Comparison of surgical site infection (SSI) between negative pressure wound therapy (NPWT) assisted delayed primary closure and conventional delayed primary closure in grossly contaminated emergency abdominal surgeries: a randomized controlled trial.

PURPOSE: NPWT has been tried in many surgical fields, including colorectal, thoracic, vascular, and non-healing wounds, for the prevention of SSI. However, its efficacy in the prevention of SSI-grade IV closed abdominal wounds is yet to be explored. METHODS: All patients with grade IV abdominal wounds were included in the study. They were randomized into the conventional arm and the VAC arm after confirming the diagnosis intra-operatively. The sheath was closed, and the skin was laid open in the postoperative period. In the VAC arm, the NPWT dressing was applied on postoperative day (POD)-1 and removed on POD-5. In the conventional arm, only regular dressing was done postoperatively. The skin was closed with a delayed primary intention on POD-5 in both arms. The sutures were removed after 7 to 10 days of skin closure. RESULTS: The rate of SSI (10% in the VAC arm vs. 37.5% in the conventional arm, p-value = 0.004) was significantly lower in the VAC arm, as were the rates of seroma formation (2.4% in the VAC arm vs. 20% in the conventional arm, p = 0.014) and wound dehiscence (7.3% vs. 30%, p = 0.011). The conventional arm had a significant delay in skin closure beyond POD5 due to an increased rate of SSI, which also led to a prolonged hospital stay (5 days in the VAC arm vs. 6.5 days in the conventional arm, p-value = 0.005). CONCLUSION: The VAC dressing can be used routinely in grade IV closed abdominal wounds to reduce the risk of SSI and wound dehiscence.

Comparison of laparoscopic port site skin closure techniques (CLOSA): transcutaneous suturing versus subcuticular sutures versus adhesive strips: a prospective single-blinded randomized control trial.

BACKGROUND: Cosmesis is an essential aspect of laparoscopic surgery. Various methods of skin closure techniques have been described. We conducted a study to evaluate the cosmesis and patient satisfaction with the scars three months after laparoscopic surgery using transcutaneous suture (TS) vs. adhesive strips (AS) and subcuticular suturing (SS). METHODS: A randomized, controlled, prospective study was conducted at AIIMS, Bhubaneswar. The included patients were randomly assigned among the three arms. The time for skin closure was measured. Wounds were assessed till discharge, at 14 days, one month, and three months. Cosmesis was measured by the Hollander Wound evaluation scale (HWES) for each incision separately, and patient satisfaction by a 10- point Visual analog scale (VAS). RESULTS: One hundred six patients were assessed for eligibility, and 90 patients were randomized. Three-month follow-up data was obtained from 83 patients (92.22%). Baseline characteristics were similar among the groups. Cosmetic outcome was assessed in 312 incisions across 83 patients, and 206 (66.03%) incisions had an HWE Score of 0, but there was no significant difference (p = 0.86). Patient satisfaction was highest in the TS group (TS = 1.29, SS = 1.79, AS = 2.04, p = 0.03). Time for skin closure was the least in the AS arm (41.4 secs, p = 0.00). Skin dehiscence was significantly more in the AS arm. Four (4.44%) patients had port site infections. CONCLUSION: This study demonstrates that skin closure by transcutaneous, subcuticular, or adhesive strip methods had comparable cosmetic outcomes at three months. However, the transcutaneous closure method showed better patient satisfaction and minimal post-operative complications.

Necrotizing fasciitis and gas gangrene due to Aeromonas hydrophila in an immunocompetent host: A rare entity.

Aeromonas hydrophila, widely distributed in various aquatic environments, is recognized as emerging opportunistic pathogens mainly causing gastrointestinal and wound infections. Necrotizing fasciitis and gas gangrene attributable to A. hydrophila are believed to develop mainly in immunocompromised hosts and have required amputation as a life-saving measure in many of these individuals. The present case re-emphasizes the virulent nature of this organism requiring amputation even in an immunocompetent host and hence, the critical need for early recognition and appropriate targeted therapy, especially after minor traumatic injuries which usually tend to get neglected.

Pattern of injuries due to wild animal attack among patients presenting to the emergency department: A retrospective observational study.

