The Impact of Blue Light Irradiation on Keratinocytes in Vitro.

BACKGROUND: This study examined the effects of irradiation with blue light on HaCaT keratinocytes. As irradiation with blue light is known to be antimicrobial, it offers a promising alternative therapy for contaminated wounds. There is evidence that red light promotes wound healing, but the potential benefits of irradiation with blue light have not yet been adequately investigated. METHODS: The rate of wound closure in sterile and contaminated cells was measured using an in vitro scratch assay wound-healing model. Additionally, cell viability after treatment was determined using a Sulforhodamine B (SRB) assay. RESULTS: In both the sterile and contaminated groups, treated cells showed delayed wound closure when compared with cells not irradiated with blue light. Additionally, treatment with blue light resulted in poorer viability in the treatment groups. CONCLUSION: Although irradiation with blue light may offer a promising alternative therapy for reducing bacterial colonization, our data indicate that re-epithelization may be negatively influenced by blue light. Further research is needed to clarify possible wound healing applications.

Functional outcome after digit replantation versus amputation.

BACKGROUND: The success of digit replantation is mainly based on survival rates. The functional outcome as well as the recovery of sensibility are essential parameters for judging the outcome after digit replantation but have been poorly assessed in previous studies. PATIENTS AND METHODS: Forty-eight patients with 56 complete traumatic digit amputations occurring between 2008 and 2013 returned for a follow-up examination, the earliest being 6 months postoperatively. Each patient's range of motion, fingertip-to-table distance, fingertip-to-palm distance, grip and pinch strengths, static two-point discrimination (2-PD), and Semmes-Weinstein monofilament (SWM) test level were assessed in order to compare functional outcome and recovery of sensibility between successful replantation (n = 19) and primary or secondary amputation (n = 37). Subjective assessments of the pain level and function of the upper extremity were performed using the numerical rating scale and the DASH score, respectively. RESULTS: Replanted digits achieved 58% of the median total range of motion of the corresponding uninjured digits. Grip and pinch strength were not significantly different after thumb or finger replantation or amputation. Recovery of sensibility was excellent after replantation, with a median static 2-PD of 5 mm and a reduction of pressure sensibility of two levels of the SWM test compared to the contralateral side. After amputation, the median static 2-PD was also very good, with a median value of 6 mm and a reduction of pressure sensibility of only one level according to the SWM test. There was significantly less pain after replantation at rest (p = 0.012) and under strain (p = 0.012) compared to patients after amputation. No significant differences were observed in the DASH score between the two groups. CONCLUSION: Comparable functional results and sensory recovery but significantly less pain at rest and under strain can be expected after digit replantation when compared to digit amputation. LEVEL OF EVIDENCE: IV.

Lunate morphology: association with the severity of scapholunate ligament injuries and carpal instability patterns.

Type II lunate has been associated with a lower incidence of dorsal intercalated segment instability (DISI) in the case of scapholunate dissociation. We aimed to evaluate the frequency of different lunate types and their influence on the prevalence and severity of scapholunate ligament (SLIL) injuries and the development of DISI. The surgical records of 414 arthroscopies were reviewed retrospectively. Lunate types were diagnosed based on radiograms and MRI examinations. The Type II lunate had a facet between hamate and lunate; in the Type I lunate, this facet is lacking. We additionally included the assessment of the capitate-triquetrum distance (CTD), which defines Type I, Intermediate, and Type II lunates. We adopted the DISI when the scapholunate angle was more than 80° and/or the radiolunate angle less than -15°. Fisher's exact test was applied to compare the distribution frequency of SLIL lesions and DISI deformity of patients with different lunate types. To quantify the inter- and the intra-rater reliability of lunate type assessment Cohen's kappa was calculated and, for CTD measurements, a Bland-Altman plot was created. Up to 77.1% patients had Type II lunates. Regarding MRI and CTD classification in patients with Type I lunates, Grade 4 SLIL injuries were more common than in those with Intermediate and Type II (p < 0.05). In the case of Grade 4 SLIL lesions, DISI was more common in patients with Type I lunates (p < 0.05). There were, however, only 25 patients with Type I lunates, and Grade 4 SLIL lesions according to MRI, and 6 according to CTD measurement.

