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Delayed primary skin closure

Gloria R Sue, Chao Long, Gordon K Lee
BACKGROUND: Mastectomy skin necrosis is a significant problem after breast reconstruction. This complication may lead to poor wound healing and need for implant removal, which may delay subsequent oncologic treatment. We sought to characterize factors associated with mastectomy skin necrosis and propose a management algorithm. METHODS: A retrospective review was performed on consecutive patients undergoing implant-based breast reconstruction by the senior author from 2006 through 2015...
March 16, 2017: Annals of Plastic Surgery
Shao-Yu Hung, Charles Yuen Yung Loh, Soo-Ha Kwon, Chia-Hsuan Tsai, Kai-Ping Chang, Huang-Kai Kao
INTRODUCTION: Oncological resection of the tongue can be reconstructed using a multitude of free flaps. The medial sural artery perforator (MSAP) flap has been well described in the literature in terms of its anatomy and harvest. However, functional outcome studies of post-reconstruction tongue defects using the MSAP flap have not been reported. This study represents the largest outcome study of patients with tongue reconstructions using MSAP flaps and a comprehensive review of its use...
2017: PloS One
Ricardo Monreal
PURPOSE: Loss of a fourth digit below the level of the proximal phalanx results in a weakened grip, loss of skilled movements, and the amputation stump is repeatedly traumatized. Transposition of an adjacent fifth digital ray can improve hand function and cosmetic appearance by closing the gap created by the missing digit. Digital ray amputation is not a commonly performed procedure. However, when performed correctly it can dramatically improve hand function and cosmesis. The aim of this study was to evaluate the functional and aesthetic results of the fifth ray radial translation and intercarpal arthrodesis in mutilating ring finger injuries...
February 3, 2017: International Orthopaedics
Judith Domínguez-Cherit, Georgina Rodríguez-Gutiérrez, Verónica Narváez Rosales, Sonia Toussaint Caire, Verónica Fonte Avalos
BACKGROUND: Non-melanoma skin cancer includes basal cell carcinoma and squamous cell carcinoma (SCC). Basal cell carcinoma is the most common and least aggressive but in a low percentage of cases, despite appropriate wide surgical margins, it can be aggressive, producing local invasion, recurrences and distance metastasis. SCC has a more aggressive behaviour invading first the skin, the lymph nodes and less frequently produces distance metastasis OBJECTIVE: To identify the characteristics of recurrent SCC and frequency of new SCC after conventional surgical and primary closure or closure delayed until a histological reporting of tumour-free surgical margins, in order to achieve a better surgical option, in our Mexican population...
January 10, 2017: Cirugia y Cirujanos
Nicholas B Abt, Priya Srikanth, Sidharth V Puram, Daniel G Deschler
INTRODUCTION: PCF is the most common major complication after salvage total laryngectomy (TL), especially for previously irradiated patients with laryngeal or hypopharyngeal cancer. METHODS/RESULTS: A 65-year-old woman presented with recurrent bilateral supraglottic SCC requiring salvage TL 5.5years after initial T1N0M0 epiglottic SCC resection. Her post-operative course was complicated by PCF development one month post-operatively and surgical fistula closure was delayed for adjuvant chemoradiotherapy...
November 25, 2016: American Journal of Otolaryngology
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
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...
January 2017: Gynecologic Oncology
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
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
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
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
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
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
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
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
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
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
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
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
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
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