Cases reported "Surgical Wound Dehiscence"

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331/393. Anastomotic disjunction in long-term patent vascular synthetic grafts in Dacron.

    This study follows the recently published paper on the in vivo behaviour of patent Dacron vascular prostheses and focuses in particular on anastomotic disjunction. The question of the evolution of anastomoses was tackled by examining its three basic components: prosthetic tissue, suture thread and arterial wall. The authors' observations were based on material taken from reoperations performed between 7 and 18 years after the first graft. These data enable the authors to affirm that the prosthesis undergoes a general physical and chemical deterioration which varies in intensity according to the type of weaving. On the contrary, in the anastomotic zone this phenomenon is not intense enough to jeopardize the anchorage of the suture thread since the original weft does not show any loss of compactness. In spite of surface morphological deterioration of various intensity, the suture threads maintain satisfactory mechanical properties and structural integrity. The artery wall in the anastomotic zone shows a massive degeneration in terms of its true anatomic structure responsible for the rupture of the suture rima. On the basis of these results the authors conclude that this phenomenon represents the "Achilles' heel" of anastomotic junction. ( info)

332/393. Optimal regional coverage of exposed in situ vein bypass by muscle flaps.

    Three patients with exposed in situ saphenous vein bypass resulting from major wound breakdown in the groin, thigh, and calf are reported. Successful coverage of the exposed arterial bypass was accomplished by appropriately placed myocutaneous or muscle flaps at three different anatomical locations in combination with antibiotic therapy and aggressive debridement. ( info)

333/393. Inferiorly based rectus abdominis flaps in critically ill and injured patients.

    Use of the rectus abdominis muscle as a free or pedicled flap is generally well tolerated by patients and accomplishes its intended purpose with minimal morbidity. In chronic or nonacute situations, high rates of success of tissue transfer and low donor site morbidity is expected. We have reviewed our results in 26 patients undergoing inferiorly based rectus abdominis muscle flaps with particular attention to the donor site. patients with multiple injuries, who have had recent abdominal laparotomy, have a significantly higher morbidity rate. Dehiscence of the abdominal wound in 3 patients and a mortal donor site infection in 1 patient after transfer of a rectus flap has led to a careful examination of the cause for these complications. Careless closure of the midline laparotomy wound with subsequent elevation of a rectus flap lends itself to ischemia of the fascia and potential dehiscence. This is especially true in seriously ill patients on ventilators with abdominal distention and nutritional compromise. Alternate sources of tissue should be used if practical in these patients. ( info)

334/393. cryotherapy to close a corneal subepithelial aqueous track after trabeculectomy.

    After filtering surgery for primary open-angle glaucoma in a 64-year-old man, a persistent wound leak was encountered from the fornix-based conjunctival flap. Cyanoacrylate adhesive was applied but was unsuccessful in sealing the leak. The limbal margin was sutured with 10/0 nylon. One week later a corneal subepithelial fistulous track developed from the edge of the bleb and extended across the cornea towards the inferonasal limbus. The inferior end of the track leaked aqueous. Further surgery was performed to refashion the conjunctival bleb, ablate the fistula at its origin and re-form the anterior chamber. The track recurred 16 days later. The upper cornea was then treated with cryotherapy, which successfully closed the track with maintenance of a functional bleb (ocular pressure 6 mmHg). A faint asymptomatic subepithelial scar persisted. ( info)

335/393. A shunting procedure for cerebrospinal fluid fistula, employing cannulation of the third and fourth ventricles.

    A modified third/fourth ventriculoperitoneal shunt is described. This procedure was used to deal with postoperative cerebrospinal fluid fistulae refractory to treatment by simpler routine measures. The possible indications of the operation are discussed. ( info)

336/393. Corneal incision dehiscence during penetrating keratoplasty nine years after radial keratotomy.

