Proceedings of the United Kingdom Periprosthetic Joint Infection Meeting 2022: Fracture-Related Infection Session.

Implant-related infections represent a relatively common and significant challenge in the surgical management of musculoskeletal trauma patients. The third United Kingdom Periprosthetic Joint Infection (UK PJI) Meeting convened in Glasgow on 1 April 2022, and brought together over 180 delegates, representing orthopaedics, infectious diseases, microbiology, plastic surgery, anaesthetics, and allied health professions, including pharmacy and specialist nurses. The meeting comprised a plenary session for all delegates, and separate breakout sessions for fracture-related infection (FRI) and arthroplasty. The UK PJI working group prepared consensus statements in advance of each session, based upon topics that were discussed at previous meetings, and delegates engaged in an anonymous electronic voting process. This article presents the findings of the FRI session, and examines each consensus topic within the context of the contemporary literature.

The clinical outcome comparison between trans-syndesmotic fixation and anatomic deltoid ligament repair in unstable ankle fractures with medial clear space widening: A systematic review and meta-analysis.

BACKGROUND: Due to the variability in evidence supporting either trans-syndesmosis fixation or deltoid ligament repair in unstable ankle fractures with medical clear space (MCS) widening makes it unclear which surgical technique leads to the best patient outcomes. The goal of our systematic review and meta-analysis was to compare clinical outcomes of trans-syndesmotic fixation versus anatomic deltoid ligament repair in the management of unstable ankle fractures with MCS widening. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized in this study. A comprehensive and systematic search was conducted using the PubMed, Embase, Web of Science and Cochrane Library databases. Outcomes investigated in this review included the rates of syndesmotic malreduction, removal of hardware, postoperative complications including wound issues, and functional/pain scores. RESULTS: A total of five level-3 studies were selected in this review, with 280 unstable ankle fractures with MCS widening: 165 for the trans-syndesmotic fixation group and 115 for the anatomic deltoid ligament repair group. Three out of five studies evaluated syndesmotic malreduction using CT. Compared to the trans-syndesmosis fixation group, the deltoid repair group showed significant lower rates of syndesmotic malreduction rates and removal of hardware: 6.5 % (4/61) Vs. 27 % (16/59) (RR=0.26, 95 % CI=[0.10, 0.68]), and 2.6 % (3/115) Vs.54.5 % (90/165) (RR=0.06, CI=[0.02, 0.14]), respectively. No significant differences were found between the two groups in postoperative wound complications, reoperations, and functional scores including AOFAS and VAS pain score. CONCLUSIONS: Based on our findings, anatomic deltoid ligament repair was associated with a lower rate of syndesmotic malreduction and the need for hardware removal while there was no significant difference in terms of postoperative wound complications, reoperation, AOFAS score, or VAS pain score. These results should be interpreted with caution due to limitations related to heterogeneity among the studies. Further high-level RCTs with larger sample sizes are necessary to establish a robust consensus.

Incisional negative pressure wound therapy for the prevention of surgical site complications in Paediatric patients with non-idiopathic scoliosis: A randomized clinical trial.

Surgical wound complications are adverse events with important repercussions for the health of patients and health system. Surgical site infections and wound dehiscences are among the most important surgical wound complications, with a high incidence in paediatric patients undergoing surgery for non-idiopathic scoliosis. Incisional negative pressure wound therapy for surgical incisions is used as a preventive measure against surgical wound complications in adults; however, there has been scant evidence for using it in children. The purpose of this study is to evaluate the cost-effectiveness of incisional negative pressure wound therapy in preventing surgical wound complications in paediatric patients undergoing surgery to treat non-idiopathic scoliosis. Randomized clinical trial. Children younger than 18 years of age undergoing surgery for non-idiopathic scoliosis were randomly assigned into two groups to receive one of two different types of dressings for the first 7 days after surgery. One group were treated with a postoperative hydrofibre and hydrocolloid dressing with silver for wounds (control group), and the other group received a single-use incisional negative pressure wound therapy system (intervention group). The wounds were assessed after removal of the dressings at 7 days after surgery and again at 30, 90, and 180 days after surgery. Surgical wound complications, sociodemographic variables, variables related to the procedure and postoperative period, economic costs of treatment of surgical wound complications, and time to healing of the surgical wound were recorded. Per protocol and per intention to treat analysis was made. The per protocol incidence of surgical wound complications was 7.7% in the intervention group versus 38.5% in the control group (p = 0.009; Fisher exact test. RR = 0.20 IC95%: 0.05-0.83). Surgical wound dehiscence, surgical site infections, seroma, and fibrin were the most common surgical wound complications. The type of surgery, duration of surgery, and patients' age were associated with a higher risk for surgical wound complications. Postoperative hydrofibre and hydrocolloid dressing with silver for wounds were found to be associated with a longer time to healing. Initial costs for dressings in the group receiving incisional negative pressure wound therapy were higher, but the total postoperative costs were higher for those receiving postoperative hydrofibre and hydrocolloid dressing with silver for wounds. It was found that for each US$1.00 of extra costs for using incisional negative pressure wound therapy, there was a benefit of US$12.93 in relation to the cost of complications prevented. Incisional negative pressure wound therapy is cost-effective in the prevention of surgical wound complications in children undergoing surgery for non-idiopathic scoliosis.

