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INTRODUCTION: Patients with ulcerative colitis (UC) receiving immunosuppressive drugs are at substantial risk of colectomy. We aimed to assess the risk of postoperative complications of tofacitinib exposure before colectomy in comparison with biologics. METHODS: A multicenter, retrospective, observational study was conducted in patients with UC who underwent total colectomy for medically refractory disease, exposed to tofacitinib or a biologic before surgery. Primary outcome was the occurrence of any complication within 30 (early) and 90 (late) days after surgery. Secondary outcomes were the occurrence of infections, sepsis, surgical site complications, venous thromboembolic events (VTE), hospital readmissions, and redo surgery within the same timepoints. RESULTS: Three hundred one patients (64 tofacitinib, 162 anti-tumor necrosis factor-α agents, 54 vedolizumab, and 21 ustekinumab) were included. No significant differences were reported in any outcome, except for a higher rate of early VTE with anti-tumor necrosis factor-α agents (P = 0.047) and of late VTE with vedolizumab (P = 0.03). In the multivariate analysis, drug class was not associated with a higher risk of any early and late complications. Urgent colectomy increased the risk of any early (odds ratio [OR] 1.92, 95% confidence interval [CI] 1.06-3.48) complications, early hospital readmission (OR 4.79, 95% CI 1.12-20.58), and early redo surgery (OR 7.49, 95% CI 1.17-47.85). A high steroid dose increased the risk of any early complications (OR 1.96, 95% CI 1.08-3.57), early surgical site complications (OR 2.03, 95% CI 1.01-4.09), and early redo surgery (OR 7.52, 95% CI 1.42-39.82). Laparoscopic surgery decreased the risk of any early complications (OR 0.54, 95% CI 0.29-1.00), early infections (OR 0.39, 95% CI 0.18-0.85), and late hospital readmissions (OR 0.34, 95% CI 0.12-1.00). DISCUSSION: Preoperative tofacitinib treatment demonstrated a postoperative safety profile comparable with biologics in patients with UC undergoing colectomy. [ABSTRACT FROM AUTHOR]

BACKGROUND Pinch grafting has experienced a resurgence in interest in recent years, stemming from its simplicity, safety, and potential in restoring tissue integrity. While historically employed for chronic nonhealing wounds, pinch grafts have shown promise following surgical procedures, particularly those involving the lower extremities. OBJECTIVE To systematically reviewthe literature and present an updated overview of the current applications of pinch grafting. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In collaboration with a medical reference librarian, the PubMed, Embase, Scopus, and Web of Science databases were searched for studies reporting on the use of pinch grafting from 2000 onward. The references of each included article were also screened. RESULTS Ten articles met final inclusion criteria. In total, 300 patients underwent pinch grafting for treatment of skin ulceration, while an additional 35 cases were performed as an alternative to primary closure following skin cancer resection. Overall, pinch grafting was safe and well tolerated, with minimal adverse outcomes reported. CONCLUSION Pinch grafting is a safe, straightforward, and effective technique to promote the healing of chronic wounds. While the procedure shows early promise in emerging applications within dermatologic surgery, only about 10% of the reported cases involved this indication, reflecting a need for further research in this area. [ABSTRACT FROM AUTHOR]

In patients with genuine congenital cataract, undergoing surgery with IOL within the critical period of visual development led to better final visual acuity. Purpose: To investigate the long-term outcomes of congenital cataract surgery performed within the first 6 months of life. Setting: 11 ophthalmic surgical sites in Japan. Design: Retrospective chart review. Methods: Medical charts were retrospectively reviewed for 216 eyes of 121 patients. The age at surgery was 2.9 ± 1.7 months, with follow-up duration 13.0 ± 2.3 years. The cohort consisted of 83 cases with bilateral aphakia, 12 with bilateral pseudophakia, 20 with unilateral aphakia, and 6 with unilateral pseudophakia. Results: Surgical intervention within the critical period of visual system development (10 weeks for bilateral and 6 weeks for unilateral cases) led to significantly better final visual acuity than surgery conducted after this time frame. The incidence of secondary glaucoma was similar between groups while the occurrence of visual axis opacification was more frequent with earlier surgery. A forward stepwise multiple regression analysis revealed that the final visual acuity was significantly associated with laterality of cataract (better outcomes in bilateral cases), phakic status (with pseudophakia outperforming aphakia), presence of systemic and ocular comorbidities, and development of secondary glaucoma. Secondary glaucoma was significantly more prevalent in aphakic eyes than pseudophakic eyes. Conclusions: In patients with genuine congenital cataract, surgery within the critical period of visual development results in better final visual acuity, albeit with an increased risk of visual axis opacification. The use of IOL with sophisticated surgical techniques shows promise even in congenital cataract surgery. [ABSTRACT FROM AUTHOR]

