Reconstruction of the lower back wound with delayed infection after spinal surgery:A case report

BACKGROUND Orthopedic surgeries after device implantation are susceptible to infections and may require device removal in the worst cases.For this reason,many efforts are being made to control infections after spinal surgery;however,the number of infec-tion cases is increasing owing to the increasing number of elderly citizens.CASE SUMMARY A 75-year-old male with a chronic spinal defect due to previous spine surgery underwent reconstruction using a perforator-based island flap.After bursectomy and confirmation that there was no connection with the deep tissue,reconstruction was performed.However,wound disruption occurred with abscess formation on postoperative day 29,which led to an imaging workup revealing delayed deep tissue infection.CONCLUSION Infection is one of the most common causes of surgical wound dehiscence and is associated with devastating results if not controlled promptly and definitively.Surgeons should always suspect delayed infections when reconstructing chronic soft tissue defects.

An Observational Study of Midline Abdominal Wound Closure Using Small Tissue Bites versus Large Tissue Bites with Reference to Surgical Site Infections and Wound Dehiscence

Background: Midline incisions have advantage of rapid and wide access to the abdominal cavity with minimal damage to muscles, nerves and the vascular supply of the abdominal wall, hence causing minimal long term morbidity. The techniques of wound closure after midline laparotomy differ among operating surgeons and institutions. Faulty techniques and suture materials used play a crucial role in post-operative wound complications like stich abscess, surgical site infections, wound burst and incisional hernia. Aims: The aim of this study is to assess the outcome of midline abdominal wound closure using small tissue bites versus large tissue bites with reference to surgical site infection and wound dehiscence. Materials and methods: The study is the prospective observational study conducted in the department of general surgery Government Medical College Srinagar. A total of 100 cases were enrolled and studied who underwent midline laparotomy in the elective as well as emergency settings from 2015 to 2018. In 50 patients midline incisions were closed with large tissue bites placed at least 10 mm from the wound edge and 10 mm apart and in another 50 patients small tissue bites were used placed 5 - 7 mm from the wound edge and 5 - 7 mm apart and included only the aponeurosis in the stitches without peritoneum. Results: In all, 100 patients, 50 patients were subjected to large tissue bites and another 50 patients to small tissue bites. 15 patients out of 50 patients (30%) in large tissue bites group and 10 patients (20%) in small tissue bites developed surgical site infection. 8 patients out of 50 patients (16%) in large tissue bites group and 4 patients (8%) in small tissue bites developed wound dehiscence. Conclusion: A total of 100 patients who underwent abdominal surgery through midline incision were divided into two groups. In 50 patients midline wound was closed using large tissue bites and in other 50 patients;small tissue bites was used to close midline incision including only aponeurosis. The research findings show that the small stitch length between 5 to 7 mm depending on the wound site is the ideal stitch length to close a midline incision. However, there was no statistical deference seen in both groups with reference to surgical site infection and wound dehiscence.

Wound irrigation for preventing surgical site infections

Wound irrigation(i.e.washing out a wound before wound closure)aims to reduce the microbial burden by removing tissue debris,metabolic waste,and tissue exudate from the surgical field before site closure.Although it is a popular procedure in every day surgical practice,the lack of procedure standardization,leads to studies with high heterogeneity and often controversial results.Thus,there are studies that advocate its use,while others discourage its implementation in clinical practice to reduce the risk of surgical site infection.The present article reviews the current literature on wound irrigation for preventing surgical site infections.Several irrigants are presented.Chlorexidine is generally considered to be less effective than povidone-iodine,while antibiotics are not that common nowadays,as they require prolonged exposure with the target to act.Hydrogen peroxide has several potential complications,which eliminate its use.Any differences in the incidence of surgical site infections between different irrigants,especially between antibacterial and non-bacterial ones,should be viewed sceptically.More randomized controlled studies are needed to provide better quality of evidence regarding the irrigants'effectiveness and safety.

