Therapeutic options and postoperative wound complications after extremity soft tissue sarcoma resection and postoperative external beam radiotherapy.

Soft tissue sarcomas occur most commonly in the lower and upper extremities. The standard treatment is limb salvage surgery combined with radiotherapy. Postoperative radiotherapy is associated with wound complications. This systematic review aims to summarise the available evidence and review the literature of the last 10 years regarding postoperative wound complications in patients who had limb salvage surgical excision followed by direct closure vs flap coverage together with postoperative radiotherapy and to define the optimal timeframe for adjuvant radiotherapy after soft tissue sarcomas resection and flap reconstruction. A literature search was performed using PubMed. The following keywords were searched: limb salvage, limb-sparing, flaps, radiation therapy, radiation, irradiation, adjuvant radiotherapy, postoperative radiotherapy, radiation effects, wound healing, surgical wound infection, surgical wound dehiscence, wound healing, soft tissue sarcoma and neoplasms. In total, 1045 papers were retrieved. Thirty-seven articles were finally selected after screening of abstracts and applying dates and language filters and inclusion and exclusion criteria. Plastic surgery provides a vast number of reconstructive flap procedures that are directly linked to decreasing wound complications, especially with the expectant postoperative radiotherapy. This adjuvant radiotherapy is better administered in the first 3-6 weeks after reconstruction to allow timely wound healing and avoid local recurrence.

Novel treatment immediately after myelomeningocele repair applying low-level laser therapy in newborns: a pilot study.

BACKGROUND/AIMS: The use of low-level laser therapy (LLLT) in neurosurgery is still hardly disseminated and there are situations in which the effects of this therapeutic tool would be extremely relevant in this medical field. The aim of the present study is to analyze the effect of LLLT on tissue repair after the corrective surgical incision in neonates with myelomeningocele, in an attempt to diminish the incidence of postoperative dehiscences following surgical repair performed immediately after birth. MATERIALS AND METHODS: Prospective pilot study with 13 patients submitted to surgery at birth who received adjuvant treatment with LLLT (group A). A diode laser CW, λ = 685 nm, p = 21 mW, was applied punctually along the surgical incision, with 0.19 J delivered per point, accounting for a total of 4-10 J delivered energy per patient, according to the surgical wound area and then compared with the results obtained in 23 patients who underwent surgery without laser therapy (group B). RESULTS: This pilot study disclosed a significant decline in dehiscences of the surgical wounds in neonates who were submitted to LLLT (7.69 vs. 17.39%). CONCLUSION: This new adjuvant therapeutic modality with LLLT aided the healing of surgical wounds, preventing morbidities, as well as shortening the period of hospital stay, which implies a reduction of costs for patients and for the institution.

[Comparative histological and light-microscopic cytomorphometric studies of the tissue repair processes in postoperative wound complications treated locally with helium-neon laser radiation or a proteolytic enzyme]. / Sravnitelni khistologichni i svetlinnomikroskopski tsitomorfometrichni prouchvaniia na tukannite reparativni protsesi pri sledoperativni ranevi uslozhneniia, tretirani lokalno s khelii-neonovo lazerno luchenie ili proteolitichen enzim.

Morphological studies were carried out on tissue material, removed from wound peripheral parts during application of secondary sutures on 69 complete perineal wound dehiscences of parturients prepared by helium-neon laser irradiation according to a method described by us, as of wound peripheral parts of 15 perineal wound dehiscences, prepared by alphahymotripsin dissolved in a solution with vitamin C. Histological preparations were stained by hematoxilin-eosin by van Gieson (for collagenous fibres), by Weigert (for elastic fibres) and by Gomori (for reticular fibres). Light microscopic cytomorphometric studies were made by a graduated ocular micrometer on stained with hematoxilin-eosin tissue sections with the help of standard optical system. The results of the performed histological examinations give foundation to accept the occurred more active stimulation of inflammatory and proliferative phase of wound reparative process after laser therapy with helium-neon laser irradiation. Light microscopic cytomorphometric studies indicate the presence of more advanced in its development granulation tissue after laser therapy by means of activation of local immunocompetent cells.

[The laser therapy of wound complications with partial dehiscence following gynecologic operations. Clinical studies]. / Lazer-terapiia na ranevi uslozhneniia s chastichni dekhistsentsii sled ginekologichni operatsii. Klinichni prouchvaniia.

