Influence of Surgical Incision Size and Interleukin 6 in the Occurrence of Postoperative Hyperalgesia in Lubumbashi/DR Congo

Background: It appeared that the conjunction inflammation and nerve damage (caused by surgery) generate the hyperalgesic component. But the probability of predicting hyperalgesia from the size of the surgical incision and/or the resulting inflammatory reaction is not well elucidated. This survey aims to study the influence of the size of the surgical incision and the resulting inflammatory reaction (interleukin 6 levels) in the occurrence of postoperative hyperalgesia in the population of Lubumbashi. Methods: The present study was descriptive cross-sectional. The data collection was prospective over 5 months, from February 1, 2024 to June 30, 2024. This study included any patient over the age of 18 who underwent surgery under general anesthesia. We used indirect signs to define hyperalgesia: higher (ENS > 6) and prolonged pain, postoperative overconsumption of morphine. Results: During our survey, we collected 48 operated patients who had severe postoperative pain, 16 of whom had hyperalgesia, i.e. a prevalence of hyperalgesia of 33.33%. The size of the incision most represented was between ≥20 and i.e. 62.50%. The type of surgery most affected by hyperalgesia was laparotomy. We observed an elevation of IL6 in 87.50% of patients. The largest elevation was 8.91 times the preoperative value and the smallest was 1.04 times. Pre- and postoperative IL6 levels were not associated with hyperalgesia (p = 0.265). Only the size of the surgical incision was associated with hyperalgesia (p = 0.04). Incision size values between [20 - 30] cm were those associated with hyperalgesia (p = 0.027). The model shows that making an incision greater than or equal to 20 cm increases the patient’s risk of developing hyperalgesia by more than 7.222 times and this is statistically significant (p = 0.004). Conclusion: According to this survey, the size of the surgical incision was associated with postoperative hyperalgesia and a size of more than 20 cm increases the patient’s risk of developing hyperalgesia by more than 7.222 times.

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.

Experimental and clinical study of influence of high-frequency electric surgical knives on healing of abdominal incision

AIM： To study the influence of high-frequency electric surgical knives on healing of abdominal incision. METHODS： Two hundred and forty white rats were divided into 10^0, 10^2, 10^5, and 10^8 groups and rat models of abdominal operation were induced by using electric surgical knives and common lancets respectively. Then they were respectively given hypodermic injections of normal saline and 0.2 mL quantitative mixture of Escherichia coil, Staphylococcus aureus and Pseudornonas aeruginosa at a concentration of 10^2, 10^5 and 10^8. On the basis of the animal experiment, 220 patients undergoing abdominal operations （above type Ⅱ） were randomly allocated into one of following three groups： electric knife （EK, 93 cases）, electro-coagulation （EC, 55 cases） and control （72 cases）. High-frequency electric surgical knives were used to dissect abdominal tissues and electro-coagulation for hemostasis in EK group. Common lancets and electro-coagulation were applied in EC group. Common lancets and tieing silk suture were used in the controls. RESULTS： In all the groups except group 10^0, infection rate of incisional wounds made by electric surgical knives were remarkably higher than that with common lancets. Furthermore, there were significant differences in groups 10^2, 10^5, and 10^8 （P 〈 0.05）, but not in group 10^0 （P 〉 0.05） between EK and EC groups. Clinical studies showed a delayed wound healing in 16 cases （17.20%） in EK, 11 cases （16.36%） in EC and 2 cases （2.86%）in the control groups. A significant difference between EK and the control groups （χ^2= 8.57, P 〈 0.01）, and between EC and the control groups （χ^2 = 5.66, P 〈 0.05） was observed, but not between EK and EC （χ^2= 0.017, P 〉 0.05）. CONCLUSION： High-frequency electric knives may remarkably delay abdominal incision healing. Its application should be minimized so as to reduce the possibility of postoperative complications.

Comparison of surgically induced astigmatism in various incisions in manual small incision cataract surgery

AIMTo determine the surgically induced astigmatism (SIA) in Straight, Frown and Inverted V shape (Chevron) incisions in manual small incision cataract surgery (SICS).

Comparison of surgically induced astigmatism among different surgeons performing the same incision

To compare surgically induced astigmatism （SIA） of different surgeons, who perform the same main incision. Two hundred and seventy eyes underwent cataract surgery with phacoemulsification by four different surgeons （A, B, C, and D）. A 3-step, 3.0 mm, superotemporal for the right eye and superonasa! for the left eye clear corneal incision was performed. A comparison in SlA among A, B, C and D surgeon was made. No significant difference was found in SlA at both first and sixth postoperative month between different surgeons （P〉0.05）. SIA is more dependent on incisional characteristics and preoperative astigmatism and less on the surgeon.

