The Use of Biologic Wound Healing Agents in Cheek Reconstruction

The unique requirements of reconstructing cheek defects, often with its proximity to the mobile elements of the face including the lip and the eyelid, have been met very handily with the directed and thoughtful use of biologic wound healing agents. One of the key advantages of these agents is their ability to provide coverage in patients with multiple comorbid conditions for the mobile elements of the cheek where the cervicofacial advancement flap is contraindicated due to its anesthetic requirement. The biologic agents are also highly successful coverage options for patients who have limited skin laxity to provide for proper skin closure using the standard cheek closure techniques with local flaps. In addition, these agents provide an ability to provide stable wound closure with minimal wound care while waiting for the excisional biopsy results to be finalized. This article describes the unique indications for biologic wound agents, including preservation of lip and eyelid mobile element anatomy without retraction from a local flap, which has not been previously described.

Laser speckle imaging to evaluate scalp flap blood flow during closure in neurosurgical procedures

Background: To measure the degree of relative ischemia caused by skin closure, we explored the potential utility of intraoperative surface blood flow measurement with laser speckle imaging (LSI). Methods: Prospective observational study of eight subjects that underwent intraoperative LSI during elective cranial neurosurgical procedures at the time of skin closure. Results: Seven 1st time incisions, with closure techniques including sutures (n = 3), staples (n = 3), and one after galeal sutures. When compared to the control region, there was a mean 63.7% reduction in flow across all seven subjects (range 18.7–95.32%). Comparing by closure type, a higher flow reduction in the three subjects with suture closure (80.7% reduction) compared to staples (61.9% reduction, P = 0.0379). One subject had a complex wound where tightening and loosening of sutures were performed to ensure adequate perfusion. Suturing resulted in significantly more local decreased flow compared to staples (P < 0.0001). Conclusion: These findings demonstrate the relative feasibility of using LSI for preoperative vascular flow assessment in planning complex incision closure. These data also provide preliminary support for the hypothesis that skin closure itself causes relative ischemia compared to deep approximation or cautery of the skin edge and that the relative ischemia from staples closure is generally less than from suture closure.

Closure of skin in surgical wounds with skin stapler and conventional sutures: a comparative study

Background: Application of suture is the technique of choice for apposition of skin edges in surgical wounds. The same procedure performed with application of staplers is faster and produce better cosmetic outcomes. A comparative study between conventional suture and stapler closure of skin in abdominal surgical wounds was undertaken to study the merits and demerits of the techniques. The aim was to study the time required for closure of surgical wounds, aesthetic outcome, post-operative complications and patient’s compliance.Methods: This was a single centre, prospective, observational study, conducted upon 100 patients undergoing abdominal surgeries. 50 patients were selected for skin closure of surgical wounds with stapler and the other 50 patients for closure with conventional nylon sutures. Data were collected for time required for closure of skin, aesthetic outcome, post-operative complications and patient’s compliance for both the groups for comparison. Data were analysed using student t test for comparison and chi square test of significance. Results: There was significant better results in stapler group in terms of cosmetic outcome (96% vs 88%, p<0.001), time taken during closure (60 vs 219 seconds, p<0.001) and patient’s compliance VAS of 1.44 vs 4.58 p<0.001).Conclusions: Closure of skin with stapler is a faster method. Patient’s compliance with stapler closure is better. It produces cosmetically acceptable scar and less discomfort or pain during its removal.

Desarda versus Lichenstein repair in treatment of inguinal hernia: our experience in KVG Medical College and Hospital