Drapes in Routine Aseptic Procedures for Environmental Sustainability (project DRAPES): a protocol for a multi-centre randomised controlled trial comparing post-operative wound complication rates following routine neutering of dogs and cats using reusable or disposable surgical drapes.

BACKGROUND: Reusable surgical drapes have a lower lifetime environmental impact than disposable drapes in most cases. There is limited evidence regarding whether drape choice impacts patient outcomes including post-operative wound complications. The aim of this study is to compare wound complication rates following routine neutering surgeries in cats and dogs when reusable drapes are used as compared with disposable drapes. METHODS: The trial will be conducted as a pragmatic, multi-centre, parallel group randomised controlled trial in the UK. Dogs and cats undergoing routine neutering will be randomised to disposable or reusable drapes with all other aspects of care occurring as they usually would at the practice. The required sample size is 2,850, with 4750 animals to be recruited from up to ten practices to allow for a 40% loss to follow-up. Demographic data and details on peri-operative care will be collected at the time of surgery. Post-operative wound complications will be assessed and recorded as usual at each practice using clinical codes. The post-operative wound clinical codes and any antibiotic use within 30 days of surgery will be retrieved from the practice management software. The primary outcome that will be compared between the two groups is the rate of post-operative wound complications within 30 days of surgery which will be analysed by multivariable logistic regression with a binary outcome of wound complication (yes/no). Secondary outcomes are the prevalence of different types of complications and antibiotic use within 30 days of surgery which will be compared between the two groups by chi square analysis. DISCUSSION: Our hypothesis is that there will be no difference in post-operative wound complication rates between disposable and reusable drapes. If the likely rate of post-surgical wound complications with reusable drapes is similar to that with disposable drapes, then veterinary clinical teams can choose the more sustainable option, confident that their patients will not be impacted by this choice. TRIAL REGISTRATION: We have retrospectively registered the protocol on the Open Science Framework on 14 Nov 2023 (Trial registration entry: https://doi.org/10.17605/OSF.IO/72HMA ).

Prophylactic antibiotics for excision of premalignant vulvar lesions: A pilot randomized controlled trial.

No prospective data have been described to inform guidelines on antibiotic prophylaxis for partial vulvectomies. Thus, we conducted a single-center, pilot, double-blind randomized controlled trial to assess the effectiveness of prophylactic antibiotics to prevent wound complications after partial vulvectomies. Patients were randomly assigned 1:1 to preoperative antibiotics or no preoperative antibiotics. The primary outcome of 30-day postoperative wound complications occurred in 31 (62 %) of all patients, with no differences between groups. The most common wound complications were superficial separation (54.2 % antibiotic prophylaxis vs. 65.3 % no prophylaxis, p = 0.37) and surgical site infection (0 % antibiotic prophylaxis vs 7.7 % no prophylaxis, p = 0.49). However, this study was limited by differences in patient characteristics between the groups. This study provides data to perform power calculations for a trial examining the effect of preoperative antibiotics on surgical site infection.

Safety and Efficacy of one vs two Incision Broström Gould With Calcaneal Osteotomy and Peroneal Tendon Debridement Surgery.