Transient Receptor Potential Ankyrin 1 Ion Channel Facilitates Acute Inflammation Induced by Surgical Incision in Mice

Background: Transient receptor potential ankyrin (TRPA) 1 is known as a peripheral initiator of acute inflammation and hyperalgesia. However, its role in the facilitation of innate immune responses followed by resolution of the inflammation triggered by a surgical incision has not been fully investigated. Therefore, we evaluated the mechanism by which TRPA1 regulates the inflammatory responses mainly facilitated by neutrophils and macrophages in the early course of wound repair after an incision. Methods: Plantar incision was performed in wild-type and TRPA1-/- mice. The infiltration of polymorphonuclear neutrophils, macrophage phenotype, and induction of inflammatory mediators were assessed for 7 days postoperatively. Results: TRPA1-/-?mice exhibited decreased infiltration of polymorphonuclear neutrophilscompared with wild-type mice on day 1. Consistently, the influx of F4/80+ iNOS+ proinflammatory M1 macrophages to incised sites was markedly decreased on day 2. Similarly, F4/80+ CD206+M2 macrophages, which regulate the resolution of inflammation and promote wound healing in the later phase of acute inflammation, were significantly decreased in TRPA1-/- compared with those in wild-type mice on day 7. In addition, the induction of heme oxygenase-1, which promotes wound healing by switching phenotype of macrophages, was decreased in the early phase of acute inflammation, whereas the expression of proinflammatory mediators such as tumor necrosis factor and cyclooxygenase-2, and 15-lipoxygenase, which are involved in the resolution of inflammation was increased in the late phase in TRPA1-/- mice. Conclusions: Early innate immune responses including neutrophil infiltration and macrophage polarization at incised sites were inhibited in TRPA1-/- mice, associated with increased pro-inflammatory mediators in later phase. Peripheral TRPA1 may facilitate the acute inflammatory process, leading to the promotion of macrophage-mediated resolution of inflammation and wound repair after a surgical incision.

Treatment of pyogenic liver abscess by surgical incision and drainage combined with platelet-rich plasma:A case report

BACKGROUND Pyogenic liver abscesses are insidious in the early stage.Some cases progress rapidly,and the patient’s condition can worsen and even become life-threatening if timely treatment is not provided.Surgery and prolonged antibiotic treatment are often required if the abscess is large and liquefied and becomes separated within the lumen.CASE SUMMARY We report a case of bacterial liver abscess with a poor outcome following pharmacological treatment,review the literature related to the use of platelet-rich plasma(PRP)in the treatment of hepatic impairment and partial hepatectomy in animals,and discuss the prognostic features of surgical incision and drainage combined with PRP in the treatment of bacterial liver abscesses.This is the first case describing the use of PRP in the treatment of a bacterial liver abscess in humans,providing new ideas for the treatment of this condition.CONCLUSION This case highlights the importance of surgical treatment for bacterial liver abscesses that are well liquefied and poorly managed medically.PRP may produce antimicrobial effects and promote the regeneration and repair of liver tissue.

Micro-power negative pressure wound technique reduces risk of incision infection following loop ileostomy closure

BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complication after ileostomy closure.AIM To evaluate the efficacy and safety of the micro-power negative pressure wound technique(MPNPWT)in preventing incisional SSI.METHODS This was a prospective,randomized controlled clinical trial conducted at a single center.A total of 101 consecutive patients who underwent ileostomy closure after rectal cancer surgery with a prophylactic ileostomy were enrolled from January 2019 to December 2021.Patients were randomly allocated into an MPNPWT group and a control group.The MPNPWT group underwent intermittent suturing of the surgical incision with 2-0 Prolene and was covered with a micro-power negative pressure dressing.The surgical outcomes were compared between the MPNPWT(n=50)and control(n=51)groups.Risk factors for incisional SSI were identified using logistic regression.RESULTS There were no differences in baseline characteristics between the MPNPWT(n=50)and control groups(n=51).The incisional SSI rate was significantly higher in the control group than in the MPNPWT group(15.7%vs 2.0%,P=0.031).However,MPNPWT did not affect other surgical outcomes,including intra-abdominal complications,operative time,and blood loss.Postoperative hospital stay length and hospitalization costs did not differ significantly between the two groups(P=0.069 and 0.843,respectively).None of the patients experienced adverse effects of MPNPWT,including skin allergy,dermatitis,and pain.MPNPWT also helped heal the infected incision.Our study indicated that MPNPWT was an independent protective factor[odds ratio(OR)=0.005,P=0.025)]and diabetes was a risk factor(OR=26.575,P=0.029)for incisional SSI.CONCLUSION MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.