When an ostomy care nurse is not available, bedside nurses must assume responsibility for providing necessary care and educating patients who undergo a urinary diversion. However, staff nurses often lack the necessary knowledge and experience to provide the best care, rehabilitation, and patient education. This article details pre- and postoperative interventions for nurses who encounter patients undergoing urostomy surgery in order to help eliminate gaps in care, increase nurses' and patients' competence and confidence, and optimize patient outcomes and quality of life. It also includes a tear sheet that nurses can use to provide patients with the basic information and skills they need for effective self-care. This article details pre- and postoperative interventions for nurses who encounter patients undergoing urostomy surgery. It also includes a tear sheet that nurses can use to provide patients with the basic information and skills they need for effective self-care. [ABSTRACT FROM AUTHOR]

This document discusses a case study of a 14-year-old patient who presented with painful bluish lesions on his back that caused diaphragmatic spasms. The patient had previously been diagnosed with glomangioma, a condition characterized by the proliferation of glomus cells with a vascular component. The spasms were debilitating and had a significant impact on the patient's daily life. The authors highlight the unique presentation of glomangioma in this case and emphasize the need for further research and understanding of this condition. [Extracted from the article]

This article discusses the repair of a medium-sized defect of the scalp in an 82-year-old male patient. The patient had a slowly growing, non-painful, erosive plaque on the scalp, and after examination, it was decided to excise the growth, leaving a circular defect of approximately 4.5 x 4.5 cm. The article explores different methods of reconstructing the defect, including the use of rhombic flaps, which have aesthetic advantages such as lack of skin tone changes and alopecia, and result in finer and less noticeable scars compared to linear incisions. The article also discusses the advantages of rhombic flaps over skin grafts, such as the elimination of periostalgia and immunologic complications. [Extracted from the article]

BACKGROUND: Surgeons' opinions vary on the cosmetic outcome of straight-line (SL) versus broken-line (W-plasty) closure methods. To date, no studies have compared the 2 techniques in the split-scar design model that resolves the confounding individual patient factors that affects the scar outcome. OBJECTIVE: Compare outcomes and wound cosmesis with SL versus W-plasty closure techniques. METHODS: This clinical trial was conducted with 50 linear surgical wounds randomized to SL closure on half and W-plasty on the other half. At 3 months, patients and 2 masked observers evaluated each scar using the Patient and Observer Scar Assessment Scale (Patient Observer Scar Assessment Scale [POSAS]). RESULTS: The mean (SD) sum of the POSAS observer component scores were 16.6 (6.18) for the SL side and 15.5 (6.37) for the W-plasty side (p =.49). The mean (SD) sum of the POSAS patient scores were 14.4 (6.8) in SL and 15.1 (8.2) in W-plasty (p =.59). The mean (SD) complications were 0.08 (0.06) for SL and 0.02 (0.14) for W-plasty (p =.18). CONCLUSION: No statistically significant difference in wound cosmesis or complications was noted between SL versus W-plasty closure techniques. Surgeons may want to consider whether the extra time involved in placing zigzag W-plasty lines is worthwhile. [ABSTRACT FROM AUTHOR]

Local problem: Sternal wound infections (SWIs), whether superficial or deep, are associated with increased morbidity, mortality, and costs. From 2016 to 2017, our facility saw a 50% decrease in SWIs among patients undergoing cardiothoracic surgery with sternotomy. From 2017 to 2018, however, we identified a 33% increase in SWIs, prompting us to address our cardiac nurses' sternal wound care education and practice. Purpose: The purpose of our quality improvement (QI) project was to identify opportunities for improvement in postoperative sternal incision care and to implement evidence-based processes to reduce the incidence of SWIs among cardiothoracic surgery patients. Methods: A literature review was performed to identify interventions focused on evidence-based SWI reduction. During the first quarter of 2019, our postoperative incision care guidelines were revised and released to staff, a new surgical wound cleansing product was supplied, and RN education was provided. Cardiac nurses were surveyed in April 2019 to identify any remaining knowledge and practice deficits and to assess their adherence to the new guidelines. The survey responses helped us to further improve our nurse education. We also provided periodic nurse reeducation and enhanced patient and family education. All such interventions were implemented by the end of June 2019. Results: Between January and June 2019, we had one SWI. From July 2019 through December 2020, an 18-month period, we experienced zero SWIs. Although beginning in 2021, we saw an increase in SWIs—four in 2021 and five in 2022—our incidence rates remain below 0.5% and we continue to work toward an SWI goal of zero. Conclusion: This QI project identified opportunities for improvement, implemented evidence-based strategies for wound care and education, and successfully achieved a zero SWI rate for a period of 18 months. This quality improvement project aimed to identify opportunities for improvement in postoperative sternal incision care and to implement evidence-based methods to reduce the incidence of sternal wound infections among cardiothoracic surgery patients. [ABSTRACT FROM AUTHOR]