[Percutaneous, antegrade Pinning of proximal phalangeal Fractures: Comparison of Early Active Motion vs. Immobilization by Splinting]. / Perkutane, antegrade K-Draht-Osteosynthese bei Fingergrundgliedfrakturen: Vergleich zwischen frühfunktioneller und statischer Nachbehandlung.

PURPOSE: This retrospective study compares the functional outcome after early active postoperative motion with the outcome after 6 weeks of immobilization by splinting in patients with proximal phalangeal fractures treated by percutaneous, antegrade pinning. PATIENTS AND METHODS: 46 out of 90 patients treated by closed reduction and percutaneous antegrade pinning of isolated fractures of the proximal phalanges were re-evaluated on average after 18.5 months. There were 17 women and 29 men with a mean age of 42.8 years. 28 patients underwent early active postoperative motion and 18 patients were immobilized by splinting for 6 weeks postoperatively. The two groups were statistically comparable with respect to age, gender, fracture localisation and morphology, mechanism of injury and operative time. Follow-up examination included measurement of active and passive range of motion (TAM; TPM) of the injured finger and the uninjured finger of the opposite side as well as grip strength of both hands. In addition, postoperative complications, the DASH-score and time interval between surgery and return to work were registered. RESULTS: There were no significant differences between the two groups regarding rate of complication, number or required revisions, finger motion and grip strenght. Patients with early active motion returned earlier back to work than patients treated by postoperative splinting (2.5 vs. 9.0 weeks; p = 0.035). With 1.7 the DASH-score in the group with early active motion was better than in the splinting group with 2.5 (p = .269). CONCLUSION: Patients with early active postoperative motion returned earlier back to work. There was no significant difference between both groups respecting global finger function.Compliant patients with a fracture of the proximal phalanx treated by closed reduction and percutaneous pinning can be treated with early active motion postoperatively.

Bilateral Simultaneous Breast Reconstruction with DIEP- and TMG Flaps: Head to Head Comparison, Risk and Complication Analysis.

BACKGROUND: A two center retrospective cohort study of simultaneous bilateral breast reconstructions using double deep inferior epigastric perforator (DIEP) flaps and double transverse myocutaneous/upper gracilis (TMG) flaps was conducted. The aim of this study was to compare surgical procedures, complications, and overall outcome. PATIENTS AND METHODS: Two study groups, either receiving a simultaneous bilateral breast reconstruction, with double DIEP flaps (n = 152) in group 1, or double TMG flaps (n = 86) in group 2, were compared. A detailed risk and complication analysis was performed. Patient characteristics, operative time and the need for further operations were evaluated. RESULTS: Double DIEP patients had donor site complications in 23.7% and double TMG patients in 16.3% (p = 0.9075, RR 1.45). Flap loss rates of 3.5% (double TMG) and 2.6% (double DIEP) were recorded (p = 0.7071, RR 1.33). The need for postoperative lipofilling was significantly higher in double TMG patients (65.1% vs. 38.2 %, p = 0.0047, RR 1.71). CONCLUSION: Complication analysis favors the double DIEP procedure. Donor site morbidity was lower and less severe in the double TMG group. Later fat grafting was more frequently needed after double TMG reconstructions. Further studies, preferably of prospective nature, are needed to evaluate the benefit of bilateral simultaneous breast reconstructions.

Fivefold Fracture in a Perilunate Fracture Dislocation Involving Scaphoid, Capitate, Hamate, Triquetrum and Lunate: A Case Report.

This case report presents a very rare fracture combination in a perilunate dislocation including the scaphoid, capitate, hamate and triquetrum and the cornu anterior of the lunate, with an intact scapholunate ligament in a left wrist. An open reduction and internal fixation of the scaphoid, capitate, hamate and triquetrum was performed.