Risk factors and strategy for surgical incision infection in department of abdominal surgery

Objective To study the risk factors of surgical wound infection among the patients in department of abodominal surgery. Methods The factors on surgical wound infection were investigated by retrospective study. The diagnosis standard was based on Diagnosis Standard of Hospital Infection published by Ministry of Health.

颞下颌关节盘复位锚固术不同入路及前附着松解方式的临床效果比较

目的 探讨不同手术方案行颞下颌关节盘复位锚固术的治疗效果,为优化此术式提供参考。方法 本研究通过医院伦理委员会批准。对颞下颌关节盘复位锚固术的患者173例(195侧关节)进行回顾性分析,根据手术方案不同分为A组(传统耳前切口-手术刀/组织剪刀松解)35例(40侧关节)、B组(传统耳前切口-等离子双极射频电极松解)42例(46侧关节)、C组(改良耳屏切口-手术刀/组织剪刀松解)50例(58侧关节)、D组(改良耳屏切口-等离子双极射频电极松解)46例(51侧关节)。术后随访6个月,比较术后1、3、6个月各组组内及组间患者的最大张口度(maximum mouth opening,MMO)差异,各组组内及组间疼痛模拟视觉评分(visual analogue scale,VAS)差异,组间关节盘复位有效率及耳前麻木、明显瘢痕发生率。结果 术后4组患者MMO均经历较术前缩小再逐渐增大过程,术后1个月复诊时等离子双极射频松解(B+D)组较手术刀/组织剪刀松解(A+C)组对患者MMO影响更小(P <0.05);4组患者术后VAS均较术前逐渐降低,其中(B+D)组患者术后1个月VAS显著低于(A+C)组(P <0.05);术后6个月4组关节盘复位有效率均高于95%,组间对比无差异(P> 0.05);改良耳屏切口(C+D)组患者较传统耳前切口(A+B)组患者耳前麻木发生率更低(4.59%vs. 12.79%,P <0.05)。(C+D)组患者明显瘢痕发生率也显著低于(A+B)组(3.67%vs. 23.26%,P <0.05)。结论 改良耳屏切口在耳颞神经保护方面优于传统耳前切口,瘢痕隐蔽。等离子双极射频电极在张口度恢复、疼痛控制等方面优于手术刀/组织剪刀。对于颞下颌关节盘复位锚固术,改良耳屏切口联合等离子双极射频电极松解关节盘前附着可作为推荐的手术方案。

3D打印技术在兽医手术工具设计中的应用

3D打印技术日益流行,尤其在医疗领域展现出巨大的潜力。该文探讨了3D打印技术在兽医手术工具设计中的应用,分析了其原理、材料特性以及在畜牧兽医手术中的需求。通过对现有手术工具的局限性进行分析,指出3D打印技术在设计中的优势。论文详细阐述了3D打印手术工具的设计流程,包括需求收集、模型设计、验证测试及用户反馈。最后,结合临床应用案例,探讨了3D打印手术工具的经济性、可持续性以及对动物福利的影响。通过对技术挑战和伦理问题的讨论,提出未来发展方向和建议,为畜牧兽医领域的实践提供参考。

内镜下经下颌角-颈静脉孔区手术入路的解剖学研究

目的探讨内镜下经下颌角-颈静脉孔区手术入路的解剖学基础。方法收集湿性尸头标本5具,模拟内镜下经下颌角-颈静脉孔区手术入路对湿性尸头标本进行解剖,观察相关解剖结构,测量手术操作深度和角度。结果该手术入路形成了带蒂下颌角骨瓣,骨瓣长为(23.74±0.95)mm,宽为(18.95±0.56)mm。移位下颌角骨瓣后手术操作深度为(8.54±0.55)mm,复位下颌角骨瓣后手术操作深度为(24.94±0.90)mm,差异有统计学意义(P<0.05);移位下颌角骨瓣后手术操作角度为(69.60±3.30)°,复位下颌角骨瓣后手术操作角度为(26.20±2.20)°,差异有统计学意义(P<0.05)。结论内镜下经下颌角-颈静脉孔区手术入路形成带蒂下颌角骨瓣,可以增加手术操作角度、缩短操作深度,提高手术自由度,该手术入路值得进一步研究和在临床实践中探讨。