BACKGROUND Based on recent research, second intention wounds may be at greater risk for postoperative infection compared with sutured wounds. Accurate diagnosis of postoperative wound infections on the lower leg can be challenging and result in unnecessary antibiotic administration. OBJECTIVE The objective of this study was to identify bacterial organisms that commonly colonize second intention surgical wounds after Mohs micrographic surgery (MMS) and isolate pathogenic organisms. METHODS Patients with second intention surgical wounds on the lower leg were evaluated 2 weeks after MMS. Wounds were swabbed for bacteria and categorized as infected or not infected based on clinical appearance. Any colonizing bacteria were recorded once the culture results were reported. RESULTS Twenty-five clinically infected wounds and 26 control wounds were cultured. Staphylococcus aureus was the most common bacteria, colonizing 8 infected wounds (15.7%) and 5 control wounds (9.8%). Eight cultures (32%) from clinically infected wounds grew normal skin flora alone. CONCLUSION Staphylococcus aureus is the most common bacteria colonizing wounds healing by second intention on the lower extremity. Thirty-two percent of clinically infected wounds grew normal skin flora, demonstrating the challenge of accurately diagnosing infection in lower extremity second intention wounds. [ABSTRACT FROM AUTHOR]

The article discusses a case study of a 72-year-old man with an atypical fibroxanthoma on his ear. The authors describe a technique called wedge-shaped single-stage Mohs surgery with a bisected specimen, followed by closure with a primary ear wedge repair. This method allows for expedited excision of tissue at high risk for cartilage invasion and provides 100% margin control. The authors find this technique useful for certain types of skin cancer but not when cartilage preservation is expected. The article also briefly mentions other treatment options for metastatic melanoma. Another section of the article discusses a method of using horizontal mattress pulley sutures to improve reconstruction after staged excision on the scalp. [Extracted from the article]

The article discusses the use of cryotherapy in the treatment of various benign and malignant diseases. The authors applied cryotherapy to three patients with three cycles of 30 seconds each, resulting in blisters and ulceration. Cryotherapy is believed to stimulate the body's immune response against malignant cells, and combining it with other treatments may have additional benefits. The article also mentions the impact of revised repair guidelines on the proportion of complex repairs performed by Mohs micrographic surgeons, showing a reduction in complex repairs billed by these surgeons. [Extracted from the article]

This article discusses the reconstruction of a full-thickness lower lip defect after Mohs micrographic surgery. The case involves a 54-year-old man with squamous cell carcinoma on his lower lip. The authors explore different options for repairing the defect, ultimately deciding on a buccal myomucosal flap combined with skin advancement. The technique provides vermillion coverage and muscular bulk without the need for large incisions, resulting in optimal aesthetic and functional outcomes. [Extracted from the article]

BACKGROUND: Lower extremity surgical sites are at an increased risk of wound infection following Mohs micrographic surgery. OBJECTIVE: To evaluate the rate of lower extremity surgical site infections following a 14-day regimen of preoperative 4% chlorhexidine gluconate (CHG) rinses and postoperative wound occlusion for 14 days. MATERIALS AND METHODS: Retrospective data were collected from procedures performed by the senior author from January 2022 through June 2023. To meet inclusion, patients must have completed waist-down CHG soak and rinse for 14 days before surgery, including the day before surgery. In addition, the patient must have kept the dressing clean, dry, and intact until the postoperative appointment at 14 days. RESULTS: A total of 100 Mohs cases met inclusion criteria. Zero patients developed a surgical site infection. CONCLUSION: Chlorhexidine gluconate preoperative rinsing and postoperative occlusion for 14 days may minimize the risk of wound infection. Although further research is indicated, an opportunity exists for the adoption of CHG into routine clinical practice in the outpatient dermatology setting. [ABSTRACT FROM AUTHOR]

Purpose: To compare the accuracy, safety, and consistency of asymmetric trapezoid and near-square side-port incision in cataract surgery. Setting: Aier Eye Hospital of Wuhan University, Wuhan, Hubei Province, China. Design: Prospective pilot study. Methods: This study included patients who underwent phacoemulsification between January 2022 and August 2022. They were divided into Group A and Group B using the random number table method. Group A was given a near-square side-port incision and Group B was given an asymmetric trapezoid side-port incision. We contrasted the differences in incision length, width, and shape; surgical time; and postoperative intraocular pressure (IOP) between the 2 groups. Results: 220 eyes of 220 patients were included. The mean external width of the incision in Group A was much smaller than that in Group B (P < .01), and the consistency of the incision diameter in Group A was better than that in Group B. There was no statistically significant difference in incision length between the 2 groups (P = .75). 1 day after surgery, there was no statistically significant difference in incision morphology between the 2 groups (P = .72). The operating time for Group A was significantly shorter than that of Group B (P < .01). There was no obvious incision leakage in both groups after surgery, and the IOP was generally elevated after surgery, but there was no significant statistical difference between the 2 groups (P = .98). Conclusions: The present study suggests that a near-square side-port results in better consistency of incision width and shorter surgical time. [ABSTRACT FROM AUTHOR]

This article explores the potential of topical timolol solution in improving the cosmetic appearance of surgical scars after Mohs micrographic surgery (MMS) with primary linear closure. The study involved 19 adult patients with nonmelanoma skin cancer who underwent MMS, with one-half of the wound treated with timolol solution and the other half treated with standard wound care. The results showed no statistically significant differences in scar cosmesis between the two groups, suggesting a limited role for timolol in improving the appearance of surgical scars in healthy patients. However, further research is needed to determine if timolol can be beneficial in cases of impaired or delayed wound healing. [Extracted from the article]