Incisional Negative Pressure Wound Therapy in the Prevention of Surgical Site Infection after Vascular Surgery with Inguinal Incisions: Rationale and Design of a Randomized Controlled Trial (INVIPS-Trial)

Background/Aims: Inguinal incisions are a common route of access in vascular surgery. Due to anatomical challenges and a diverse bacterial flora in this area, surgical site infections (SSI) represent a common, debilitating and sometimes life-threatening complication. The INVIPS-Trial evaluates the role of Negative Pressure Wound Therapy (NPWT) on closed inguinal incisions in elective vascular surgery to prevent SSI and other wound complications. Methods: This randomized controlled trial (RCT) registered at ClinicalTrials.gov (Identifier: NCT01913132) compares the effects of a NPWT dressing (PICO, Smith & Nephew, UK) and the center’s standard wound dressing (Vitri Pad, ViTri Medical, Sweden) on postoperative wound complications, especially SSI. The study includes two distinct vascular procedures with different SSI risk profiles: endovascular aortic repair (EVAR) and open surgical approaches involving the common femoral artery (OPEN). Results: Four hundred ninety-five groin incisions in both treatment arms are anticipated to be included in the EVAR group and 147 inguinal incisions in both treatment arms in the OPEN group. Since a large percentage of inguinal vascular procedures in both groups but especially in the EVAR group are performed bilaterally, many patients can serve as their own control by randomly receiving NPWT on one and the standard dressing on the contralateral inguinal incision. Conclusions: This ongoing RCT attempts to elucidate the potential benefit of NPWT on closed inguinal incisions after different vascular procedures. Outcome and conclusions of this trial could have implications on postoperative wound care of patients in both vascular surgery and other surgical specialties.

Analysis of a ten step protocol to decrease postoperative spinal wound infections

AIM To define a ten-step protocol that reduced the incidence of surgical site infection in the spine surgery practice of the senior author and evaluate the support for each step based on current literature.METHODS In response to unexplained increased infection rates at our institution following spine surgery,a ten-step protocol was implemented:(1) preoperative glycemic management based on hemoglobin A1 c(HbA1 c);(2) skin site preoperative preparation with 2% chlorhexidine gluconate disposable cloths;(3) limit operating room traffic;(4) cut the number of personnel in the room to the minimum required;(5) absolutely no flash sterilization of equipment;(6) double-gloving with frequent changing of outer gloves;(7) local application of vancomycin powder;(8) re-dosing antibiotic every 4 h for prolonged procedures and extending postoperative coverage to 72 h for high-risk patients;(9) irrigation of subcutaneous tissue with diluted povidone-iodine solution after deep fascial closure; and(10) use of Dura Prep skin preparation at the end of a case before skin closure. Through an extensive literature review,the current data available for each of the ten steps was evaluated.RESULTS Use of vancomycin powder in surgical wounds,routine irrigation of surgical site,and frequent changing of surgical gloves are strongly supported by the literature. Preoperative skin preparation with chlorhexidine wipes is similarly supported. The majority of current literature supports control of HbA1 c preoperatively to reduce risk of infection. Limiting the use of flash sterilization is supported,but has not been evaluated in spine-specific surgery. Limiting OR traffic and number of personnel in the OR are supported although without level 1 evidence. Prolonged use of antibiotics postoperativelyis not supported by the literature. Intraoperative use of Dura Prep prior to skin closure is not yet explored.CONCLUSION The ten-step protocol defined herein has significantly helped in decreasing surgical site infection rate. Several of the steps have already been shown in the literature to have significant effect on infection rates. As several measures are required to prevent infection,instituting a standard protocol for all the described steps appears beneficial.

Vancomycin lavage for the incidence of acute surgical site infection following primary total hip arthroplasty and total knee arthroplasty