Surgical intervention, such as the Broström-Gould procedure, is typically indicated for patients with chronic lateral ankle instability. In this study, we are comparing the safety and efficacy of the Broström-Gould procedure with peroneal tendon debridement, a sliding lateralizing calcaneal osteotomy, and adjuvant procedures performed with a single- versus double-incision approach. Our retrospective analysis included patients who underwent the procedure of interest between 2011 and 2020. Patients were divided into 2 groups: undergoing either a 1-incision (n = 53) or a 2-incision approach (n = 47), both with a lateralizing calcaneal osteotomy. A significant difference in skin bridge breakdown was observed between the 2-incision (n = 6 [13%]) and 1-incision groups (n = 0 [0%]). There were no significant differences in infection, deep wound dehiscence, nerve palsy, or neuroma between patients in the 2 groups. Furthermore, no statistically significant differences in mean PROMIS scores existed between the cohorts. The described Broström-Gould procedure shows promise for treating chronic ankle instability. While patients in both single- and double-incision groups had similar rates of postoperative complications, the decreased incidence of skin bridge breakdown in the 1incision group highlights the approach's safety and potential benefits in reducing wound-related complications.

The use of incisional negative pressure wound therapy on high-risk breast cancer mastectomy patients.

BACKGROUND: The main complications seen in patients who have undergone modified radical mastectomy (MRM) are seroma, surgical site infection, hematoma, wound dehiscence, flap necrosis, and nerve damage. While these complications lead to some problems the most feared effect in the early period is that they cause a delay in adjuvant treatment. Incisional Negative Pressure Wound Therapy (iNPWT) decreases wound dehiscence by reducing oedema and tension, especially in the incision line. This study aim to compare recovery times and wound site complications between patients treated with conventional wound dressings and patients treated with iNPWT after MRM. METHODS: A retrospective screening was made of the data of 50 patients who underwent MRM because of breast cancer in the General Surgery Clinic of XXX Hospital between 2018 and 2022, and were at high-risk of wound site complications. Two groups were formed as 30 patients applied with iNPWT and 20 patients applied with conventional dressings. RESULTS: The mean age of the 50 female patients was 53.58 years (range, 30-80 years). The most frequently seen complications were seroma (20 patients) and partial flap ischaemia (14 patients). The mean number of iNPWT applications was 1.30 (range, 1-2), and the mean number of days of application was 4.47 (range, 2-9). Postoperative seroma was observed in 8 patients in the iNPWT group and in 12 patients in the conventional dressings group (p = 0.018). Flap ischaemia and the probability of dehiscence was determined at a statistically significantly higher rate in the patients in the conventional dressings groups (p = 0.005, p = 0.021). CONCLUSION: The results of this study demonstrated that the use of iNPWT significantly reduced the amount of postoperative drainage, thereby contributing to early drain removal. Furthermore, iNPWT significantly reduced postoperative seroma, flap ischaemia, and flap dehiscence compared to conventional dressings.

A Prospective Study of Sutured Versus Non-sutured Subcutaneous Fat Tissue in Laparotomy Wound Closure.

Background This study was conducted to determine the wound-related complications, such as wound dehiscence, delayed post-operative stay, and reinterventions in both groups, and compare the incidence of surgical site infection in elective laparotomy wounds in two groups - those with closing subcutaneous fat tissue and those without. Methods At the Government Medical College, Thrissur, 248 patients undergoing elective abdominal surgeries during the period from August 2019 to August 2020 participated in this one-year prospective cross-sectional study. The institutional ethics committee approved the study, and participants provided written informed consent. Patients were randomly assigned to the subcutaneous closure group (S) and the non-closure group (N). Post-operative events were then systematically documented. Results The group with no subcutaneous suture (N) had a considerably greater percentage of patients with seromas (12 patients, 9%), hematomas (13 patients, 10.5%), superficial surgical site infection and total wound dehiscence as compared to the subcutaneous tissue closure group (S). Groups N and S displayed comparable numbers of suture sinus developments and partial wound dehiscence. Group N and Group S had similar hospital stays, according to the overall length of stay displayed. Conclusion Subcutaneous suturing during elective laparotomy wound closure significantly reduced superficial surgical site infection, hematoma, seroma, and total wound dehiscence; in the remaining categories, subcutaneous and non-subcutaneous sutures did not differ significantly. It also did not help to reduce hospital stays.

