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Antiseptic negative pressure instillation therapy for the treatment of septic wound healing deficits in oral and maxillofacial surgery.
Eckstein, FM, Pinsel, V, Wurm, MC, Wilkerling, A, Dietrich, EM, Kreißel, S, von WIlmowsky, C, Schlittenbauer, T
Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 2019;(3):389-393
Abstract
INTRODUCTION Impaired wound healing, chronic wounds and extended soft tissue defects present a crucial problem in reconstructive surgery of the head and neck region, even more after radiation therapy. In such cases the standard is a prolonged open wound treatment. The negative pressure instillation therapy might present an alternative therapy option. MATERIAL AND METHODS In this study the effects of negative pressure instillation therapy on the healing of chronic wounds in 15 patients diagnosed with impaired wound healing were investigated. These based upon infected osteoradionecrosis and osteomyelitis of the jaw. The parameters investigated as markers of the therapeutic success were serum inflammatory parameters i.e. white blood cell counts, wound smear results and wound surface reduction. RESULTS The use of negative pressure instillation therapy lead to a reduction of the bacterial load and formation of a stabile granulation tissue in all but one case. The mean inpatient time of the patients was 13.33 ± 4.62 days. Between 2 and 8 dressing changes were needed to reach clinical sufficient wound healing results. Secondary intention wound healing could be obtained in 14 out of 15 cases. The crucial part for the successful application was a watertight enoral suturing as oro-cutaneous fistulae were present in most cases. CONCLUSION The negative pressure instillation therapy poses a good treatment for wound healing problems and extended size soft tissue defects, even when oro-cutaneous fistulae were present. Especially in cases that contraindicate micro-vascular reconstruction, negative pressure instillation therapy could be a good alternative.
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2.
Does intrawound application of vancomycin influence bone healing in spinal surgery?
Eder, C, Schenk, S, Trifinopoulos, J, Külekci, B, Kienzl, M, Schildböck, S, Ogon, M
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2016;(4):1021-8
Abstract
PURPOSE Surgical site infections represent a major complication of spinal surgery. The application of lyophilised vancomycin into the wound is reported to significantly decrease infection rates. As concentrations applied locally can exceed the minimal bacterial inhibitory concentration for more than a 1000-fold, toxic side effects on local tissue may be possible. METHODS Primary osteoblast cell cultures were generated from bone tissue samples of 10 patients. Samples were incubated in absence or presence of either 3, 6 or 12 mg/cm(2) vancomycin according to a planned phase I clinical trial protocol. Changes in pH, osteoblast migration, proliferation and viability were analysed. Alkaline phosphatase as well as mineralisation patterns was studied. RESULTS The application of more than 3 mg/cm(2) vancomycin induced a decline of pH. The migration potential of osteoblasts was decreased from 100% (control samples) to zero (12 mg/cm(2) vancomycin) in a dose-dependant manner. Cell proliferation was significantly inhibited at dosages above 3 mg/cm(2). Significant cell death was observed if the dosage applied exceeded 6 mg/cm(2). The synthesis of alkaline phosphatase was markedly reduced in all dosages applied and calcium deposition was significantly decreased in dosages above 3 mg/cm(2). CONCLUSION As bone remodelling requires the immigration, proliferation and differentiation of osteoblasts at the fusion site, high dosages of intrawound vancomycin might interfere with regenerative processes and increase the risk of non-union. To allow an appropriate balance of infection risk and the risk of non-union, the minimal local concentration required should be determined by controlled in vivo studies.
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Reduced infections with perioperative immunonutrition in head and neck cancer: exploratory results of a multicenter, prospective, randomized, double-blind study.