BACKGROUND Surgical site infection is a rare but serious complication associated with total joint arthroplasty(TJA).There are limited data on the effectiveness of intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure for preventing acute surgical site infection following primary total hip arthroplasty(THA)and total knee arthroplasty(TKA).AIM To investigate the effectiveness of prophylactic intraoperative application of vancomycin(1000 mg/L;2 L)solution vs.plain irrigation in reducing the incidence of acute surgical site infection following primary THA and TKA.METHODS A retrospective review of 2725 consecutive patients undergoing THA or TKA from January 2012–December 2019 was performed.These patients received either intrawound irrigation with normal saline before wound closure between January 2012 and December 2015(group 1,1018 patients;453 undergoing THA and 565 undergoing TKA)or intrawound irrigation with vancomycin solution(1000 mg/L)before wound closure between January 2016 and December 2019(group 2,1175 patients;512 undergoing THA and 663 undergoing TKA).The outcomes were the incidences of postoperative surgical site infection and wound healing complications within 3 mo of primary TJA.RESULTS There were no significant demographic differences between the 2 groups.There was a significantly higher incidence of acute infection at the surgical site in patients who received intrawound irrigation with normal saline before wound closure than in those who received intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure(overall incidence of infection:group 1,2.46%vs group 2,0.09%,P<0.001).There was no significant difference in the incidence of wound healing complications between the two groups.CONCLUSION Prophylactic irrigation with vancomycin solution(1000 mg/L;2 L)significantly decreases the incidence of acute surgical site infection after primary TJA.This strategy is a safe,efficacious,and inexpensive method for reducing the incidence of acute surgical site infection after TJA.

Risk Factors for Wound Infection Following Caesarean Section: A Case Control Study from Sir Salimullah Medical College &Mitford Hospital in Dhaka, Bangladesh

Background: Post caesarean section (CS) wound infection or surgical site infection is a leading cause of prolonged hospital stay or readmission. An understanding of its risk factors is important. Methods: A case control study was conducted in the Department of Obstetrics and Gynecology of Sir Salimullah Medical College & Mitford Hospital, in Dhaka, Bangladesh from January to June 2014 to evaluate the risk factors of postoperative surgical site infection following CS. One hundred patients were studied. Results: Fifty patients of post CS wound infection (surgical site infection: SSI) were selected as cases. Body mass index > 25 (kg/m2), anemia (p = 0.001), prolonged rupture of membrane (p = 0.005), prolonged operation time (p = 0.019), and junior surgeons performing the operation (p = 0.011) were the risk factors for CS-SSI. Conclusions: Pre- and postoperative care and surgical training of junior doctors should be directed to these risk factors.

Intraoperative vs 24-Hour Administration of Cefamandole to Prevent Deep Sternal Wound Infection and Endocarditis after Adult Cardiac Surgery

Background and Objectives: Duration of antibiotic prophylaxis for cardiac surgery is still debated and controversial. International guidelines are vague: French guidelines recommend an intraoperative administration, while the Society of Thoracic Surgeons’ guidelines suggest that optimal postoperative prophylactic antibiotics be given for 48 hours or less. Very few studies have compared the same antibiotic with 2 different administration durations. The study was designed to compare the efficacy of 24-hour administration of cefamandole vs intraoperative cefamandole to prevent deep sternal wound infection and endocarditis after cardiac surgery. Methods: This retrospective and observational study compared the rates of severe surgical site infections (deep sternal wound infection, endocarditis) after cardiac surgery between period 1, 01/01/2008-31/08/2008, with 24-hour administration of cefamandole, and period 2, 01/09/2008-30/04/2009 with intraoperative cefamandole. Results: Among 933 patients, 14 patients (1.5%) developed surgical site infection during the 16-month study: 1.3% during the first period and 1.7% during the second (ns). The populations (470 patients in period 1 and 463 in period 2) were homogeneous and comparable for pre-, intra- and postoperative characteristics. Surgical site infection characteristics (pathogens involved, time to diagnosis) and consequences (longer hospital stay, outcomes) were comparable in the 2 groups. Conclusions: Intraoperative cefamandole was as safe as its 24-hour administration to prevent deep sternal wound infection and endocarditis after adult cardiac surgery.