Background: Desarda technique of inguinal hernia repair introduced in 2001 is still not considered standard tissue-based hernia repair technique. The aim of the study was to compare the tissue based Desarda technique with standard Lichtenstein repair in treatment of primary inguinal hernia.Methods: 72 cases were allocated into 2 groups. Desarda (D Group) had 36 and Lichtenstein (L Group) had 36 patients. Primary outcome factors included operative time measured from skin incision to skin closure. Post operative pain scores was using Sheffield scale. Ecchymosis, hematoma, seroma, surgical site infections, foreign body sensation etc. were evaluated as postoperative complications. A follow up examination was planned for 6 month to look for early recurrence (<6 month) and chronic groin pain.Results: Mean age in desarda’s group 44.94±15.5 years while Lichtenstein group was 45.47±13.12 years. The mean duration of surgery 42.83 min (D) versus 50.72 min (L). Duration of hospital stay 3.38 days (D) versus 4.08 days (L). Time taken to return to normal and work activities was significantly less in Desarda group (p=0.001). After 6-month mean follow up period 1 recurrence is noted in each arm (p=1).Conclusions: On comparison of Desarda with Lichtenstein repair. Desarda technique does not use a mesh. Patients after Desarda's operative procedure gets normal activity sooner as compared to the standard Lichtenstein mesh repair. Complications similar to standardized technique. We also found the use of Desarda technique in patients with indirect hernia is a technically sound option than Lichtenstein technique.

Non-ICU-Based Staged Management of Laparotomy-Related Abdominal Compartment Syndrome in a 23-Year-Old Male

Introduction: Abdominal compartment syndrome (ACS) is a sustained intraabdominal pressure (IAP) of 20 mmHg or higher with new organ dysfunction. Decompression is required when IAP exceeds 25 mmHg even without evidence of organ dysfunction. Common abdominal surgical diseases and operations can be complicated by ACS, and clinicians should have the requisite capacity to detect and intervene early enough. Intensive care unit (ICU) care has traditionally been the mainstay of ACS management. Case Presentation: A 23-year-old male was referred with a combined mesh and Bogota bag anterior abdominal construct after a midline laparotomy 24 hours earlier, following which the abdominal wall could not be closed primarily without tension. This was the result of significant edema of the bowel and retroperitoneum. This patient, after adequate resuscitation, underwent a two-staged procedure, 6 days apart, to achieve skin closure. After an unremarkable skin healing, a mesh repair for the consequent incisional hernia was carried out 15 months later. Conclusions: This patient’s ACS was successfully managed in a non-ICU setting and could demonstrate the possibility of successfully managing selected cases of laparotomy-related ACS in low-resource settings without ICU facilities.

Comparison of intra-articular administration of adenosine, lidocaine and magnesium solution and tranexamic acid for alleviating postoperative inflammation and joint fibrosis in an experimental model of knee arthroplasty

Background Dysregulated inflammatory responses are implicated in the pathogenesis of joint stiffness and arthrofibrosis following total knee arthroplasty (TKA). The purpose of this study was to compare the effects of intra-articular (IA) administration of tranexamic acid (TXA), an anti-fibrinolytic commonly used in TKA, and ALM chondroprotective solution on postoperative inflammation and joint tissue healing in a rat model of knee implant surgery. Methods Male Sprague–Dawley rats (n = 24) were randomly divided into TXA or ALM treatment groups. The right knee of each rat was implanted with titanium (femur) and polyethylene (tibia) implants. An IA bolus (0.1 ml) of TXA or ALM was administered after implantation and capsule closure, and before skin closure. Postoperative coagulopathy, haematology and systemic inflammatory changes were assessed. Inflammatory and fibrotic markers were assessed in joint tissue, 28 days after surgery. Results Haemostasis was comparable in animals treated with TXA or ALM after knee implant surgery. In contrast to ALM-treated animals, systemic inflammatory markers remained elevated at day 5 (IL-6, IL-12, IL-10, platelet count) and day 28 (IL-1β, IL-10) following surgery in TXA-treated animals. At day 28 following surgery, the extension range of motion of operated knees was 1.7-fold higher for ALM-treated animals compared to the TXA group. Key inflammatory mediators (NF-κB, IL-12, IL-2), immune cell infiltration (CD68+ cells) and markers of fibrosis (α-SMA, TGF-β) were also lower in capsular tissue of ALM-treated knees at day 28. Conclusion Data suggest that IA administration of ALM is superior to TXA for reducing postoperative systemic and joint inflammation and promoting restoration of healthy joint tissue architecture in a rat model of TKA. Further studies are warranted to assess the clinical translational potential of ALM IA solution to improve patient outcomes following arthroplasty.