Falewee, MN, Schilf, A, Boufflers, E, Cartier, C, Bachmann, P, Pressoir, M, Banal, A, Michel, C, Ettaiche, M
Clinical nutrition (Edinburgh, Scotland). 2014;(5):776-84
Abstract
BACKGROUND & AIMS Head and neck cancer surgery is affected by complications in 20-60% of cases, with risk factors being malnutrition, alcoholism and immunosuppression due to cancer. The aim of the study was to investigate whether preoperative or perioperative immunonutrition could reduce postoperative infectious complications (IC) and surgical-site infections (SSI) in this population. METHODS This was a multicenter, prospective, randomized, double-blind study. Patients with oropharyngeal and pharyngolaryngeal tumour were randomly allocated to three groups: a) perioperative formula of Impact(®) without immune nutrients, named "reference diet" (group A, control); b) preoperative Impact(®) and "reference diet" postoperatively (group B); c) Impact(®) perioperatively (group C). Products were available in oral and enteral formula and were given 7 days before surgery and for 7-15 days postoperatively. The primary and secondary endpoints were the incidence of IC and SSI, respectively. RESULTS Of 312 randomized patients, 205 were evaluable for ITT analysis. There was no significant difference in IC and SSI. However out of this population, only 64 patients had taken at least 75% of the theoretical intake from surgery to day 10 (per-protocol population). In this condition, a significant difference in IC (OR = 0.24, p = 0.05), SSI (OR = 0.17, p = 0.04) and also in the median length of postoperative stay (18 vs. 25 days, p = 0.05) was demonstrated between groups A and C. CONCLUSIONS In the ITT population, no significant difference in IC, SSI and LOS was demonstrated. Positive exploratory results on the perioperative Impact(®) per-protocol population, encourage further study in head and neck cancer patients. Registered under ClinicalTrials.gov Identifier no. NCT00765440.
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[Proctological surgery: use of a salsobromoiodic gel solution in the post-operative period].
Gaj, F, Sportelli, G, Veltri, S, Crispino, P
La Clinica terapeutica. 2009;(2):111-3
Abstract
BACKGROUND This study was aimed to demonstrate the advantages and the efficacy of a salsobromoiodic gel solution sponge to use in coloproctology after surgery for the most frequent pathologies of anal canal and of perineal region. MATERIALS AND METHODS The Authors have tested the salsobromoiodic gel solution (Fertomcidina U) in a consecutive series of patients referred to 5 coloproctological centers where they have been submitted to surgery for pathologies of anal canal and of perineal region. A total of 30 patients, 15 with clinico-instrumental diagnosis of III-IV degree haemorrhoids and 15 with diagnosis of chronic anal fissure entered in a clinical follow-up after an out-patient setting or surgery for the respective pathologies. The gel formulation is realized as a salsobromoiodic solution containing salicylic acid and magnesium biphosphate making a strong bactericide and fungicide action applicable on human skin for tissues reparation and their re-epithelization. The experimental treatment was performed on the duration of at least 10 days, with two topic applications. RESULT In 100% of the treated patients, the used gel has determined the prevention of infective complications, favouring a normal re-epithelization of tissue submitted to surgery or affected by previous anal mucosal lesions. The use of gel has not caused irritation and skin damage. No symptom and sign of toxicity were observed. CONCLUSIONS The use of salsobromoiodic gel solution has been useful to prevent infections and to contribute to the cicatrisation, healing and re-epithelization of anal mucosal lesions after surgery on a normal outpatients setting. The use of gel formulation resulted easy and satisfactory for the patients affected by the most frequent proctological pathologies which require a surgical treatment.
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Intravenous iron following cardiac surgery does not increase the infection rate.
Torres, S, Kuo, YH, Morris, K, Neibart, R, Holtz, JB, Davis, JM
Surgical infections. 2006;(4):361-6
Abstract
BACKGROUND Intravenous iron (FeIV) has been used increasingly, alone or in combination with recombinant erythropoietin, to promote red cell production as part of a blood conservation program. Given the important role that iron plays in the growth of bacteria, it has been hypothesized that this use of FeIV may promote surgical site infection. However, this hypothesis has not yet been tested appropriately. To assess this hypothesis, postoperative infection rates in patients undergoing cardiothoracic surgery were analyzed. METHODS Data were collected on 863 patients undergoing cardiopulmonary bypass surgery in 2001. Patients were either enrolled voluntarily in a blood conservation program in which they received either postoperative FeIV and erythropoietin (n=302), as indicated, or blood transfusions and no FeIV (n=561), as indicated, to correct postoperative anemia. Infections were defined according to the U.S. Centers for Disease Control and Prevention guidelines. RESULTS Thirty-nine infections developed. The overall infection rate was 4.52%, with an infection rate of 3.97% in the iron-treated group (n=12) and a rate of 4.81% in the untreated group (n=27). When the impact of gender, age, diabetes mellitus, operating time, type of surgery, and blood transfusions were controlled for, FeIV did not increase the risk of infection (odds ratio of 1.031 for each increment of 125 mg of FeIV; 95% confidence interval 0.908, 1.170; p=0.64). CONCLUSIONS There was no impact of FeIV on the subsequent infection rate in a cardiac surgery patient cohort, indicating its safety for use in the postoperative setting.