Clinical studies were carried out on 160 women, aged from 26 to 58 years, with partial wounded dehiscence after gynecological operations. The influence of helium neon laser energy with densities of power of 100, 90, 80, 70, 50 m W/cm2 at exposition time of the field of 1.5 min was studied in respect to anesthetic and antiinflammatory effects, initial clearing of devitalized tissues with the appearance of young granulation tissue on the wounded defects till the final healing of the complicated operative wounds. Resorption of inflammatory tissue changes and analgetic effect occurred for the shortest periods of treatment in patients with wounded dehiscences, irradiated with densities of power of laser irradiation of 90 mW/cm2. Initial clearing of devitalized tissues with appearance of young granulation tissue was achieved by the smallest number of irradiations with density of power of laser irradiation within the ranges of 90-70 mW/cm2. The highest alternatively relative part of healed partial wounded dehiscences for a period of 5-10 days of treatment was achieved by the applied density of power of laser irradiation within the ranges of 100-70 mW/cm2. The density of power of the laser irradiation of 50 mW/cm2 was slightly effective in respect to its stimulating possibilities both at the inflammatory phase and at the phases of proliferation and reorganization of the wounded process.

Low level laser therapy in acute dehiscence saphenectomy: therapeutic proposal.

Dehiscence is a feared complication after major surgeries. Patient who had undergone coronary artery bypass grafting developed saphenectomy's dehiscence on lower limb with edema and pain on the 15th postoperative day. Conventional treatment had been initially performed without clinical improvement. On the 30th postoperative day only Low Level Laser Therapy (LLLT) was applied punctually around surgical wounds edge. The results revealed granulated tissue, reduction of inflammatory process and analgesic effect since the first application. In this pilot study, LLLT has shown a considerable role as a wound healing agent, through a new proposal for efficient, safe and noninvasive therapy.

[The laser therapy of the regenerative tissue processes in long-term nonhealing postoperative wound dehiscence]. / Lazerterapiia na regenerativnite tukanni protsesi pri produlzhitelno nezarastvashti sledoperativni ranevi dekhistsentsii.

Clinical studies were performed in 97 complicated operative wounds with partial dehiscences, involving the skin and the subcutaneous connective tissue, and deeper ones reaching the fascia, after gynecological abdominal operations. All complicated operative wounds before prescription of laser therapy were locally treated, without achieving their healing for 10 to 60 days with antibiotic proteolytic ferments, flagyl, Vishnevski's paste and antiseptic dressings. As a result of helium-neon laser therapy with power density 90 mW/cm2 and 70 mW/cm2 healing of these complicated operative wounds occurred in 5 to 18 days (after 5 to 18 irradiations). The studies showed that laser therapy dose (power density) of 90 mW/cm2 stimulated more effectively the tissue reparatory processes at exposure time of 1.5 min per field.

Laser de baixa intensidade em deiscência aguda de safenectomia: proposta terapêutica / Low level laser therapy in acute dehiscence saphenectomy: therapeutic proposal

Deiscência é uma complicação temida em cirurgias de grande porte. Paciente submetida a revascularização miocárdica evoluiu com deiscência de safenectomia em membro inferior, edema e dor no 15º dia pós-operatório (PO), tendo sido realizado inicialmente o tratamento convencional no ambulatório sem melhora clínica. No 30º PO, aplicou-se somente Laser de Baixa Intensidade (LBI) ao redor da borda da ferida, pontualmente. A lesão respondeu com tecido de granulação, diminuição do processo inflamatório e analgesia desde a primeira aplicação. Neste estudo piloto, a laserterapia mostrou ter um papel importante como agente facilitador de cicatrização, por meio de uma terapia nãoinvasiva, eficaz e segura.

Dehiscence is a feared complication after major surgeries. Patient who had undergone coronary artery bypass grafting developed saphenectomy's dehiscence on lower limb with edema and pain on the 15th postoperative day. Conventional treatment had been initially performed without clinical improvement. On the 30th postoperative day only Low Level Laser Therapy (LLLT) was applied punctually around surgical wounds edge. The results revealed granulated tissue, reduction of inflammatory process and analgesic effect since the first application. In this pilot study, LLLT has shown a considerable role as a wound healing agent, through a new proposal for efficient, safe and noninvasive therapy.