在人工关节置换术中应用聚维酮碘溶液冲洗预防术后感染效果的Meta分析

目的:系统评价在人工关节置换术中应用聚维酮碘溶液冲洗预防术后感染的效果。方法:应用计算机检索中国知网、万方数据库、PubMed、Embase、Web of Science和Cochrane Library中关于在人工关节置换术中应用聚维酮碘溶液冲洗预防术后感染的对比研究文献,检索时限均为建库至2023年11月1日。试验组术中采用聚维酮碘溶液冲洗,对照组术中采用其他冲洗液冲洗。依据文献检索及筛选方案筛选出符合要求的文献后,由2名研究人员分别独立进行数据提取和质量评价。采用RevMan5.3软件进行Meta分析。结果:共检索到601篇文献,最终纳入14篇,共涉及61 471例患者,其中试验组20 110例、对照组41 361例。2组总感染发生率、假体周围感染发生率、切口延迟愈合或不愈合发生率、二次手术率的组间比较,差异均无统计学意义[OR=0.68,95%CI(0.43,1.07),P=0.090;OR=0.68,95%CI(0.38,1.23),P=0.210;OR=2.08,95%CI(0.73,5.96),P=0.170;OR=1.18,95%CI(0.92,1.51),P=0.200],试验组浅层感染发生率低于对照组[OR=0.52,95%CI(0.30,0.89),P=0.020]。结论:现有证据表明,与其他冲洗液相比,在人工关节置换术中应用聚维酮碘溶液冲洗并不能显著减少术后假体周围感染和切口延迟愈合或不愈合的发生,但能减少术后浅层感染的发生。

Colon perforation with severe peritonitis caused by erotic toy insertion and treated using vacuum-assisted closure:A case report

BACKGROUND Colorectal foreign bodies are commonly encountered during surgery.They are frequently observed in men 20 to 90 years of age and have bimodal age distribution.Surgical management is necessary for cases of rectal perforation.However,surgical site infections are the most common complications after colorectal surgery.CASE SUMMARY We discuss a case of rectal perforation in a patient who presented to our hospital 2 d after its occurrence.The perforation occurred as a result of the patient inserting a sex toy in his rectum.Severe peritonitis was attributable to delayed presentation.CONCLUSION Vacuum-assisted closure was performed to treat the wound,which healed well after therapy.No complications were noted.

急诊外科创伤手术患者给予抗感染治疗的效果分析

目的:观察急诊外科创伤手术患者给予抗感染治疗的效果。方法:选取2022年1月—2023年1月于广西壮族自治区江滨医院急诊科进行急诊外科创伤手术的患者90例为研究对象,根据随机数字表法分为对照组与观察组,各45例。对照组给予常规消毒治疗,观察组在对照组基础上给予抗感染治疗。比较两组炎性因子水平、伤口细菌定量、伤口微循环状况的变化,并观察两组伤口愈合情况。结果:治疗后,两组白细胞介素-8、C反应蛋白水平均降低,观察组低于对照组,差异有统计学意义(P<0.05);治疗后,两组伤口细菌定量水平均降低,观察组低于对照组,差异有统计学意义(P<0.05);治疗后,两组伤口血流量、经皮氧分压均升高,观察组高于对照组,差异有统计学意义(P<0.05)。观察组A级占比高于对照组,C级占比低于对照组,差异有统计学意义(P<0.05)。结论:临床对急诊外科创伤手术患者给予抗感染治疗可改善炎性因子水平、伤口微循环状况,降低伤口细菌定量,促进伤口愈合。

Biological mesh reconstruction of the pelvic floor following abdominoperineal excision for cancer:A review

Extralevator abdominoperineal excision and pelvic exenteration are mutilating operations that leave wide perineal wounds.Such large wounds are prone to infection and perineal herniation,and their closure is a major concern to most surgeons.Different approaches to the perineal repair exist,varying from primary or mesh closure to myocutaneous flaps.Each technique has its own associated advantages and potential complications and the ideal approach is still debated.In the present study,we reviewed the current literature and our own local data regarding the use of biological mesh for perineal wound closure.Current evidence suggests that the use of biological mesh carries an acceptable risk of wound complications compared to primary closure and is similar to flap reconstruction.In addition,the rate of perineal hernia is lower in early follow-up,while long-term hernia occurrence appears to be similar between the different techniques.Finally,it is an easy and quick reconstruction method.Although more expensive than primary closure,the cost associated with the use of a biological mesh is at least equal,if not less,than flap reconstruction.