腔镜手术机器人系统远心机构设计及运动学分析

远心机构是腔镜手术机器人系统中的一个重要部件,影响系统整体的运动性能和系统其他部件的选择,通过腹腔镜手术的临床需求,对远心机构的设计准则进行分析,设计一款基于双平行四边形结构的远心机构。该机构使用双同步带传动,并对传统的四连杆机构进行优化设计,使其承载能力更强,且弥补了双同步带传动机构末端定位精度不高的问题,同时对横滚关节、摆动关节和平移关节的机械机构和实现形式进行设计。并研究远心机构的运动学特性,包括求解正逆运动学、速度雅可比变换矩阵和工作空间分析。通过以上计算和分析可以证明所设计远心机构的正确性和机构末端的稳定性,且横滚和摆动两个自由度都在±60°之间上下运动,满足设计要求,表明该远心机构能够满足微创手术相关技术的要求。

Application of digital positioning guide plates for the surgical extraction of multiple impacted supernumerary teeth:A case report and review of literature

BACKGROUND An extra tooth in the normal tooth sequence in any region of the dental arch is regarded as a supernumerary tooth(SNT).Due to the large variation in location and morphology,the extraction of impacted SNTs is an extensive and complex procedure with high risks of several complications.This report presents a rare case of seven impacted SNTs in the bilateral upper and lower arch that were successfully extracted with the use of digital positioning guide plates.CASE SUMMARY In January 2022,a 21-year-old male was referred to our department with a chief complaint of pain in relation to tooth#36.Clinical examination showed a deep carious lesion with pulpal involvement in tooth#36 and lingual swelling of the bilateral mandibular posterior area.Radiographic examination revealed seven deeply impacted SNTs in the bilateral posterior area and bilateral impacted mandibular third molars.Based on these findings,the patient was diagnosed with bilateral,multiple impacted SNTs and tooth#36 chronic pulpitis.A root canal treatment and an all-ceramic crown restoration for tooth#36 were performed.An individualized digital positioning guide plate was designed by computer-aided design/computer-aided manufacturing technology and cone-beam computed tomography for extraction of the impacted SNTs.During the operation,the digital positioning guide plate allowed rapid positioning and exposure of the SNTs while avoiding adjacent important anatomical structures.At 3-month follow-up,regeneration of bone and soft tissues was visible.CONCLUSION The application of digital positioning guide plates is useful for the individualized and minimalized extraction of impacted supernumerary teeth.

Design and Experiments of Ultrasound Image-Guided Multi-DOF Robot System for Brachytherapy

To implant radioactive seeds through a needle precisely and safely, a novel multi-DOF surgical robotic system is presented in this paper for percutaneous prostate intervention through the patient’s perineum under real-time ultrasound image guidance. The proposed robot, which is designed with 9-DOF, consists of a 3-DOF automatic location platform for position adjustment, 2-DOF for automatic ultrasonic probe adjustment mounted with electromagnetic trackers, and 4-DOF for manually adjusting the guided template. Meanwhile, a new registration method based on the quaternion algorithm and least square method is developed, and the needle insertion is performed under the real-time guidance of a navigation system. Furthermore, the robot system has undergone some preliminary experiments with a laser tracker to evaluate the repeatability and accuracy of the robot system. The location error of the puncture needle tip can be controlled under 0.7 mm in air for the whole robotic system. The acquired results endorse the precision of the robot system for prostate seed implantation brachytherapy. © 2017, Tianjin University and Springer-Verlag GmbH Germany.