Purpose: To determine (1) if measurements of surgically induced astigmatism (SIA) as measured by keratometry (K) and total keratometry (TK) differ (2) if SIA affects the magnitude and/or meridian of keratometric astigmatism (3) if SIA evolves over time. Setting: Tertiary care center. Design: Retrospective data analysis. Methods: A swept-source optical coherence tomography biometry dataset (IOLMaster700) consisting of 498 eyes (327 patients) from a tertiary care center was analyzed. For all eyes preoperative and postoperative biometric measurements at 1- month, 3-month, and 6-months postoperative visits were considered for vector analysis of SIAK and SIATK. Results: Centroids in right and left eyes were 0.26 diopters (D) @5 degrees/0.31 D @1 degree for SIAK and 0.27 D @4 degrees/0.34 D @1 degree for SIATK. Centroids for difference vectors K-TK in right and left eyes were 0.02 D @ 176 degrees/0.03 D @6 degrees. The mean SIA magnitudes in right and left eyes were 0.48 ± 0.41 D and 0.50 ± 0.37 D for SIAK and 0.53 ± 0.42 D and 0.54 ± 0.40 D for SIATK. In eyes with ATR astigmatism, an increase in postoperative astigmatism magnitude was more common than a decrease. More than 30% of eyes showed changes in the meridian of more than 15 degrees. Conclusions: Overall, we observed differences in K- and TKderived SIA, and changes in SIA magnitude over time. For postsurgical interventions, postoperative astigmatism meridian values should be measured to base treatments. Astigmatism magnitude showed a tendency to decrease for steep-meridian incisions and to increase in flat-meridian incisions. [ABSTRACT FROM AUTHOR]

This article discusses the quality of photographs of tumor biopsy sites referred for Mohs micrographic surgery at an academic medical center. The authors evaluated biopsy photographs from a specific time period and analyzed them based on various criteria, such as the use of tools, presence of anatomic landmarks, and angle of the photograph. They found that while most surgical sites had biopsy photographs, the quality could be improved, especially for sites on the scalp. The authors suggest including anatomic landmarks in photographs to facilitate better identification of scalp lesions. [Extracted from the article]

Supplemental Digital Content is Available in the Text. BACKGROUND: There is no standardized definition of surgical site infections (SSI) after Mohs micrographic surgery (MMS) used in the clinical or research settings, which may contribute to heterogeneity in the differences in infection rates reported. OBJECTIVE: To use an electronic survey of Mohs surgeons across the country to better understand how Mohs surgeons define SSI after MMS. METHODS: A web-based survey was developed and distributed to Mohs surgeons. Respondents were asked to respond to several different scenarios that could represent SSI after MMS. RESULTS: Of potential 1,500 respondents, 79 (5.3%) responded to the survey. Presentation of a surgical site with warmth, swelling, erythema, and pain at 7 days postoperatively resulted in 79.7% consensus of SSI. Surgical sites that were cultured and found to be Staphylococcus aureus -positive resulted in 100% agreement of SSI. There was no consensus regarding timing after MMS. CONCLUSION: There is consensus on numerous aspects of SSI after MMS among Mohs surgeons, which may allow for development of standardized definition in the future. [ABSTRACT FROM AUTHOR]

One of the most popular plastic surgical interventions both abroad and in Kazakhstan is blepharoplasty. Plastic surgeons continue to debate various methods for performing this operation; however, some of the methods used by plastic surgeons for preoperative marking of the upper eyelid skin may not be suited to the type of incision that should be used on the eyelids of individuals from Kazakhstan. For this reason, the surgery may not achieve the desired results. We conducted a study of patients from Kazakhstan who underwent upper blepharoplasty using a simplified technique for eyelid marking that we developed at our plastic surgery center. We used the Patient-Reported Outcome Measure Questionnaire (PROM-Q) to measure patient satisfaction and the Patient and Observer Scar Assessment Scale (POSAS) to measure scar quality. The results of our study showed that the majority of patients who underwent upper blepharoplasty performed by surgeons using our method of preoperative marking were extremely satisfied with the effect. The patients noted rapid tissue repair and minimal scarring. We concluded that the use of a simplified marking technique can significantly help aesthetic surgeons performing upper blepharoplasty by reducing the risk for negative postoperative effects. [ABSTRACT FROM AUTHOR]

IOL scaffolding in MSICS can be safely performed in hypermature cataract, phacolytic glaucoma, and lens-induced uveitis. It should be avoided in subluxated cataract, hard cataract, and single-piece IOL. Purpose: To describe the surgical technique of intraocular lens (IOL) scaffolding in hypermature/Morgagnian cataract in manual small-incision cataract surgery (MSICS). Setting: Charitable section of the hospital through direct availed services at free/subsidized cost. Design: Interventional study. Methods: 38 eyes of 38 patients operated at the charitable section of the hospital through direct availed services at free/subsidized cost were included in this study. Results: IOL scaffolding in MSICS was executed in 38 patients, of whom 25 patients were diagnosed as hypermature cataract, pseudoexfoliation syndrome with mature cataract in 5 patients, 5 patients had phacolytic glaucoma, and 3 patients had lens-induced uveitis. This technique was successful in 35 of 38 patients and was not successful in 3 patients in whom traditional SICS was performed in 2 patients and retrohaptic iris fixation in 1 patient. Conclusions: A technique that uses the IOL as a scaffold in hypermature cataract in MSICS that provides a stable barrier by stretching the capsular bag to prevent the crumpling of the bag or whole bag removal after nucleus delivery is described. [ABSTRACT FROM AUTHOR]