Cranial stair-step incision for minimizing postoperative complications in neuro-oncologic surgery: A propensity score-matched analysis.

PURPOSE: Craniotomies for tumor resection can at times result in wound complications which can be devastating in the treatment of neuro-oncological patients. A cranial stair-step technique was recently introduced as an approach to mitigate these complications, especially in this patient population who often exhibit additional risk factors including steroids, chemoradiation, and VEGF inhibitor treatments. This study evaluates our cranial stair-step approach by comparing its postoperative complications using propensity score matching with those of a standard craniotomy wound closure. METHODS: A retrospective chart review was conducted on patients with intracranial neoplasms undergoing primary craniotomy at a single institution. Patients with prior craniotomies and less than three months of follow-up were excluded. Analyses were performed using R Studio. RESULTS: 383 patients were included in the study, 139 of whom underwent the stair-step technique while the rest underwent traditional craniotomy closures. The stair-step cohort was older, had higher ASA classes, and had a higher prevalence of coronary artery disease. The stair-step patients were administered fewer steroids before (40.29% vs. 56.56%, p < 0.01) and after surgery (87.05% vs. 94.26%, p = 0.02), fewer immunotherapy (12.95% vs. 20.90%, p = 0.05), but they received more radiation preoperatively (15.11% vs. 8.61%, p = 0.05). They also underwent fewer operations for recurrences and residuals (0.72% vs. 10.66%, p = 0.01). On propensity score matching, we found 111 matched pairs with no differences except follow-up duration (p < 0.01). The stair-step group had fewer soft tissue infections (0% vs. 3.60%, p = 0.04), fewer total wound complications (0% vs. 4.50%, p = 0.02), was operated on less for these complications (0% vs. 3.60%, p = 0.04), and had a shorter length of stay (6 vs. 9 days, p < 0.01). Notably, the average time to wound complication in our cohort was 44 days, well within our exclusion criteria and follow-up duration. CONCLUSION: The cranial stair-step technique is safe and effective in reducing rates of wound complications and reoperation for neuro-oncologic patients requiring craniotomy.

Incision Closure for Direct Anterior Total Hip Arthroplasty: Is There a Difference in the Rate of Superficial Wound Complications With Suture Versus Staples?

Background Direct anterior total hip arthroplasty (DA-THA) has increased in popularity over recent decades. However, DA-THA has been reported to have a higher incidence of superficial wound complications, including infection and incisional dehiscence, compared to other surgical approaches to hip arthroplasty. While this indicates a need for optimal wound closure, little research exists on the preferred method of skin closure following DA-THA. This study aimed to determine if there was any difference in rates of superficial infection, wound dehiscence, or overall wound complications with skin closure using a running subcuticular 3-0 Monocryl® suture compared to surgical staples following DA-THA.  Methods Records of patients who underwent DA-THA at our institution between July 2017 to July 2022 were retrospectively reviewed. Data were abstracted on patient demographics, comorbidities, skin closure method, and wound complications from the electronic medical record. Superficial infection and wound dehiscence were classified based on explicit diagnosis in post-operative records and incision photographs taken during follow-up visits. Overall wound complications were classified in patients who experienced either superficial infection, incisional dehiscence, or both complications following surgery. Descriptive statistics and chi-squared measures were obtained from post-operative patient data, and significance was set at p [Formula: see text] 0.05. Results A total of 365 DA-THAs were completed in 349 patients. A running subcuticular 3-0 Monocryl® suture closed 207 surgeries (56.7%), while surgical staples closed 158 surgeries (43.3%). There was no significant difference in independent rates of superficial infection (p = 0.076) or wound dehiscence (p = 0.118) between suture and staple cohorts; however, suture closure (10, 2.7%) was associated with a significantly higher rate of overall wound complications compared to staple closure (1, 0.3%) (p = 0.020). Conclusion DA-THA carries the risk of overall wound complications, including superficial infection and wound dehiscence. Our findings suggest superficial skin closure with staples may be preferred over sutures due to lower rates of overall wound complications. Further studies are needed to determine the optimal method of skin closure following DA-THA.