New skin closure system facilitates wound healing after cardiovascular implantable electronic device surgery

The manuscript describes the efficacy of a new skin closure system(Zip Line?) for wound closure after pacemaker/implantable cardioverter defibrillator surgery. The system is particularly useful when wound healingis difficult with traditional methods and in patients at high risk for surgical site infections(SSIs). This skin closure option is easy and quick to apply and remove, and produces excellent cosmetic results. Although it is associated with a minimal expense upcharge, the benefits, including the potential for decrease in SSI, make it attractive and worth considering for skin closure in device patients, particularly those at increased risk of complications.

Postpartum Infection in Morbidly Obese Women after Caesarean Section: Does Early Prophylactic Oral Antibiotic Use Make a Difference?

The rising prevalence of morbid obesity particularly in women coupled with a higher likelihood of having a caesarean section (C-section) birth and an increased risk of surgical site infection (SSI) places wound management among priority areas in maternity care. There is ambiguity about the efficacy of routine preventative care pathways particularly in morbid obese women with regards to SSI after caesarean section. A pilot study was therefore undertaken to explore the number of women with a C-section infection in a cohort of morbidly obese women during six weeks postpartum against a protocol of standard care of early antibiotic prophylaxis and skin closure practice. A short questionnaire was sent to 59 women with an early pregnancy BMI ≥ 40 who gave birth?via?C-section in a large maternity unit in Sheffield, UK. Data were collated from 39 women with 20 (51%) developing a post-operative wound infection within 6 weeks postpartum. Infections were higher in the women who had emergency C-section births (14/24, 60%). There was no significant difference in wound infection risk with respect to wound closure material (Chi-square = 0.298, p-value = 0.86) or the use of oral prophylactic antibiotic after birth (Chi-square = 0.2053, p-value = 0.650). Although all the women received routine intravenous (IV) antibiotics before C-section, only 26/39 received the 5-day oral antibiotic prophylaxis after birth. Six of 13 women who did not receive postpartum oral antibiotics (46%) developed a SSI. In summary, over half of morbidly obese women who delivered by C-section developed a wound infection, despite receiving prophylactic antibiotics. We acknowledge the limitations of these results from?a small-sample retrospective observational study. However,?this may indicate that post operative antibiotic prophylaxis confers no additional benefit in this group of patients and thus requires further investigation.

The Keys to Optimising Breast Wounds: A Meta-Analysis

Background: Breast disease and breast cancer management form a major part of healthcare delivery. Surgical site occurrence (SSO) poses septic and oncological risks to patients. This study undertook a meta-analysis to identify key risk factors and interventions that may alter the incidence of SSO in patients undergoing breast surgery. Methods: An ethically approved, PROSPERO-registered meta-analysis following PRISMA guidelines and Cochrane Handbook for Systematic Reviews was undertaken of all published English articles using electronic databases from 2010 to 2017 incorporating MeSH terms “risk factors”, “surgical site infections”, “breast surgery”, and “interventions”. Articles scoring > 10 for non-comparative studies and >15 for comparative studies, using MINORS criteria were included. The OR or RR using random-effects, Mantel-Haenszel method were computed for each risk factor and intervention respectively with RevMan 5. Results: The pre-operative factors affecting breast surgery SSO were diabetes mellitus (OR = 2.52, CI = 1.78 - 3.59, p < 0.001), smoking (OR = 2.39, CI = 1.57 - 3.63, p < 0.001), ASA ≥ III (OR = 2.37, CI = 1.51 - 3.74, p < 0.001), obese versus non-obese (OR = 1.84, CI = 1.52 - 2.24, p < 0.001), over-weight/obese versus normal BMI (OR = 1.70, CI = 1.36 - 2.13, p < 0.001), hypertension (OR = 1.63, CI = 1.39 - 1.90, p < 0.001), and antibiotics prophylaxis (RR = 0.58, CI = 0.36 - 0.95, p = 0.03). The intraoperative factors were surgical wound classifications 3 - 4 (OR = 6.16, CI = 2.52 - 15.02, p < 0.001), surgical drains (OR = 2.80, CI = 1.06 - 7.38, p = 0.04), and axillary lymph node dissection (OR = 1.46, CI = 1.18 - 1.80, p < 0.001). The post-operative factors were adjuvant radiotherapy (OR = 1.77, CI = 1.26 - 2.50, p = 0.001), re-operated patients (OR = 1.65, CI = 1.01 - 2.70, p = 0.05), post-operative antibiotics (RR = 0.57, CI = 0.33 - 0.98, p = 0.04), and drain antisepsis care (RR = 0.15, CI = 0.03 - 0.82, p = 0.03). Conclusions: This study identified key factors associated with increased risk of breast surgery wound occurrence. It will facilitate the development of a peri-operative breast wound bundle to optimize outcomes.