Study Design.: A retrospective cohort study. Objective.: To compare the surgical site infection (SSI) rate in patients undergoing spinal instrumentation surgery who received vancomycin suspended in fibrin glue at the surgical site and those who did not. Summary of Background Data.: The intrawound application of vancomycin powder for preventing SSI after spinal surgery remains controversial. Vancomycin suspended in fibrin glue is another option for local administration that may be effective. The present study assessed whether vancomycin suspended in fibrin glue could prevent SSI after spinal instrumentation surgery. Materials and Methods.: We enrolled patients who underwent posterior spinal instrumentation surgery with or without fusion for degenerative conditions, spinal trauma, or tumor. A multiple logistic regression model with inverse probability of treatment weighting based on propensity score was used to assess the efficacy of vancomycin suspended in fibrin glue and to account for confounding. A secondary multivariate logistic regression analysis was performed to identify the risk factors associated with SSI. Results.: Of the 264 patients enrolled in this study, 134 underwent application of vancomycin suspended in fibrin glue at the surgical site and 130 did not. The incidence of SSI was lower in patients who were treated with vancomycin suspended in fibrin glue (2.2% vs. 8.5%) even after inverse probability of treatment weighting adjustment (adjusted odds ratio: 0.25; 95% CI, 0.0768–0.91; P =0.03). Multivariate logistic regression analysis showed that the treatment with vancomycin suspended in fibrin glue was significantly associated with a lower odds of SSI (odds ratio: 0.2; 95% CI, 0.05–0.85; P =0.03). Conclusions.: The administration of vancomycin suspended in fibrin glue was significantly associated with a lower likelihood of SSI in patients undergoing spinal instrumentation surgery. [ABSTRACT FROM AUTHOR]

Background: Surgical wound-healing complications after tumor resections in tissue that has been preoperatively radiated are a major clinical problem. Most studies have reported that complications occur in more than 30% of patients undergoing such resections in the lower extremity. There is currently no available method to predict which patients are likely to have a complication. Transcutaneous oximetry has been identified in preliminary studies as potentially useful, but the available evidence on its efficacy for this application thus far is inconclusive. Questions/purposes: (1) Does transcutaneous oximetry measurement below 25 mmHg at any location in the surgical wound bed predict a wound-healing complication? (2) Does recovery (increase) in transcutaneous oxygen measurement during the rest period between the end of radiation and the time of surgery protect against wound-healing complications? Methods: A prospective, multi-institution study was coordinated to measure skin oxygenation at three timepoints in patients undergoing surgery for a lower extremity soft tissue sarcoma after preoperative radiation. Between 2016 and 2020, the five participating centers treated 476 patients for lower extremity soft tissue sarcoma. Of those, we considered those with a first-time sarcoma treated with radiation before limb salvage surgery as potentially eligible. Based on that, 21% (98 of 476) were eligible; a further 12% (56 of 476) were excluded because they refused to participate or ultimately, they were treated with a flap, amputation, or skin graft. Another 1% (3 of 476) of patients were lost because of incomplete datasets or follow-up less than 6 months, leaving 8% (39 of 476) for analysis here. The mean patient age was 62 ± 14 years, 62% (24 of 39) of the group were men, and 18% (7 of 39) of patients smoked cigarettes; 87% (34 of 39) of tumors were intermediate/high grade, and the most common histologic subtype was undifferentiated pleomorphic sarcoma. In investigating complications, a cutoff of 25 mmHg was chosen based on a pilot investigation that identified this value. All patients were assessed for surgical wound-healing complications, which were defined as: those resulting in a return to the operating room, initiation of oral or IV antibiotics, intervention for seroma, or prolonged wound packing or dressing changes. To answer the first research question, we compared the proportion of patients who developed a wound-healing complication between those patients who had any reading below 25 mmHg (7 of 39) and those who did not (32 of 39). To answer the second question, we compared the group with stable or decreased skin oxygenation (22 of 37 patient measurements [two patients missed the immediate postoperative measurement]) to the group that had increased skin oxygen measurement (15 of 37 measurements) during the period between the end of radiation and the surgical procedure; again, the endpoint was the development of a wound-healing complication. This study was powered a priori to detect an unadjusted odds ratio for wound-healing complications as small as 0.71 for a five-unit (5 mmHg) increase in TcO2 between the groups, with α set to 0.05, β set to 0.2, and a sample size of 40 patients. Results: We found no difference in the odds of a wound-healing complication between patients whose transcutaneous oxygen measurements were greater than or equal to 25 mmHg at all timepoints compared with those who had one or more readings below that threshold (odds ratio 0.27 [95% confidence interval (CI) 0.05 to 1.63]; p = 0.15). There was no difference in the odds of a wound-healing complication between patients who had recovery of skin oxygenation between radiation and surgery and those who did not (OR 0.63 [95% CI 0.37 to 5.12]; p = 0.64). Conclusion: Transcutaneous oximetry cannot be considered a reliable test in isolation to predict wound-healing complications. This may be a function of the fact that transcutaneous oximetry samples a relatively small portion of the landscape in which a wound-healing complication could potentially arise. In the absence of a reliable diagnostic test, clinicians must still use their best judgment regarding surgical timing and work to address modifiable risk factors to avoid complications. The unanswered question that remains is whether there is a skin perfusion or oxygenation issue at the root of these complications, which seems likely. Alternative approaches that can assess the wound more broadly and in real time, such as fluorescent probes, may be deserving of further investigation. Level of Evidence: Level II, diagnostic study. [ABSTRACT FROM AUTHOR]