"What really matters to the patients?": assessing the impact of wound healing on the quality of life in patients undergoing incisional hernia repair.

PURPOSE: We aim to evaluate the impact of surgical wound complications in the first 30 postoperative days after incisional hernia repair on the long-term quality of life of patients. In addition, the impact of the surgical technique and preoperative comorbidities on the quality of life of patients will also be evaluated. METHOD: Prospective cohort study, which evaluates 115 patients who underwent incisional hernioplasty between 2019 and 2020, using the onlay and retromuscular techniques. These patients were initially assessed with regard to surgical wound outcomes in the first 30 postoperative days (surgical site infection (SSI) or surgical site occurrence (SSO)), and then, assessed after three years, through a specific quality of life questionnaire, the Hernia Related Quality of Life Survey (HerQLes). RESULTS: After some patients were lost to follow-up during the study period, due to death, difficulty in contact, refusal to respond to the questionnaire, eighty patients were evaluated. Of these, 11 patients (13.8%) had SSI in the first 30 postoperative days and 37 (46.3%) had some type of SSO. The impact of both SSI and SSO on quality of life indices was not identified. When analyzing others variables, we observed that the Body Mass Index (BMI) had a significant impact on the patients' quality of life. Likewise, hernia size and mesh size were identified as variables related to a worse quality of life outcome. No difference was observed regarding the surgical techniques used. CONCLUSION: In the present study, no relationship was identified between surgical wound outcomes (SSO and SSI) and worse quality of life results using the HerQLes score. We observed that both BMI and the size of meshes and hernias showed an inversely proportional relationship with quality of life indices. However, more studies evaluating preoperative quality of life indices and comparing them with postoperative indices should be carried out to evaluate these correlations.

Effect of comprehensive nursing intervention on the formation of pressure sore in patients undergoing orthopaedic surgery in prone position.

Pressure ulcers are a common complication of prone orthopaedic surgery, causing pain and inconvenience to patients. This study aimed to evaluate a comprehensive nursing intervention for pressure ulcer formation in these patients. A total of 120 patients undergoing prone orthopaedic surgery were randomly divided into two groups. The study group (60 patients) received a comprehensive nursing intervention, whereas the control group (60 patients) received a routine nursing intervention. After 2 weeks, the comprehensive nursing intervention significantly reduced the incidence and degree of pressure sores and led to a shorter recovery time than the routine nursing intervention (p < 0.05). The incidence of postoperative wound complications was decreased, and patient satisfaction was significantly improved (p < 0.05). The Hamilton Anxiety Scale, Hamilton Depression Scale and visual analogue scale scores of the study group were significantly lower than those of the control group, and the Short Form 36 Health Survey Questionnaire scores were higher than those of the control group (p < 0.05). A comprehensive nursing intervention can significantly reduce the incidence and degree of pressure ulcers, accelerate recovery time, reduce postoperative wound complications and improve the quality of life and satisfaction of patients undergoing prone orthopaedic surgery.

Vertical or Horizontal (Bikini) Incision for Direct Anterior Total Hip Arthroplasty: Outcomes of Early (<90 day) Revision.

BACKGROUND: The horizontal 'bikini' incision for direct anterior approach (DAA) total hip arthroplasty has gained popularity due to its early wound healing characteristics; however, the nonextensile nature of this approach may pose problems in treating early complications. This study sought to characterize the outcomes of early revision (<90 days) in patients who underwent anterior hip arthroplasty utilizing either a traditional longitudinal incision or a horizontal (bikini) incision. METHODS: This retrospective study identified patients who underwent DAA primary total hip arthroplasty with a subsequent DAA revision within 90 days. Patients were divided into two cohorts based on the orientation of their incision: either 'longitudinal incision' (in accordance with the Smith Peterson interval) or 'horizontal bikini incision' (in accordance with the hip flexion crease). RESULTS: There were 74 patients who underwent DAA revision arthroplasty within 90 days of primary arthroplasty; 65 had a longitudinal incision, and 9 had a horizontal (bikini) incision. In the longitudinal incision group, 2 patients (3.1%) required plastic surgery closure, and 11 patients (16.9%) required additional operations. Of the 9 bikini incision patients, 6 patients required the assistance of plastic surgery closure, and 7 patients required multiple orthopaedic operations. CONCLUSIONS: Our study suggests that a horizontal bikini incision is less forgiving in the early postoperative period if a more extensile exposure is needed for revision surgery, as measured by the need for plastic surgery and additional returns to the operating room. In our cohort, the longitudinal incision allowed for the management of early surgical complications with less morbidity.