Value of the Two-Point Discrimination Test: Evaluation of 238 Isolated Finger Nerve Injuries.

Background: It may be difficult to diagnose a nerve injury on a finger or a hand under emergency settings. The goal of this study was to elaborate whether the clinical testing of two-point discrimination was a safe and reliable method in the diagnosis of acute finger nerve injuries. Methods: Through a retrospective assessment, patients' records were analyzed whether the result of the two-point discrimination test corresponded with the intraoperative findings of a damaged nerve. Patients with a prolonged or missing two-point discrimination, who had undergone surgery at our institution between the years 2008 and 2017, were included in the study. The control groups were identified in the same manner and as an additional group, patients with Dupuytren's contracture were included to serve as a healthy cohort regarding finger nerves. Results: A total of 249 patients with nerve lesion were enrolled in the study; apart from this, 25 patients with Dupuytren's contracture were included. The sensitivity of the two-point discrimination test was 99%, with a positive predictive value of 0.93 and with high inter-observer reliability. Conclusions: The two-point discrimination is a valid test to use in the routine examination of suspected nerve injuries on the hands and fingers; it is very reliable and safe for indicating surgical interventions.

[SL fusion - no alternative for the treatment of chronic scapholunate dissociation]. / SL-Fusion ­ keine Alternative zur Behandlung der chronischen skapholunären Dissoziation.

INDRODUCTION: The treatment of chronic scapholunate dissociation (SLD) is currently uneven and still presents a major challenge. Both, the primary ligament suture and frequently applied ligament reconstruction techniques cannot provide a permanent stable connection between the scaphoid and lunate. For this reason, the present study evaluates the value of a bony compound as a treatment option for the treatment of chronic SLD. PURPOSE: To evaluate the radiological and clinical outcome of scapholunate fusion for chronic SLD. PATIENTS AND METHODS: Ten patients with a scapholunate fusion with corticocancellous iliac bone graft interposition and Herbert screw fixation for symptomatic chronic SLD were retrospectively evaluated in terms of clinical and radiological findings after a mean of 7.6 years. The examination included range of motion, grip strength, pain, DASH, Krimmer and Modified Mayo Wrist Score (MMWS), and a radiological examination. RESULTS: Primary bone healing was achieved in 4 out of 10 patients. In 2 patients, bone healing of the scapholunate fusion was achieved after revision surgery, in one patient by including the capitate bone in the fusion. Two patients developed fibrous nonunion. In 2 patients, the SLD persisted, requiring a four-corner fusion and wrist denervation, respectively. In all patients, degenerative changes were seen in the radiocarpal joint at follow-up. In spite of the radiological results, the clinical results ranged from fair to good. Seven patients were pain-free at rest. The average MMWS Score was 72 (40-95), the Krimmer Score 78 (55-100), and the DASH Score 17 (0-60). CONCLUSION: Although the clinical results were fair to good, scapholunate fusion cannot be recommended for the treatment of chronic SLD due to a primary failure rate of 60 % regarding bone healing and a 40 % rate of revision surgery.

Outcome of Body-Contouring Procedures After Massive Weight Loss.

BACKGROUND: With the increased popularity of bariatric surgery, the demand for body-contouring procedures is growing. Associated with these procedures are a number of complications due to different risk factors and patients' characteristics. The aim of this study was to assess the outcome of body-contouring procedures and correlate it to possible risk factors. METHODS: The study included a collective of 112 patients who underwent 157 body-contouring procedures. Patients' characteristics, risk factors, and complications have been recorded. Three groups were formed based on the type of surgical procedure to perform correlations of BMI, weight of resected tissue, and length of hospital stay using Spearman's rank test. Correlations between patients' risk factors and complication occurrence were analyzed with Fisher's exact test. RESULTS: The most common procedure patients underwent was the classic abdominoplasty (n = 53). A significant correlation was found between preoperative BMI and weight of resected tissue in abdominoplasties (rho = 0.69), Fleur-de-Lis abdominoplasties (rho = 0.64), and body lifts (rho = 0.60). There was a significant correlation between weight of resected tissue and length of hospital stay (rho = 0.53) and preoperative BMI and length of hospital stay (rho = 0.4) as well. There was no significant correlation between patients' comorbidities or smoking status and the postoperative complication rate. The mean weight of resected tissue was higher in patients with than without complications requiring surgical revision. CONCLUSIONS: The relevance of risk factors commonly believed to have an influence on postoperative complications should be revised. The weight of resected tissue has an influence on complication.