This document, titled "How We Do It: Two Wedges in One--Combining Mohs Surgery and the Ear Wedge Closure," is a journal article published in Dermatologic Surgery in August 2024. The article discusses the combination of Mohs surgery and the ear wedge closure technique for the treatment of cutaneous squamous cell carcinoma. It also mentions the use of cryotherapy in patients with cutaneous metastatic melanoma. The article includes a case study of a patient with metastatic melanoma who underwent metastasectomy and initiated treatment with a PD-1 inhibitor. The authors of the article are affiliated with the Department of Dermatology at the University of California, San Francisco, and the University of Rochester Medical Center. [Extracted from the article]

Background: Wound assessment is a critical part of the care of hospitalized infants in neonatal intensive care. Early recognition and initiation of appropriate treatment of wounds are imperative to facilitate wound healing and avoid complications such as secondary infection and wound dehiscence. There are, however, no validated tools for assessing surgical wounds in infants. Purpose: The aim of this study was to develop and interrogate a tool for the assessment of surgical wounds. Specific aims for the tool included interrater reliability (give a consistent and dependable result independent of user) and test criterion validity (give an accurate assessment of the wound compared with an expert). Methods: This was an exploratory cohort study involving a structured wound tool applied by nursing staff to 40 surgical wounds. The wounds were also assessed by wound experts (a pediatric wound care nurse and a pediatric surgeon). Comparisons were made to elucidate estimates of reliability and validity. Results: The wound tool demonstrated interrater reliability with intraclass correlation coefficient of 0.775 (95% CI, 0.665-0.862) as well as criterion validity with rank correlation coefficient of 0.55 (95% CI, 0.34-0.76) to 0.71 (95% CI, 0.53-0.88). To obtain 100% sensitivity to distinguish mild from moderate-severe wounds, a low cutoff score was needed. Implications for Practice and Research: Wound assessment continues to be a subjective exercise, even with the utilization of a tool. Additional research is needed for strategies to support the assessment of surgical wounds in infants. Such tools are needed for future research, particularly when multiple institutions are involved. [ABSTRACT FROM AUTHOR]

Manual small incision cataract surgery is relatively safe in hypermature cataract and yields adequate visual outcome. Preoperative risk factors, in addition to hypermaturity, increase the complication rate. Purpose: To evaluate the visual outcome and complication rate of manual small incision cataract surgery (MSICS) in hypermature morgagnian cataract (HMC). Setting: Aravind Eye Hospital, Pondicherry, India. Design: Retrospective, single center study. Methods: Case records of patients diagnosed with HMC and who underwent MSICS from January to December 2019 were retrospectively collected. Data were analyzed for demographic details, preoperative risk factors, intraoperative/postoperative complications, and visual outcome at 1-month follow-up. Results: 105 patients were included in the study. Preoperative risk factors like dense pseudoexfoliation were seen in 6 patients (5.7%), phacolytic glaucoma in 7 patients (6.7%), lens induced uveitis in 5 (4.7%), and phacodonesis in 30 patients (28.5%). Overall intraoperative complication rate was 14.3%, which included posterior capsular rent (n = 4), zonular dialysis (n = 7), and whole bag removal (n = 4). Due to poor posterior capsular bag support, 7 patients (6.6%) did not receive intraocular lens implantation in primary surgery. Both the intraoperative and postoperative complication rate were high in those with risk factors, and this difference was statistically significant (P <.001 and.0005, respectively). On the first postoperative day, 70 patients (66.7%) had a corrected distance visual acuity (CDVA) better than 20/40, and at 1 month, 98 patients (93.3%) had a CDVA of 20/60 or better of which 89.5% had CDVA of ≥20/40. Conclusions: MSICS for hypermature cataract is relatively safe and yields adequate visual outcome. Preoperative risk factors, in addition to hypermaturity, increase the complication rate. [ABSTRACT FROM AUTHOR]