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Efficacy of surgical preparation solutions in foot and ankle surgery.
Ostrander, RV, Botte, MJ, Brage, ME
The Journal of bone and joint surgery. American volume. 2005;(5):980-5
Abstract
BACKGROUND Previous studies have demonstrated higher infection rates following orthopaedic procedures on the foot and ankle as compared with procedures involving other areas of the body. Previous studies also have documented the difficulty of eliminating bacteria from the forefoot prior to surgery. The purpose of the present study was to evaluate the efficacy of three different surgical skin-preparation solutions in eliminating potential bacterial pathogens from the foot. METHODS A prospective study was undertaken to evaluate 125 consecutive patients undergoing surgery of the foot and ankle. Each lower extremity was prepared with one of three randomly selected solutions: DuraPrep (0.7% iodine and 74% isopropyl alcohol), Techni-Care (3.0% chloroxylenol), or ChloraPrep (2% chlorhexidine gluconate and 70% isopropyl alcohol). After preparation, quantitative culture specimens were obtained from three locations: the hallux nailfold (the hallux site), the web spaces between the second and third and between the fourth and fifth digits (the toe site), and the anterior part of the tibia (the control site). RESULTS In the Techni-Care group, bacteria grew on culture of specimens obtained from 95% of the hallux sites, 98% of the toe sites, and 35% of the control sites. In the DuraPrep group, bacteria grew on culture of specimens obtained from 65% of the hallux sites, 45% of the toe sites, and 23% of the control sites. In the ChloraPrep group, bacteria grew on culture of specimens from 30% of the hallux sites, 23% of the toe sites, and 10% of the control sites. ChloraPrep was the most effective agent for eliminating bacteria from the halluces and the toes (p < 0.0001). CONCLUSIONS The use of effective preoperative preparation solution is an important step in limiting surgical wound contamination and preventing infection, particularly in foot and ankle surgery. Of the three solutions tested in the present study, the combination of chlorhexidine and alcohol (ChloraPrep) was most effective for eliminating bacteria from the forefoot prior to surgery.
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Evaluation of effectiveness of 10% polyvinylpyrrolidone-iodine solution against infections in wire and pin holes for Ilizarov external fixators.
Camilo, AM, Bongiovanni, JC
Sao Paulo medical journal = Revista paulista de medicina. 2005;(2):58-61
Abstract
CONTEXT AND OBJECTIVE Superficial infection at wire and pin insertions in the skin is a frequent disorder among patients utilizing the Ilizarov method. The objective of this study was to evaluate the effectiveness of daily topical application of 10% polyvinylpyrrolidone-iodine solution against infections of the holes for Kirschner wires and Schanz pins among patients using Ilizarov external fixators, in comparison with cleaning these holes only with 0.9% sterile physiological saline solution. DESIGN AND SETTING Controlled randomized clinical trial, in the Orthopedics and Traumatology Outpatient Clinic, Hospital São Paulo, and Orthopedics and Traumatology Center of Jundiaí. METHODS 30 patients were treated using the Ilizarov technique: 15 were instructed to apply 0.9% physiological saline dressing on the wire and pin insertions and 15 to apply 0.9% physiological saline plus 10% polyvinylpyrrolidone-iodine. Patients were evaluated at outpatient return visits for identification of signs and symptoms of superficial infection at wire and pin insertion sites. Samples were collected from cases of purulent exudate secretion, for culturing and clinical tests. RESULTS The chi-squared and Fischer exact tests were applied, but no statistically significant association between the intervention of topical polyvinylpyrrolidone-iodine solution and the prevention of infections at wire and pin insertions could be found. CONCLUSIONS Topical 10% polyvinylpyrrolidone-iodine solution applied daily to Kirschner wire and Schanz pin insertions did not reduce the incidence of superficial infection at these holes, in comparison with mechanical removal of dirt using 0.9% physiological saline solution.
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Perioperative treatment with human growth hormone down-regulates apoptosis and increases superoxide production in PMN from patients undergoing infrarenal abdominal aortic aneurysm repair.