The Impact of Age on Perioperative Complications after Extremity Reconstruction with the Free Gracilis Flap: A Retrospective Cohort Study Involving 153 Patients.

BACKGROUND: The need for plastic and reconstructive surgery on elderly patients has been on the rise due to an increase in life expectancy in the past decades. Therefore, a study was conducted on young and elderly patients following microsurgical extremity reconstructions with free gracilis muscle flaps with the primary aim to investigate the influence of age and the American Society of Anesthesiologists (ASA) score on the general outcome, as well as surgical and medical complications. METHODS: A retrospective analysis of 153 patients receiving free gracilis muscle flaps for extremity reconstructions between November 2009 and January 2018 was performed at two partner institutions specialized in microsurgical reconstructions. A logistic regression analysis was performed to correlate age and the ASA score with postoperative complication probability. Patients younger than 70 years were directly compared with elderly patients with respect to age, gender, ASA score, preexisting comorbidities, localization, and postoperative medical and surgical complications. RESULTS: Age turned out to be not significantly associated with major flap complications (p = 0.925) but with higher ASA scores (p = 0.016). However, an age-related significant increase in minor flap complications could be observed in the elderly (p = 0.008). A significant correlation between minor medical complications and age could be observed (p = 0.001) in contrast to ASA score (p = 0.912). CONCLUSION: An increased minor flap, as well as minor and major medical complications, must be expected in extremity reconstructions with free gracilis flaps in elderly patients. Higher ASA scores correlate with a higher incidence of major flap complications. Septuagenarians are more prone to develop perioperative major medical complications than patients younger than 70 years. Age and general medical condition, coupled with the performance of each patient, should be thoroughly assessed individually to facilitate a tailored reconstructive approach using risk assessment tools and established scoring systems.

Comparison of spontaneous sensory recovery of noninnervated anteromedial thigh flap, latissimus dorsi flap, and gracilis muscle flap in lower extremity reconstruction: A prospective comparative study.

BACKGROUND: We evaluated the time course and differences in the sensory recovery of three commonly used free flaps for lower extremity reconstruction. Furthermore, the sensory recovery of skin-grafted muscle and skin paddle in latissimus dorsi flaps (LDMF) were differentiated. METHODS: In a prospective study, 26 patients who had undergone free flap lower extremity reconstruction were enrolled. Among them, 9 received LDMF, 9 received gracilis muscle flaps (GMF), and 8 received anterior lateral thigh flaps (ALTF). The sensory recovery was investigated by using the Semmes-Weinstein test (SWT) at 6 and 12 months after the surgery. RESULTS: All flaps recorded spontaneous sensory recovery. The GMF showed the smallest anesthetic area after 12 months as compared with the ALTF and LDMF (1 ± 3% vs. 18 ± 39% (p < .05) vs. 35 ± 35% (p < .05), respectively). Qualitatively, ALTF exhibited the best sensory recovery with the lowest SWT values (ALTF 4.57 ± 1.12 vs. GMF 5.01 ± 0.81 8 [p < .05], vs. LDMF 5.84 ± 0.52 [p < .05]). The sensory recovery of skin-grafted muscle was superior to that of the skin paddle in the LDMF (anesthetic area 29 ± 36% vs. 54 ± 33% [p < .05], SWT 5.85 ± 0.60 vs. 6.30 ± 0.18 [p < .05], respectively). CONCLUSION: All flaps displayed spontaneous sensory recovery potential over the investigation period, which appeared to be influenced by the flap type and size. The LDMF skin paddle showed lower potential for sensory recovery as compared with the skin-grafted muscle area of the same flap. The GMF demonstrated a near-complete sensory recovery after 12 months.