BACKGROUND: Inguinal lymph node dissection (ILND) is used for diagnosis and treatment in penile cancer (PC), vulvar cancer (VC), and melanomas draining to the inguinal lymph nodes. However, ILND is often characterized by its morbidity and high wound complication rate. Consequently, we aimed to characterize wound complication rates after ILND. STUDY DESIGN: The NSQIP database was queried for ILND performed from 2005 to 2018 for melanoma, PC, or VC. Thirty-day wound complications included wound disruption and superficial, deep, and organ-space surgical site infection. Multivariable logistic regression was performed with covariates, including cancer type, age, American Society of Anesthesiologists score ≥3, BMI ≥30, smoking history, diabetes, operative time, and concomitant pelvic lymph node dissection. RESULTS: A total of 1,099 patients had an ILND with 92, 115, and 892 ILNDs performed for PC, VC, and melanoma, respectively. Wound complications occurred in 161 (14.6%) patients, including 12 (13.0%), 17(14.8%), and 132 (14.8%) patients with PC, VC, and melanoma, respectively. Median length of stay was 1 day (interquartile range 0 to 3 days), and median operative time was 152 minutes (interquartile 83 to 192 minutes). Readmission rate was 12.7%. Wound complications were associated with longer operative time per 10 minutes (odds ratio 1.038, 95% CI 1.019 to 1.056, p < 0.001), BMI ≥30 (odds ratio 1.976, 95% CI 1.386 to 2.818, p < 0.001), and concomitant pelvic lymph node dissection (odds ratio 1.561, 95% CI 1.056 to 2.306, p = 0.025). CONCLUSIONS: Predictors of wound complications after ILND include BMI ≥30, longer operative time, and concomitant pelvic lymph node dissection. There have been efforts to decrease ILND complication rates, including minimally invasive techniques and modified templates, which are not captured by NSQIP, and such approaches may be considered especially for those with increased complication risks. [ABSTRACT FROM AUTHOR]

This document is a comment on a study titled "Chin Augmentation With Hyaluronic Acid: An Injection Technique Based on Anatomical Morphology." The comment suggests that bovine collagen xenografts are a useful treatment for wounds in various anatomical locations. The author recommends further studies comparing the effectiveness of bovine collagen xenografts with other treatments. The document is published in the journal Dermatologic Surgery. [Extracted from the article]

After small-incision cataract surgery, against-the-rule (ATR) astigmatic changes continue over 20 years, regardless of the type of preoperative astigmatism: with-the-rule, ATR, and oblique astigmatism. Purpose: To retrospectively assess astigmatic changes over 10 years and 20 years after small-incision cataract surgery. Setting: 5 ophthalmic surgical sites in Japan. Design: Retrospective case series. Methods: Data were collected from patients who had undergone phacoemulsification and implantation of an intraocular lens through a 2.2 to 2.4 mm incision. Preoperative corneal and postoperative manifest astigmatism were converted to power vector notations: horizontal/vertical (J0) and oblique (J45) astigmatism components. Results: 422 eyes of 422 patients were followed for 10 years, and data preoperatively and at 1 month and at 1 year, 3 years, 5 years, 8 years, and 10 years postoperatively were analyzed. The mean J0 decreased significantly (P <.001, repeated measures analysis of variance) with an against-the-rule (ATR) shift of 0.363 ± 0.433 diopter (D) over 10 years, but the mean J45 did not change significantly (P =.150). Double-angle plot analyses also showed similar ATR shifts in all astigmatism groups. In the subgroup analysis conducted in 34 patients who were followed for 20 years, J0 declined significantly (P <.001) by 0.649 ± 0.576 D, whereas J45 did not (P =.516). The postoperative changes in J0 and J45 were not significantly different between eyes with preoperative with-the-rule, ATR, or oblique astigmatism. Conclusions: Postoperative astigmatism continued to shift toward ATR during the follow-up period of 20 years after small-incision cataract surgery, which seems to reflect the natural course of corneal astigmatic changes that commonly occur with aging. ATR astigmatic shifts were similar in both pattern and magnitude regardless of the type of preoperative astigmatism. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. BACKGROUND: Identifying risk factors is essential for preventing surgical site infections (SSIs) in dermatologic surgery. OBJECTIVE: To analyze whether specific procedure-related factors are associated with SSI. METHODS: This systematic review of the literature included MEDLINE, EMBASE, CENTRAL, and trial registers. The Newcastle–Ottawa Scale was used for risk bias assessment. If suitable, the authors calculated risk factors and performed meta-analysis using random effects models. Otherwise, data were summarized narratively. RESULTS: Fifteen observational studies assessing 25,928 surgical procedures were included. Seven showed good, 2 fair, and 6 poor study quality. Local flaps (risk ratio [RR] 3.26, 95% confidence intervall [CI] 1.92–5.53) and skin grafting (RR 2.95, 95% CI 1.37–6.34) were associated with higher SSI rates. Simple wound closure had a significantly lower infection risk (RR 0.34, 95% CI 0.25–0.46). Second intention healing showed no association with SSI (RR 1.82, 95% CI 0.40–8.35). Delayed wound closure may not affect the SSI rate. The risk for infection may increase with the degree of preoperative contamination. There is limited evidence whether excisions >20 mm or surgical drains are linked to SSI. CONCLUSION: Local flaps, skin grafting, and severely contaminated surgical sites have a higher risk for SSI. Second intention healing and probably delayed wound closure are not associated with postoperative wound infection. [ABSTRACT FROM AUTHOR]