Decker, D, Springer, W, Tolba, R, Lauschke, H, Hirner, A, von Ruecker, A
Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society. 2005;(3):193-9
Abstract
BACKGROUND Recombinant human growth hormone (hGH) therapy has a beneficial effect on catabolism and wound healing after major surgery. Polymorphonuclear neutrophils (PMN) play an important role in this context. In a prospective, double-blind, randomized, placebo-controlled trial we studied the effect of perioperative hGH treatment on postoperative wound healing and on changes in superoxide generation and susceptibility to apoptosis of PMN in elderly patients undergoing elective abdominal aortic aneurysm repair. METHODS Seven patients were treated with high-dose hGH (16 U/d) for nine days, seven patients with a placebo. IGF-I, neutrophil count, O2-production induced by opsonized zymosan and apoptosis of PMN were measured and correlated with clinical outcome. RESULTS Perioperative hGH treatment more than doubled the O2- production in PMN before and 24 h after surgery (p < 0.01). The long-term capacity of PMN to generate O2 in vitro was prolonged (p < 0.001) in the hGH group. Spontaneous and Fas-inducible apoptosis was strongly down-regulated in PMN after surgery in all patients (p < 0.01). hGH-treatment distinctly reduced apoptosis in PMN before and after surgery (p < 0.01). Clinical outcome was similar in both groups. CONCLUSION Perioperative hGH treatment results in an enhanced O2- production in PMN and in a prolongation of the functional life span of these cells. This may improve immune function and help to overcome the postoperative anergic state of the immune system especially in elderly individuals.
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[Feasibility of short-term antibiotic prophylaxis after pulmonary resection].
Otani, S, Endo, S, Sato, Y, Hasegawa, T, Saito, N, Sohara, Y
Kyobu geka. The Japanese journal of thoracic surgery. 2004;(13):1171-4; discussion 1175-6
Abstract
How long to administer antibiotics after lung surgery is controversial. We investigated the feasibility of short-duration cefmetazole sodium administration as antibiotic prophylaxis after lung cancer surgery. A total of 40 patients were randomized into either a short-duration prophylaxis group (n=20) that was given 4 g of cefmetazole sodium for 2 days or a long-duration patients group (n=20) that was given 14 g of cefmetazole sodium for 7 days. Daily changes in body temperature, WBC, and plasma CRP concentration were determined for 9 days after surgery. The data were compared statistically between the 2 groups. Postoperative infection occurred in 20% of patients in the short-duration group and in 30% of patients in the long-duration group. The mean hospital stay after surgery was 15.5 days in the short-duration group and 18.6 days in the long-duration group. All variables did not differ significantly between the 2 groups. Our results indicate that short-duration antibiotic administration is an effective prophylactic treatment after surgery for lung cancer.
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Randomised clinical trial of synbiotic therapy in elective surgical patients.
Anderson, AD, McNaught, CE, Jain, PK, MacFie, J
Gut. 2004;(2):241-5
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Abstract
BACKGROUND It is possible to manipulate the composition of the gastrointestinal microflora by administration of pre- and probiotics. This may help to preserve gut barrier function and reduce the incidence of septic morbidity. AIMS To assess the effects of a combination of pre- and probiotics (synbiotic) on bacterial translocation, gastric colonisation, systemic inflammation, and septic morbidity in elective surgical patients. PATIENTS Patients were enrolled two weeks prior to elective abdominal surgery. Seventy two patients were randomised to the synbiotic group and 65 to the placebo group. Patients were well matched regarding age and sex distribution, diagnoses, and POSSUM scores. METHODS Patients in the synbiotic group received a two week preoperative course of Lactobacillus acidophilus La5, Bifidobacterium lactis Bb-12, Streptococcus thermophilus, and Lactobacillus bulgaricus, together with the prebiotic oligofructose. Patients in the placebo group received placebo capsules and sucrose powder. At surgery, a nasogastric aspirate, mesenteric lymph node, and scrapings of the terminal ileum were harvested for microbiological analysis. Serum was collected preoperatively and on postoperative days 1 and 7 for measurement of C reactive protein, interleukin 6, and antiendotoxin antibodies. Septic morbidity and mortality were recorded. RESULTS There were no significant differences between the synbiotic and control groups in bacterial translocation (12.1% v 10.7%; p = 0.808, chi(2)), gastric colonisation (41% v 44%; p = 0.719), systemic inflammation, or septic complications (32% v 31%; p = 0.882). CONCLUSIONS In this study, synbiotics had no measurable effect on gut barrier function in elective surgical patients. Further studies investigating the place of pre- and probiotics in clinical practice are required.