS: A single-center, retrospective analysis was completed of 252 knees, over a 13-year period, in 194 patients (average age, 14...
December 8, 2015: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/26606210/rotational-and-axial-pattern-flaps-in-a-cat-for-wound-reconstruction-secondary-to-urethral-rupture
#16
Gwyneth K Watrous, Dawn M Martin, Rhea L Plesman, Brendon Ringwood
A 3 yr old intact male domestic shorthair cat was presented with urine extravasation from urethral rupture. Extensive skin necrosis developed in the perineal region and left hind limb that necessitated delayed primary wound closure with a caudal superficial epigastric axial pattern flap, scrotal and preputial rotational skin flaps, and perineal urethrostomy.
January 2016: Journal of the American Animal Hospital Association
https://www.readbyqxmd.com/read/26364879/use-of-small-intestinal-submucosal-and-acellular-dermal-matrix-grafts-in-giant-omphaloceles-in-neonates-and-a-rabbit-abdominal-wall-defect-model
#17
COMPARATIVE STUDY
Weiwei Jiang, Jie Zhang, Xiaofeng Lv, Changgui Lu, Huan Chen, Xiaoqun Xu, Weibing Tang
BACKGROUND: The described surgical strategies for the management of omphalocele include primary closure, staged closure, and delayed closure. A primary repair is not suitable for all giant omphaloceles. We implanted two grafts, small intestinal submucosal (SIS) and acellular dermal matrix (ADM) onto abdominal wall defects in neonates to study the safety and efficacy of SIS and ADM graft techniques for initial closure of giant omphaloceles in infants, and we also implanted these grafts onto abdominal wall defects in an animal model...
March 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/26352284/use-of-npwt-with-and-without-soft-port-technology-in-infected-foot-wounds-undergoing-partial-diabetic-foot-amputation
#18
J A Schwartz, A Fuller, E Avdagic, C Gendics, J C Lantis
OBJECTIVE: Negative pressure wound therapy (NPWT) has previously been shown to be effective in closing diabetic foot wounds that have undergone amputation over a 16-week period. For patients with plantar foot wounds, NPWT is a key therapy. An alternative NPWT with and without a novel soft, flexible port system needs to be evaluated for its comparable efficacy. Our objective was to show the non-inferiority of an alternative negative pressure system, and in a small subset, a novel foam dressing system...
September 2015: Journal of Wound Care
https://www.readbyqxmd.com/read/26331392/early-versus-delayed-dressing-removal-after-primary-closure-of-clean-and-clean-contaminated-surgical-wounds
#19
REVIEW
Clare D Toon, Charnelle Lusuku, Rajarajan Ramamoorthy, Brian R Davidson, Kurinchi Selvan Gurusamy
BACKGROUND: Most surgical procedures involve a cut in the skin that allows the surgeon to gain access to the deeper tissues or organs. Most surgical wounds are closed fully at the end of the procedure (primary closure). The surgeon covers the closed surgical wound with either a dressing or adhesive tape. The dressing can act as a physical barrier to protect the wound until the continuity of the skin is restored (within about 48 hours) and to absorb exudate from the wound, keeping it dry and clean, and preventing bacterial contamination from the external environment...
2015: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/26291899/a-skin-stretching-wound-closure-system-to-prevent-and-manage-dehiscence-of-high-tension-flap-donor-sites-a-report-of-2-cases
#20
Xue Dan, Jiang Hongfei, Zhang Huahui, Han Chunmao, Hu Hang
Tension on the suture line of flap donor sites raises the risk of delayed healing and wound dehiscence. Closing a large flap donor site without a skin/flap graft is a major surgical challenge. Recently, the authors started using a skin-stretching wound closure system designed to harness both mechanical creep and stress-relaxation principles for the management of a variety of surgically closed wounds, including flap donor sites. The system consists of a pair of attachment plates connected by a long, flexible approximation strap that can be invasively (sutured) or noninvasively (by adhesion) secured to the skin wound edges and gradually tightened...
August 2015: Ostomy/wound Management
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