2-Octyl-Cyanoacrylate Mesh Dressings for Total Joint Arthroplasty: Dressing Design Influences Risks of Wound Complications.

BACKGROUND: Recent liquid adhesive skin closure systems with a mesh patch and a 2-octyl cyanoacrylate liquid formula have shown promising results in total joint arthroplasty. Chemical accelerators are typically included to promote the rapid polymerization of 2-octyl cyanoacrylate. The goal of the study is to distinguish designs and wound complication differences between 2 similar systems. METHODS: An 18-week retrospective study was conducted from July to December 2023, including 207 total hip arthroplasty and 212 total knee arthroplasty cases from 4 attending surgeons at 1 institution that used 1 of 2 dressing designs. Both dressings had a 2-octyl cyanoacrylate liquid adhesive formula that applied topically to a polyester-based mesh overlaying the wound. Mesh A (used in 274 cases) included an accelerator, a quaternary ammonium salt, on the mesh patch, whereas Mesh B (used in 145 cases) included a similar accelerator within the adhesive applicator. RESULTS: Wound complications (3.2 versus 7.6%; X2 = 3.86; df = 1; P = .049), early periprosthetic joint infections (0 versus 2.8%; X2 = 7.63; df = 1; P = .006), and 90-day reoperations for wound complications (0.4 versus 3.4%; X2 = 6.39; df = 1; P = .011) were significantly lower in patients who received Mesh A versus B, respectively. There was no difference in superficial surgical site infections (0.7 versus 0%; X2 = 1.06; df = 1; P = .302) or allergy rates (3.3 versus 4.1%; X2 = 0.12; df = 1; P = .655) between Mesh A and B. CONCLUSIONS: We observed significantly different performance in wound complications, early postoperative periprosthetic joint infections, and 90-day reoperation between the 2 designs. Having the accelerator in the applicator rather than on the mesh patch may lead to premature polymerization before bonding appropriately with the mesh to create the desired wound closure and seal. LEVEL OF EVIDENCE: Level III.

Minimizing Incision in Living Donor Liver Transplantation: Initial Experience and Comparative Analysis of Upper Midline Incision in 115 Recipients.

Living donor liver transplantation (LDLT) needs "Mercedes Benz" or "J-shaped" incision, causing short and long-term complications. An upper midline incision (UMI) is less invasive alternative but technically challenging. Reporting UMI for recipients in LDLT vs. conventional J-shaped incision. Retrospective analysis, July 2021 to December 2022. Peri-operative details and post-transplant outcomes of 115 consecutive adult LDLT recipients transplanted with UMI compared with 140 recipients with J-shaped incision. Cohorts had similar preoperative and intraoperative variables. The UMI group had significant shorter time to ambulation (3 ± 1.6 vs. 3.6 ± 1.3 days, p = 0.001), ICU stay (3.8 ± 1.3 vs. 4.4 ± 1.5 days, p = 0.001), but a similar hospital stay (15.6±7.6 vs. 16.1±10.9 days, p = 0.677), lower incidence of pleural effusion (11.3% vs. 27.1% p = 0.002), and post-operative ileus (1.7% vs. 9.3% p = 0.011). The rates of graft dysfunction (4.3% vs. 8.5% p = 0.412), biliary complications (6.1% vs. 12.1% p = 0.099), 90-day mortality (7.8% vs. 12.1% p = 0.598) were similar. UMI-LDLT afforded benefits such as reduced pleuropulmonary complications, better early post-operative recovery and reduction in scar-related complaints in the medium-term. This is a safe, non-inferior and reproducible technique for LDLT.

Sternal Complications Following Coronary Artery Bypass Grafting and Robicsek Repair: Comprehensive Sternal Reconstruction With Sternal Plating and the Use of Novel Biologic Therapies.