    As the use of radial keratotomy (RK) to correct myopia increases, more patients are having penetrating keratoplasty (PK). Radial keratotomy incisions are known to show incomplete wound healing. When the radial corneal RK incisions are cut by the corneal trephine, the peripheral part of each incision may open, even years after surgery. In this case, a 56-year-old man had visual distortion and diplopia in one eye nine years after RK. contact lenses did not correct the problem, and the patient could not tolerate the contact lenses. Penetrating keratoplasty was performed. During surgery about one-third of the peripheral RK incisions spontaneously opened, making suturing difficult. Although the final visual result was 20/20 corrected acuity, this case shows that RK incisions may remain incompletely healed and easily open during PK surgery as long as nine years after the RK surgery. ( info)

337/393. Expanded polytetrafluoroethylene patch versus polypropylene mesh for the repair of contaminated defects of the abdominal wall.

    Contaminated defects of the abdominal wall continue to be a significant problem for patients and surgeons. The lack of sufficient tissue may require the insertion of a prosthetic material. Polypropylene (PP) mesh is still the most widely used material for this purpose, although the propensity to induce extensive visceral adhesions and erosion of the skin or intestine is a well-known drawback. Expanded polytetrafluoroethylene (PTFE) patch has better mechanical properties and has a low potential for infection. Therefore, we used expanded PTFE patch to repair contaminated abdominal wall defects in three patients. In one patient, the postoperative course was uneventful. In the other two patients, the patch had to be removed for ongoing wound sepsis and because the patch disintegrated. In an experimental study, contaminated abdominal wall defects created in Wistar rats were repaired with expanded PTFE patch (PTFE group, n = 21) or PP (PP group, n = 21). wound infection occurred in 16 rats in the PTFE group and in 14 rats in the PP group. Two rats in each group died. Two rats in the PTFE group died as a result of peritonitis, one rat in the PP group died as a result of ileus and one as a result of peritonitis. Incisional hernia was found to be significantly more frequent in the PTFE group (n = 13) than in the PP group (n = 3). fistula formation was only found in three rats in the PP group. Adhesion formation was more pronounced in rats in the PP group. It is concluded that the expanded PTFE is unsuitable for the reconstruction of contaminated abdominal wall defects and that PP mesh is more suitable, although this material has a high risk of complications. ( info)

338/393. Superglue sealant for persistent leakage of cerebrospinal fluid.

    A patient is presented in whom a persistent low-pressure CSF leak was stopped by using histoacryl tissue glue following initial local flap closure. ( info)

339/393. Futility of muscle flaps for self-inflicted wounds.

    Unacceptable forms of self-mutilation usually are resistant to surgical intervention and have a basis in psychopathology. Establishing this diagnosis may be as difficult as is the treatment, frequently involving a prolonged process of exclusion of other known disease entities. Management of these chronic self-inflicted wounds demands flexibility by the surgeon who must be aware of this possibility and willing to deviate from the normal approach to wound healing. Simplicity is of paramount importance. The use of vascularized tissues and, in particular, the sacrifice of scarce muscle flaps probably is unwarranted except as a last resort because these wounds nevertheless remain recalcitrant to permanent healing. Instead, a nonconfrontational approach with long-term psychotherapy should be a major part of the initial therapy with surgery considered only important in an adjunctive role. ( info)

340/393. Avoiding blow-out of the aortic stump by reinforcement with fibrin glue. A report of two cases.

    Generally vascular surgeons agree that the most rational way to treat a patient with an infected aortic graft or aortoenteric fistula is excision of the graft, closure of the aortic stump and construction of an axillobifemoral bypass. Due to the feared complication of blow-out of the aortic stump, other solutions have been proposed, such as in-situ reconstruction with homologous saphenous veins or even with a synthetic graft, provided the perigraft fluid is non-purulent. Since this alternative is not always feasible, various methods to reinforce the closure of the aortic stump have been proposed. The present report describes two cases, where fibrin glue (Tisseel) was successfully used to reinforce the suture row of the aortic stump. ( info)
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