Changes in the Biomechanical Properties of Human Skin in Hyperthermic and Hypothermic Ranges.

INTRODUCTION: The prevalence of thermal skin injuries is high. Despite new research findings, skin burns and acute cold-contact injuries, together with resulting tissue damage, are not entirely understood. In particular, little is known about how these types of injuries alter the biomechanical properties of skin. OBJECTIVE: This study evaluates hyperthermic- and hypothermic-induced alterations in the biomechanical properties of human skin using a skin elasticity measurement device. MATERIALS AND METHODS: In 54 cases, local hypothermia (15°C and 5°C) and local hyperthermia (40°C and 45°C) were induced at the palmar forearm of healthy participants. The biomechanical properties of skin were measured using the skin elasticity measurement device before and after each temperature change at 2 different depths. RESULTS: The skin firmness, pliability, retraction, and elasticity/calculated elasticity showed a continuous decrease in values with decreasing skin temperatures in total skin measurements and an increase in values with increasing skin temperatures in the upper layer and total skin measurements. CONCLUSIONS: As per the results, the investigators believe these hyperthermic- and hypothermic-induced alterations in biomechanical skin properties are due to increased blood flow, in addition to a reversible increase in interstitial and intracellular fluid contents, thermal contraction, and expansion of collagen and elastic fibers, all of which are precursors to irreversible damage.

[Tissue engineering of adipose tissue with biodegradable biomaterials for soft tissue reconstruction]. / Tissue Engineering von Fettgewebe mittels bioabbaubaren Biomaterialien zur Weichteildefektdeckung.

Soft tissue defects resulting from injuries, tumor resection, congenital anomalies or chronic wounds pose a great challenge to reconstructive surgery. The current gold standard in therapy of such defects is the tissue transplantation in terms of free or local flaps. Unfortunately, donor site morbidity remains a considerable risk of flap surgery. Therefore, tissue engineering of autologous vascularized long term stable adipose tissue constructs could enrich the therapeutic possibilities of soft tissue defects. De novo adipose tissue growing requires fundamental knowledge about this kind of tissue and its synthesis, closely linked to angiogenesis. Bioresorbable biomaterials (scaffolds) are of crucial importance for adipose tissue engineering. Simulation or replacement of extracellular matrix for tissue growth by scaffold application requires a profound understanding of cell-matrix interactions. A proper biomaterial should be capable of supporting cell adherence, proliferation and differentiation. Important features are biocompatibility and resorption without toxic metabolites. In this review, various scaffold materials are discussed and novel achievements are presented. Persisting problems of de novo adipose tissue formation are high resorption rates and small tissue volumes of adipose constructs. Adipose tissue formation in a tissue engineering chamber is an additional possibility for in vivo tissue engineering. Recent studies proof that long term stable de novo adipose tissue formation of clinically relevant tissue volumes is possible. This method, in our opinion, has the potential to improve therapeutic strategies of soft tissue defects significantly.

Analysis of Operative Techniques of Fractures of the First Metacarpal Base.