Sternal non-union and fractured sternal wires are rare but devastating complications of median sternotomy for cardiac surgery, and these can lead to chronic pain, instability, and impaired quality of life. Patients may present with various symptoms such as clicking sensations, chest wall discomfort, and even respiratory difficulties. The underlying causes are multifactorial, including patient comorbidities, surgical technique, and postoperative management. The treatment options range from conservative measures to complex surgical interventions, such as sternal debridement, rewiring, and reconstruction with rigid fixation systems. Novel therapeutic technologies, including amniotic membranes and platelet-rich plasma, have shown promise in promoting wound healing and reducing complications in these challenging cases. We present the case of a 58-year-old male who underwent coronary artery bypass grafting (CABG) and subsequently developed sternal dehiscence requiring Robicsek repair. Despite undergoing this procedure, the patient experienced poor sternal healing, and hence he was referred to our center, presenting with shortness of breath, pain due to fractured sternal wires, and sternal non-union. The patient underwent a complex sternal reconstruction involving redo full median sternotomy, removal of sternal wires, and sternal plating, along with the application of amniotic membranes and platelet-rich plasma to the sternal wound. The procedure successfully stabilized the sternum. This report highlights the benefits of a multifaceted approach to addressing repeated sternal breakdown following CABG and the potential therapeutic benefits of novel technologies in promoting wound healing.

Smoking is not associated with wound complications in augmented urethroplasty: a NSQIP analysis.

OBJECTIVE: To investigate if predictors of wound complications differed between patients undergoing excision and primary anastomosis urethroplasty (EPA) and augmented urethroplasty. METHODS: The National Surgical Quality Improvement Program database from 2006 to 2018 was queried for male patients undergoing urethroplasty. Thirty-day wound complications were identified and categorized (superficial/deep/organ-space surgical site infections and dehiscence). Multivariable logistic regression was performed to determine risk factors associated with wound complications. Smoking history was defined as current smoker within the past year. RESULTS: Urethroplasty was performed in 2251 males, with 25.46% (n = 573) using a flap or graft. There was no significant difference in wound complications for patients undergoing augmented urethroplasty (n = 17, 2.97%) or EPA (n = 45, 2.68%) (p = 0.9). The augmented group had a higher BMI, longer operative time, and longer length of stay. On multivariable logistic regression, risk factors associated with wound complications for patients undergoing EPA were diabetes (OR 2.56, p = 0.03) and smoking (OR 2.32, p = 0.02). However, these factors were not associated with wound complications in patients undergoing augmented urethroplasty. CONCLUSIONS: Smoking and diabetes were associated with increased wound complications for men undergoing EPA, but not in patients undergoing augmented urethroplasty. Patients with comorbidities associated with worse wound healing may be more likely to have a wound complication when undergoing EPA.

A Comparison of Wound Complications Following Total Hip Arthroplasty Performed Through the Direct Anterior Versus Direct Lateral Approach.

Background: Some studies have suggested the risk of wound complications may be higher using the direct anterior (DA) approach to total hip arthroplasty (THA). This study aimed to compare the risk of early postoperative wound complications between the DA and direct lateral (DL) approaches to THA and to determine patient risk factors that may contribute to this problem. Methods: All patients who underwent primary THA with a single surgeon over a 5-year period were retrospectively reviewed. All patients were treated with either the DA or DL approach. Data collected included patient demographics, surgical approach, and wound status. There was a minimum follow-up of 6 weeks to allow for an adequate assessment of surgical wound healing. Univariate and multivariate analyses were used to compare the 2 approaches. Results: Five hundred seventy-nine patients (77.6%) who underwent DA approach and 167 patients (22.4%) who underwent DL approach were included. Patients who underwent DL approach had a higher body mass index and a higher rate of diabetes than those treated with the DA approach. Forty patients (6.9%) in the DA cohort and 14 (8.4%) in the DL cohort experienced early wound complications, P = .523. After controlling for potential confounding variables, the surgical approach was not an independent risk factor for early postoperative wound complications. Conclusions: While there have been concerns regarding use of the DA approach in patients with higher body mass index and certain medical comorbidities, the results of this study suggest the choice of surgical approach may have minimal effect on the rate of early postoperative wound complications.