PURPOSE: The human-wildlife conflicts (HWCs) causing nuisances and injuries are becoming a growing public health concern over recent years worldwide. We aimed to study the demographic profile, mode of injury, pattern of injury, and outcome of wild animal attack victims presented to the emergency department. METHODS: This retrospective cross-sectional study was conducted in the emergency department of a tertiary-care hospital in Eastern India. Data were retrieved from the medical records from May 2017 to May 2021. Patients of all ages and genders attacked by wild animals and secondary injuries were included in this study. Patients with incomplete data, injuries due to the attack of stray and domestic animals and trauma due to other causes were excluded. Demographic profile, mode of injury, the pattern of injury, injury severity score (ISS), radiological pattern, and outcome were recorded. Statistical analysis with R (version 3.6.1.) was conducted. RESULTS: A total of 411 wild animal attack victims were studied, of which 374 (90.9%) were snakebite injuries and 37 (9.1%) were wild mammalian (WM) attack injuries. The mean age of WM attack victims was 46 years, and the male-to-female ratio was 4:1. Elephant attack injury (40.5%) was the most common WM attack injury reported. Most WM attacks (43.2%) occurred between 4:00 a.m. to 8:00 a.m. The median ISS was 18.5 (13-28), where 54.2% of patients had polytrauma (ISS>15). Elephant attack was associated with a higher ISS, but the difference was not significant compared to other animal types (p = 0.2). Blunt trauma was common pattern of injury in the elephant attack injury cases. Lacerations and soft tissue injuries were common patterns in other animal attacks. Among snakebites, neurotoxic was the most common type (55.4%), and lower extremity was the most common site involved. CONCLUSION: The young male population is the major victim of HWCs; and elephant is the most common animal involved. There is a need to design scientifically sound preventive strategies for HWCs and to strengthen the preparedness in health establishments to manage victims effectively.

Injuries in survivors of elephant attack: Report of three cases.

Human-elephant conflict (HEC) in India is becoming a growing health problem causing many fatalities every year. Elephants produce injuries by trampling, stomping, squeezing, tossing in the air, or crushing/targeting the head and chest commonly. The adult elephants are most aggressive in their mating season, leading to maximum incidences of HECs in this period. These attacks are mostly unprovoked, though most HECs are provoked. In this case series, the authors described the injuries sustained by three survivors in a short span of one month due to the sudden and unprovoked elephant attack. All the injuries were mild to moderate in severity and involved the chest in common. Timely rescue and prompt initiation of treatment were pivotal in their survival. The authors also want to create awareness about the mating season of elephants to minimize these unfortunate events in the future.

Laparoscopic-assisted Tranversus Abdominis Plane (TAP) Block Versus Ultrasonography-guided Transversus Abdominis Plane Block in Postlaparoscopic Cholecystectomy Pain Relief: Randomized Controlled Trial.

OBJECTIVES: Transversus abdominis plane (TAP) block for postoperative analgesia in laparoscopic cholecystectomy is usually given under ultrasound guidance. Laparoscopic-assisted TAP block has been suggested as an alternative to ultrasonogram (USG)-guided block as it is less time consuming and does not need extra equipments. This study was done to compare the efficacy of both the techniques. PATIENTS AND METHODS: We conducted a randomized controlled trial between October 2012 and June 2014 involving adult patients with symptomatic gall stone disease. Patients were randomly assigned to laparoscopic or ultrasound-guided TAP block. Both groups were compared for amount of opioid consumption, postoperative pain scores, postoperative nausea and vomiting, bowel movements, peak expiratory flow rate, and time taken for administering the block. RESULTS: We included 60 adult patients in our study. The groups were comparable with respect to demographic characteristics, symptomatology, comorbidities, and intraoperative complications. Amount of opioid consumption and postoperative pain relief were comparable between the 2 groups. The time taken for laparoscopy-assisted block was shorter when compared with the time taken for USG-guided block (P≤0.05). Postoperative nausea and vomiting, bowel movements, and peak expiratory flow rate were comparable between the 2 groups. CONCLUSIONS: Laparoscopy-assisted TAP block is faster and equally efficacious when compared with USG-guided block and has a definite role in centers where ultrasound is not available in operating rooms.

Melioidosis presenting as pseudomyxoma peritonei: yet another pretense of the great mimicker: an unreported entity.

BACKGROUND: Melioidosis, a lethal infectious disease caused by Burkholderia pseudomallei, an important human pathogen in tropical regions, is notorious for its diverse clinical presentations. METHODS: We report a case of a 55-year-old woman with a history of total abdominal hysterectomy with bilateral salpingo-oophorectomy for ovarian mucinous cystadenocarcinoma five years back, who presented with complaints of chest pain, abdominal distention, and breathlessness for one week. Ultrasound-guided aspiration of the peritoneal free fluid revealed a thick gelatinous material consistent with pseudomyxoma peritonei. Cytologic analysis of the aspirate was negative for malignant cells, but bacterial culture proved positive for Burkholderia pseudomallei. RESULTS: She was started on ceftazidime, and she improved symptomatically and was discharged on oral doxycycline and chloramphenicol after three weeks of intravenous antibiotic therapy. CONCLUSION: This case is being reported to emphasize an unusual presentation of melioidosis and the significance of timely appropriate antibiotic therapy.