INTRODUCTION: Over time, the operative treatment of extra-articular and intra-articular fractures of the first metacarpal base has gained significant importance, and at present, there are many operative strategies available because of the different osteosynthesis procedures in practice today. PURPOSE: In this retrospective cohort study, we analyze the possible differences between 2 distinguished operative osteosynthesis techniques, in terms of patient outcome, operation time, duration of radiation exposure, and postoperative radiographic results. METHODS: Fifty-two patients operated on for first metacarpal extra-articular or intra-articular base fracture were investigated retrospectively by means of records. After reduction, osteosynthesis was performed on 34 patients with K-wires (group I), and on 18 patients with plates and/or screws (group II). Of the 52 patients, 19 were available for a prospective follow-up examination. RESULTS: After analyzing the operation time, a significant difference between the 2 operative techniques for epibasal and Bennett fractures (P = 0.0089 and P = 0.02) was recorded. Furthermore, for the time of radiation exposure, no significant difference could be detected. Also, no statistical difference was found between the 2 analyzed groups in terms of patient outcomes and postoperative radiographic results. CONCLUSIONS: The determined data of the operated extra-articular and intra-articular first metacarpal base fractures revealed approximately equal results for patient outcome, postoperative x-ray results, and time of radiation exposure during the operation. After analyzing the operation time of epibasal and Bennett fractures, we can recommend that the K-wire fixation is superior to the plate and/or screw osteosynthesis as a treatment, because of the associated benefits of keeping costs low without harming the patient in the long term.

[Preservation of the outer ear in a complex burn injury]. / Erhalt des äußeren Ohres bei einer komplexen Verbrennung.

Saving the outer ear in burn injuries is a challenging task for the treating surgeon that should not be underestimated. Burns which are initially evaluated as superficial, particularly in this region, often have a tendency to undergo progressive tissue destruction whereby conservative treatment is often no longer sufficient to preserve the skin of the auricle with the underlying cartilage. Various possibilities for saving the ear and for ear reconstruction are described, but in the case of severely burned patients it is often necessary to carry out a quick and relatively simple treatment. In the complicated case of a severely burned patient involving the external ear, a good cosmetic result could be finally obtained with preservation of form and function by means of an economical cartilage resection with subsequent adaptation.

A Quantitative Analysis of Microcirculation in Skin Defects Covered with Topical Wound Dressings or a Newly Developed Collagen Matrix.

OBJECTIVE: Innovative skin substitutes and temporary wound dressings are frequently used in the treatment of superficial and partial-thickness wounds. The aim of this study was to compare 2 commonly used temporary skin dressings with a newly developed collagen matrix to determine changes in microcirculation as measured by blood flow, hemoglobin oxygenation, and relative hemoglobin values during healing of partial-thickness skin defects. METHODS: This animal study involved 28 adult male Lewis rats. On the back of each rat, 2 standardized partial-thickness skin defects were generated through a skin dermatome (n = 56). Then, wounds were treated with polylactide-based copolymer skin substitute (Suprathel, PolyMedics, Denkendorf, Germany; n = 14), biosynthetic skin dressing (Biobrane, Smith & Nephew, Hamburg, Germany; n = 14), or Collagen Cell Carrier (CCC; Naturin Viscofan, Weinheim, Germany; n = 14). The remaining control wounds were left untreated (n = 14). MAIN OUTCOME MEASURES: Perfusion dynamics were assessed every 10 days for 80 days with the O2C device (LEA Medizintechnik, Gießen, Germany) to determine blood flow, hemoglobin oxygenation, and relative amount of hemoglobin. MAIN RESULTS: Blood flow was increased in all wounds for at least 30 days after wound generation. The relative amounts of hemoglobin were increased in superficial layers (2 mm) for 10 to 20 days. Hemoglobin oxygenation in the superficial layers decreased in the polylactide-based copolymer skin substitute and biosynthetic skin dressing-treated groups and initially increased in the untreated wounds and CCC groups on day 10; these values also decreased. CONCLUSIONS: The presented results demonstrate the complex changes in microcirculation in the course of healing partial-thickness wounds with different wound dressings and contribute to a better understanding of these wounds. However, based on the results of the study, a clear recommendation for a specific substitute is not yet possible.

Facial microcirculatory and biomechanical skin properties after single high energy (Er):YAG laser application.