Evaluation of long-term outcome following therapeutic mammaplasty: the effect of wound complication on initiation of adjuvant therapy and subsequent oncological outcome.

INTRODUCTION: Therapeutic mammaplasty (TM) facilitates large tumour resection while maintaining optimal aesthetic outcome. It carries higher wound complication risks, which may delay adjuvant therapy initiation. Whether this delay affects oncological outcome requires evaluation. METHODS: Data were collected for consecutive patients receiving TM at the Leeds breast unit (2009-2017). A prospectively maintained database was used to determine tumour characteristics, wound complication rates, receipt of adjuvant therapy and breast cancer recurrence or death. RESULTS: In total 112 patients (median age of 54 years) underwent 114 TM procedures. The most common histological subtypes were invasive ductal carcinoma (61.4%), invasive lobular carcinoma (13.2%) and ductal carcinoma in situ (13.2%). Of the patients, 88.2% had oestrogen receptor-positive cancer and 14% had human epidermal growth factor receptor-positive cancer; 26.3% had multifocal cancer. The median tumour size was 30mm. The median Nottingham Prognostic Index was 4.2. The local recurrence rate was 3.5% (median follow-up of 8.6 years). The 5- and 10-year disease-free survival (DFS) was 88.5% and 83.5%, and the equivalent overall survival (OS) rates were 94% and 83.5%. Wound complication rate was 23.6% (n=27), the commonest being wound infection (11.4%; n=13) and T-junction wound breakdown (10.5%; n=12). The median time to adjuvant therapy was 72 days (interquartile range [IQR] 56-90) for patients with wound complications, and 51 days (IQR 42-58) for those without. However, this delay did not affect DFS or OS (log-rank test; p=0.58 and p=0.94, respectively). This was confirmed on Cox regression analysis. CONCLUSION: Our study finding demonstrates that although wound complications after TM leads to a modest delay to adjuvant therapy, the long-term oncological outcomes were comparable with those in patients without wound complications.

Intrawound Vancomycin Powder in Primary Total Hip Arthroplasty: A Prospective Quality Control Study.

BACKGROUND: The purpose of this retrospective analysis of a prospective quality control project was to determine whether the use of intrawound vancomycin powder (IVP) decreases the rate of periprosthetic joint infection (PJI) within 90 days following primary total hip arthroplasty (THA). METHODS: From October 2021 to September 2022, a prospective quality control project was undertaken in which 10 high-volume THA surgeons alternated between using and not using IVP each month while keeping other perioperative protocols unchanged. A retrospective analysis of the project was performed to compare the group of patients who received IVP to the group of patients who did not. The primary outcome was a culture positive infection within 90 days following primary THA. Secondary outcomes included gram-positive culture, overall reoperation rate, wound complications, readmission, and wound complications within 90 days post-operatively. A total of 1,193 primary THA patients were identified for analysis. There were 523 (43.8%) patients who received IVP and were included in the IVP group, while 670 (56.2%) did not and were included in the non-IVP group. Age, body mass index, and sex were similar between the 2 groups (P > .25). RESULTS: The IVP group had a higher rate of culture positive joint infections (1.7 [0.8, 3.2] versus 0.3% [0.04, 1.1], P = .01) than the non-IVP group. All PJI's were found to have gram positive bacteria in both groups. The IVP group had a higher overall reoperation rate than the non-IVP group (6.1 [4.2, 8.5] versus 2.4% [1.4, 3.9], P < .01). The IVP group had a higher reoperation rate for any wound complication compared to non-IVP patients (2.7 [1.5, 4.5] versus 0.7% [0.2, 1.7], P < .01). The overall readmission rate (6.1 [4.2, 8.5] versus 2.8% [1.7, 4.4], P < .01), as well as readmission for suspected infection (2.1 [1.1, 3.7] versus 0.6% [0.02, 1.5], P = .03), were higher in the IVP group. CONCLUSIONS: The use of IVP in primary THA was associated with a higher rate of PJI, overall reoperation, reoperation for wound complications, and readmission in a prospective quality control project. Until future prospective randomized studies determine the safety and efficacy of IVP in THA conclusively, we advocate against its utilization.