MITOMYCIN C “STRAIGHT SCLERAL TUNNEL INCISION”-TRABECULECTOMY WITH A RELEASABLE SUTURE

Objective To evaluate the efficacy of ＂straight scleral tunnel incision＂-trabeculectomy with a releasable suture supplemented with mitomycin C （MMC） on reducing intraocular pressure （ IOP）, complications, and corneal astigmatism in patients with primary angle-closure glaucoma （PACG）. Methods Totally 217 acute or chronic PACG patients with occludable angle above 180℃ and IOP above 21 mm Hg were divided into 3 groups. Patients in group A （98 cases, 128 eyes）, B （71 cases, 95 eyes）, and C （48 cases, 60 eyes） were treated with ＂straight scleral tunnel incision＂-trabeculectomy with a releasable suture supplemented with MMC, releasable suture trabeculectomy with MMC, and trabeculectomy with MMC, respectively. IOP, complications, and sureicallv induced astigmatism （SIA） were evaluated oreooerativelv and up to 12 months oostoperatively. Results IOP of 2 weeks after treatment was significantly lower than preoperative IOP in all the 3 groups （ all P〈0.001）. Success rates （IOP≤20 mmHg） in groupA, B, and C were 87. 91% , 89.23%, and 83.72% respectively at 12 months after treatment （P = 0.256）. The incidence of shallow anterior chamber and hypotony had no significant difference between group A and B, but both of them were lower than that in group C （ P 〈 0.05 ）. There were no significant differences in preoperative corneal astigmatism among the 3 groups. The corneal astigmatism after 2 weeks in group A （1.71 ±1.47D） was higher than that before operation （ 1.28 ± 1.05D, P =0. 126）. With 12 months gone, the astigmatism almost returned to preoperative levels. The corneal astigmatisms after 2 weeks in group B and C （ 1.99 ± 1.20D and 2. 22 ± 1.39D） were significantly higher than those before operation （ 1.20 ± 0. 85D and 1.18 ±0.93D, P =0. 002, P =0. 001 ）, respectively. With 112 months gone, the mean astigmatisms in group B and C （ 1.87 ± 0. 91D and 1.90 ± 1.16D） were still significantly higher than those before operation （P = 0. 001, P = 0. 003 ）. The highest astigmatic polar values in group A, B, and C （ 1.00D, 1.89D, and 1.77D） occurred after 2 weeks, 1 month, and 1 month postoperation, respectively, which were significantly higher than those before operation （0.19 ± 1.32D, 0. 12 ± 1.22D, and 0.17 ± 1.25D, P 〈 0.01 ）, respectively. With 12 months gone, they were 0.03D, -0.18D, and -0.13D higher than those before operation, respectively. The rates of function bleb and thin-wall bleb were 71.43% and 26. 37% in group A, 75.38% and 29.23% in group B, 72.09% and 25.58% in group C, respectively at 12 months after treatment. There were no significant differences among the 3 groups. Conclusion ＂Straight scleral tunnel incision＂-trabeculectomy with a releasable suture supplemented with MMC can reduce complications and get satisfactory results in reducing lOP and SIA.

Hand-Held Surgical Instrument with the Function of Self-Locking for Minimally Invasive Surgery

In order to improve the flexibility of the surgical instruments, a wire-driven wrist-like structure is proposed in this paper. The instrument has three degrees of freedom (DOFs) of rotation, yaw, opening and closing. Furthermore, we also acknowledge no coupling motion for each DOF. Moreover, the self-locking motion contributes to sustaining joint posture under external force. A static analysis for the end effector was conducted using the ANSYS software. At the end of this paper, a series of experiments for the prototype was performed. The results revealed that for the same surgical task, the proposed instrument had higher flexibility and the completion time of the operation tasks was obviously less than that of the traditional instrument. The results of the self-locking and operating force test showed that the surgical instruments perform well in maintaining joint posture under the force of 8.2N. The proposed surgical instrument meets the requirements of minimally invasive surgery (MIS).

2-Octyl Cyanoacrylate Skin Adhesive for Topical Skin Incision Closure in Female Pelvic Surgery