OBJECTIVE: Owing to skin aging and the growing demand for skin rejuvenation, minimal invasive aesthetic treatments such as laser procedures are increasingly coming into focus. However, until now, little has been known about the objective effects of these procedures with respect to skin microcirculation or changes in skin elasticity. STUDY DESIGN: Facial skin rejuvenation was performed on 32 volunteers using ablative Erbium: YAG laser. Skin microcirculation and skin elasticity have then been evaluated objectively. METHODS: Microcirculation (flow, SO2 , velocity, and rHB) has been analyzed before and directly after the laser session by using the O2C device. Skin elasticity has been evaluated by using the Cutometer device (Uf, Ua, Ur, and Ue) before and directly after the laser treatment, as well as 1 week and then 1, 3, and 6 months post treatment. Further, the outcome for the volunteers regarding their satisfactory level after laser treatment was evaluated. RESULTS: Twenty volunteers were available for a complete follow-up. Microcirculation displayed statistically significant increase in all values to 2 mm depth. The biomechanical skin parameter of firmness of skin displayed statistically significant improvement in superficial skin layer after 6 months. CONCLUSION: Concerning microcirculation and skin elasticity the ablative Erbium: YAG laser treatment revealed similar effects on the skin like a superficial burn injury. In contrast to the determined skin elasticity parameters, firmness of skin objectively revealed a skin tightening effect after 6 months. Along with the important epidermal effect, the suitability of ablative laser treatment for skin rejuvenation has been proved in a long-term follow-up. Lasers Surg. Med. 49:891-898, 2017. © 2017 Wiley Periodicals, Inc.

Do prophylactic antibiotics in gynecologic surgery prevent postoperative inflammatory complications? A systematic review.

PURPOSE: The aim of this study was to systematically review the literature on antibiotic prophylaxis in gynaecologic surgeries to prevent inflammatory complications after gynaecological operations. The study was carried out as a systematic review. METHODS: Only randomised controlled trials of women undergoing gynaecological surgery were included. The Medline and the Cochrane library databases were searched from 1966 to 2016. The trials must have investigated an antibiotic intervention to prevent an inflammatory complication after gynaecological surgery. Trials were excluded if they were not randomised, uncontrolled or included obstetrical surgery. RESULTS: Prophylactic antibiotics prevent inflammatory complications after gynaecological surgery. Prophylactic antibiotics are more effective in surgery requiring access to the peritoneal cavity or the vagina. Cefotetan appears to be more capable in preventing the overall inflammatory complication rate than cefoxitin or cefazolin. No benefit has been shown for the combination of antibiotics as prophylaxis. No difference has been shown between the long-term and short-term use of antibiotics. There is no need for the primary use of an anaerobic antibacterial agent. CONCLUSION: Antibiotics help to prevent postoperative inflammatory complications after major gynecologic surgeries.

Refinement of Tissue-Engineering Chamber Implantation in the Rat.

PURPOSE: Rodent in vivo models that successfully generate new adipose, muscle, or vascular tissue in a tissue-engineering chamber (TEC) has advanced in the last decade. In this article, technical refinements in these operative foreign body implantations have been described to improve the execution of animal models in a way so that they can reduce wastage of time and resources. MATERIALS & METHODS: Male Sprague-Dawley rats were studied and randomly divided into two equal sized groups. In each group, a different operative procedure was used for implanting the TEC. Twenty animals were operated with diagonal incisions in the groin region, followed by staples for wound closure after TEC implantation. The remaining 20 animals received longitudinal incisions in the abdominal region followed by wound closure with ongoing intradermal nonresorbable sutures and skin glue. The outcome of both procedures with regard to complications, animal growth, and experimental failure was compared. Statistical analysis was performed using the nonparametric chi-squared (χ2) test. RESULTS: Significant difference in wound dehiscence was recorded in Group I as compared to Group II (p = 0.0001). Consequently, 55% of the experiments had to be aborted in Group I and the animals were removed from the experiment. On the contrary, in Group II, all the animals could be kept. CONCLUSION: Median longitudinal incisions and thorough wound closure with ongoing intradermal nonresorbable sutures, followed by application of skin glue, are strongly recommended to prevent surgical site complications, such as wound dehiscence, animal harm, and failure of the individual experiment.