Systematic review of absorbable vs non-absorbable sutures used for the closure of surgical incisions

AIM: To report a systematic review of published randomized controlled trials(RCTs) investigating the role of absorbable suture(AS) against non-AS(NAS) used for the closure of surgical incisions.METHODS: RCTs investigating the use of AS vs NAS for the closure of surgical incisions were statistically analysed based upon the principles of meta-analysis and the summated outcomes were represented as OR.RESULTS: The systematic search of medical literature yielded 10 RCTs on 1354 patients. Prevalence of wound infection(OR = 0.97; 95%CI: 0.56, 1.69; Z = 0.11; P = 0.92) and operative morbidity(P = 0.45) was comparable in both groups. Nonetheless, the use of AS lead to lower risk of wound break-down(OR = 0.12; 95%CI: 0.04, 0.39; Z = 3.52; P < 0.0004).CONCLUSION: This meta-analysis of 10 RCTs demonstrates that the use of AS is similar to NAS for skin closure for surgical site infection and other operative morbidities. AS do not increase the risk of skin wound dehiscence,rather lead to a reduced risk of wound dehiscence compared to NAS.

Comparison of modified gunsight suture technique and traditional interrupted suture in enterostomy closure

BACKGROUND Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection due to trauma or tumors.However,the traditional interrupted suturing technique used in enterostomy closure surgery has several issues,including longer surgical incisions and higher incision tension,which can increase the risk of postoperative complications.To address these issues,scholars have proposed the use of a“gunsight suture”technique.This technique involves using a gunsight incision instead of a traditional linear incision,leaving a gap in the center for the drainage of blood and fluid to reduce the risk of infection.Building on this technique,we propose an improved gunsight suture technique.A drainage tube is placed at the lowest point of the incision and close the gap in the center of the gunsight suture,which theoretically facilitates early postoperative mobility and reduces the burden of dressing changes,thereby reducing the risk of postoperative complications.AIM To compare the effectiveness of improved gunsight suture technique with traditional interrupted suture in closing intestinal stomas.METHODS In this study,a retrospective,single-center case analysis was conducted on 270 patients who underwent prophylactic ileostomy closure surgery at the Department of Colorectal Surgery of Qilu Hospital from April 2017 to December 2021.The patients were divided into two groups:135 patients received sutures using the improved gunsight method,while the remaining 135 patients were sutured with the traditional interrupted suture method.We collected data on a variety of parameters,such as operation time,postoperative pain score,body temperature,length of hospital stays,laboratory indicators,incidence of incisional complications,number of wound dressing changes,and hospitalization costs.Non-parametric tests and chi-square tests were utilized for data analysis.RESULTS There were no statistically significant differences in general patient information between the two groups,including the interval between the first surgery and the stoma closure[132(105,184)d vs 134(109,181)d,P=0.63],gender ratio(0.64 vs 0.69,P=0.44),age[62(52,68)years vs 60(52,68)years,P=0.33],preoperative body mass index(BMI)[23.83(21.60,25.95)kg/m²vs 23.12(20.94,25.06)kg/m²,P=0.17].The incidence of incision infection in the improved gunsight suture group tended to be lower than that in the traditional interrupted suture group[(n=2/135,1.4%)vs(n=10/135,7.4%),P<0.05],and the postoperative hospital stay in the improved gunsight suture group was significantly shorter than that in the traditional interrupted suture group[5(4,7)d vs 7(6,8)d,P<0.05].Additionally,the surgical cost in the modified gunsight suture group was slightly lower than that in the traditional suture group[4840(4330,5138)yuan vs 4980(4726,5221)yuan,P>0.05],but there was no significant difference in the total hospitalization cost between the two groups.CONCLUSION In stoma closure surgery,the improved gunsight technique can reduce the incision infection rate,shorten the postoperative hospital stay,reduce wound tension,and provide better wound cosmetic effects compared to traditional interrupted suture.