Background: 2-octyl cyanoacrylate (2OCA) high viscosity tissue adhesive (Medline Industries, Inc., Mundelein, IL) is a liquid topical skin adhesive. 2OCA offers the same design features and clinical utility in terms of flexibility, strength, and low complication rate as the commercially available 2OCA tissue adhesives. Additionally, 2OCA features high viscosity allowing for better control during the application process, polymerization without the use of an external activator, and a distinctive violet color for ease of application visualization. Objective: The aim of this prospective case series is to descriptively report clinical data with the application of 2OCA as a topical incision closure system in female pelvic surgery. The primary outcomes included: incisional pain, incisional dehiscence, and post-operative bleeding. The secondary outcome included drying times of the adhesive with regard to incision length. Methods: A prospective open-label observational case series study was conducted to evaluate the use of 2OCA in surgical wound closure of the topical skin in adult patients undergoing gynecologic surgical procedures. A total of 50 adult women undergoing gynecologic surgery were enrolled. 2OCA was applied only by surgeons who had undergone product training to the incisions in a standardized, protocol-defined fashion. Drying times for the adhesive and photography were recorded intraoperatively. Post treatment follow-up was conducted with queries of pain level, incisional dehiscence, and incisional bleeding immediately post-operatively, 48 hours, 5 - 10 days and 14 days post-treatment. Adverse events were documented. Results: 2OCA was applied to a total of 154 incisions from the 50 patients enrolled to the study. The procedures included: 16 laparoscopic total hysterectomies, 4 diagnostic laparoscopies, 2 laparoscopic myomectomies, 2 laparoscopic bilateral or unilateral salpingo-oophorectomies, 5 total robotic-assisted laparoscopic surgeries (2 total hysterectomies, 1 supracervical hysterectomy, 1 sacrocolpopexy, and one excision of endometriosis), 7 sacral neuromodulation procedures, and 18 midurethral slings. The overall rate of incisional dehiscence was 3% (4/154). The rate of reported incisional bleeding was 3% (4/154). There was 1 incisional infection. The pain reports based on a 10-point scale had a mean of 4.96 immediately post-operatively, which decreased to a mean score < 1 (0.2) by post-op day (POD) 14. The mean drying times for the various lengths of incisions included the following: 1.28 minutes for incisions ≤ 5 mm, 1.53 minutes for 6 - 8 mm, 1.66 minutes for 10 mm - 20 mm, and 1.57 minutes for the 40 - 50 mm incisions. In 23% (36/154) of incisions 2OCA was the sole method of skin closure. Conclusion: This study demonstrates that 2OCA is safe to use in gynecologic surgical incisions with low rates of post-operative incisional bleeding and incisional dehiscence. Post-operative reports of pain maintained expected levels for recovery. 2OCA is a practical alternative or augmentation to traditional suture closure of skin incisions at the time of gynecologic surgery.

Incision Site in Manual Small Incision Cataract Surgery in Case of Preoperative Direct Astigmatism

We compared surgically induced astigmatism (SIA) by a superior incision with a temporal incision in manual small incision cataract surgery (MSICS), in patients with bilateral direct (regular) preoperative corneal astigmatisms. Patients and method: We carried out a prospective study from July 1st 2018 to September 30th 2019 in the department of ophthalmology at the University Hospital of Brazzaville. Keratometric readings were recorded before surgery to assess preoperative corneal astigmatisms. Keratometric evaluation was done 45 days post-operatively. Patients were followed 90 days after surgery in order to assess the healing of the surgical site. The surgically induced astigmatism (SIA) is the difference in the magnitude vectors between the preoperative and postoperative astigmatism. The result was positive if the postoperative astigmatism was greater than the preoperative astigmatism and negative if the postoperative astigmatism was less than the preoperative astigmatism. Results: Our study sample included 48 eyes from 24 patients, including 24 operated on temporal incision and 24 in superior incision. The average SIA for superior incisions was 0.33 ± 1.55 diopters (D), versus 0.33 ± 1.44 for temporal incisions. For superior incisions the SIA was 0.81 for astigmatisms lower than 2D, against 0.16D for the temporal incisions. On the other hand, for preoperative astigmatisms greater than 2D, the surgically induced astigmatism was &plusmn;0.62D, marking a decrease in preoperative astigmatism for the superior incisions against an increase of 0.5D for the temporal incisions. The healing was delayed for the temporal incisions responsible for discomfort persisting beyond 45 days. Conclusion: The temporal incision had better results than the superior incision for astigmatisms lower than 2D, and less good for astigmatisms higher than 2D. The temporal incision healed less well.

Midline Supraumbilical Incision as an Option for Morbidly Obese Patients? Case Report

Background: Nowadays we observe growing rates of obesity, mainly among women. It has a great impact on maternal and fetal morbimortality and requires a specific obstetric approach. Aim: To discuss different approaches to abdominal incision in cesarean section in obese patients. Case presentation: Patient with morbid obesity submitted to an elective cesarean section due to fetal macrosomia and who underwent a cesarean section with a supraumbilical median incision evolving without any postpartum complications. Conclusion: It’s important to evaluate and chose the best incision in morbidly obese pregnant women aiming to reduce difficulties in fetal extraction and postoperative complications. Midline supraumbilical incision is a good choice in these cases, reducing surgical time and postpartum hemorrhage.