分层引流联合乳头内陷矫正术治疗非哺乳期乳腺炎合并乳头内陷的效果及安全性观察

目的探讨分层引流联合乳头内陷矫正术治疗非哺乳期乳腺炎合并乳头内陷的临床效果。方法选择2022年6月—2023年6月收治的非哺乳期乳腺炎合并乳头内陷120例,应用随机数字表法分为观察组和对照组,每组60例。对照组采用常规炎症病灶切除配合单层引流加药物治疗,观察组在对照组基础上采用分层引流联合乳头内陷矫正术治疗。比较2组治愈率、乳房外观满意度、术后积液排出率、复发率、术后并发症发生率。结果观察组总有效率高于对照组(P<0.05)。观察组乳头凸起、乳头形态、触碰感受评分均高于对照组,且乳房形态完整率高于对照组(P<0.01)。观察组复发率低于对照组,术后积液排出率高于对照组(P<0.01)。观察组术后感染率及并发症总发生率低于对照组(P<0.01)。结论分层引流联合乳头内陷矫正术为治疗非哺乳期乳腺炎合并乳头内陷的有效手段,可取得满意手术效果,提高美容效果,预防复发,且并发症发生率低。

脑深部电刺激器再植入术后脑脓肿1例报告并文献复习

目的 探讨帕金森病患者脑深部电极再植入术后发生脑脓肿的临床特点及治疗措施。方法 回顾性分析中南大学湘雅医院神经外科2020年6月收治的1例在脑深部电极再植入术后发生脑脓肿的帕金森患者的临床资料,并对相关文献进行复习。结果 因第一次植入术后皮下感染,所有植入物均被移除,并接受敏感抗生素治疗。4个月后,再次行植入手术。患者术后出现严重颅内脓肿,再次取出植入物,并接受立体定向脓肿穿刺引流术及抗生素治疗,最终康复。结论 有潜在感染风险的患者在脑深部电极再次植入手术前,需进行足量足疗程的抗感染治疗,并进行全面的感染指标检查,以明确感染是否已完全消除。

头孢唑林钠对手外科感染患者临床疗效及对创面感染的影响

目的探讨头孢唑林钠对手外科感染患者临床疗效及对创面感染的影响。方法选取2020年4月至2021年6月北京市顺义区医院收治的86例手外科感染患者作为研究对象,根据随机数字表法分为对照组(43例)和观察组(43例)。对照组患者采用阿莫西林钠-克拉维酸钾进行治疗,观察组采用头孢唑林钠进行治疗。比较两组患者临床治疗效果、治疗前后疼痛评分、炎症因子及两组用药后感染发生率。结果观察组治疗有效率(97.67%)明显高于对照组(83.72%),差异有统计学意义(P<0.05)。治疗前,两组患者疼痛评分比较,差异无统计学意义(P>0.05);治疗后,观察组疼痛评分明显低于对照组,差异有统计学意义(P<0.05)。用药前,两组患者的炎症因子TNF-α、IL-8、IL-6及CRP水平比较,差异无统计学意义(P>0.05);用药后,观察组患者炎症因子TNF-α、IL-8、IL-6及CRP水平明显优于对照组,差异有统计学意义(P<0.05)。用药治疗后,观察组感染发生率(2.33%)明显低于对照组(13.95%),差异有统计学意义(P<0.05)。结论头孢唑林钠治疗手外科感染患者,可有效修复其创面感染,降低其因感染带来的疼痛,改善其炎症因子水平,可效有避免其再次感染的发生率,临床治疗效果显著。