During the past decade, there has been some controversy related to using flap fixation techniques instead of conventional wound closure methods and drain placement during mastectomy procedures. The purpose of our study was to address this controversy using a systematic review and meta-analysis of current published literature. Nineteen studies met our inclusion criteria. Our sample population consisted of 2,956 participants divided into two groups. The study group (SG) consisted of 1,418 individuals and the control group (CG) consisted of 1,538 participants. We found there was a significant reduction in the incidence of seroma formation (odds ratio [OR] = 0.35; 95% confidence interval, CI [0.3, 0.42]; p <.000) and surgical site infection (OR = 0.65; 95% CI [0.48, 0.88]; p =.006) in the SG compared with the CG. The length of hospital stay was also significantly reduced in the SG (0.59 days; 95% CI [0.73, 0.46]; χ2[6, N = 502] = 52.88; p <.000) compared with the CG. The results of our study show that using a flap fixation technique after mastectomy can decrease the patient's risk for seroma formation and surgical site infection while reducing their length of hospital stay. Further studies with longer follow-up periods are warranted to evaluate long-term complications associated with using a flap fixation technique compared with using conventional wound closure techniques and drain placement. [ABSTRACT FROM AUTHOR]

Following cataract extraction, the preferred placement of an intraocular lens (IOL) is within the capsular bag. In 2 studies, suture breakage occurred in ~27% of cases.[[9]] In contrast, Gore-Tex is an extremely durable suture material used extensively in cardiac and vascular surgeries, and suture breakage has not yet been reported. However, in the setting of inadequate capsular support, 3 main options remain: the IOL can be placed in the anterior chamber (ACIOL), the IOL can be fixated to the iris (IFIOL), or the IOL can be fixated to the sclera (SFIOL). Combined 27-gauge pars plana vitrectomy and scleral fixation of an Akreos AO60 intraocular lens using Gore-Tex suture. [Extracted from the article]

Before the inset of the pedicle, the primary and secondary defects were widely undermined, and the cheek was advanced medially and sutured inferior-to-superior to close the secondary defect, along with the eyelid and cheek portions of the primary defect. The V-Y advancement flap is equivalent to the Mustardé flap for ectropion prevention in the reconstruction of moderate-size lid-cheek junction defects. Immediate postoperative photograph with the V-Y transposition flap and cheek advancement flap in place. [Extracted from the article]

Patients with certain risk factors such as inflammatory arthropathy, diabetes, or poor glycemic control are more likely to experience prosthetic joint infection, but are they also more likely to have culture-positive synovial fluid at the time of the index primary arthroplasty? The most common indications for first revision after primary THA in the recent Australian Orthopaedic Association National Joint Replacement Registry report include aseptic loosening (22.1%) and prosthetic joint infection (17.4%) [[4]]. Revision of hip and knee arthroplasty: supplementary report in hip, knee & shoulder arthroplasty: 2022 annual report. [Extracted from the article]

Background: Next-generation DNA sequencing (NGS) detects bacteria-specific DNA corresponding to the 16S ribosomal RNA gene and can identify bacterial presence with greater accuracy than traditional culture methods. The clinical relevance of these findings is unknown. The purpose of the present study was to compare the results from bacterial culture and NGS in order to characterize the potential use of NGS in orthopaedic trauma patients.Methods: A prospective cohort study was performed at a single academic, level-I trauma center. Three patient groups were enrolled: (1) patients undergoing surgical treatment of acute closed fractures (presumed to have no bacteria), (2) patients undergoing implant removal at the site of a healed fracture without infection, and (3) patients undergoing a first procedure for the treatment of a fracture nonunion who might or might not have subclinical infection. Surgical site tissue was sent for culture and NGS. The proportions of culture and NGS positivity were compared among the groups. The agreement between culture and NGS results was assessed with use of the Cohen kappa statistic.Results: Bacterial cultures were positive in 9 of 111 surgical sites (110 patients), whereas NGS was positive in 27 of 111 surgical sites (110 patients). Significantly more cases were positive on NGS as compared with culture (24% vs. 8.1%; p = 0.001), primarily in the acute closed fracture group. No difference was found in terms of the percent positivity of NGS when comparing the acute closed fracture, implant removal, and nonunion groups. With respect to bacterial identification, culture and NGS agreed in 73% of cases (κ = 0.051; 95% confidence interval, -0.12 to 0.22) indicating only slight agreement compared with expected chance agreement of 50%.Conclusions: NGS identified bacterial presence more frequently than culture, but with only slight agreement between culture and NGS. It is possible that the increased frequency of bacterial detection with molecular methods is reflective of biofilm presence on metal or colonization with nonpathogenic bacteria, as culture methods have selection pressure posed by restrictive, artificial growth conditions and there are low metabolic activity and replication rates of bacteria in biofilms. Our data suggest that NGS should not currently substitute for or complement conventional culture in orthopaedic trauma cases with low suspicion of infection.Level Of Evidence: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Purpose: To assess a single-piece monofocal hydrophobic acrylic intraocular lens (IOL) with hydroxyethyl methacrylate (HEMA) (Clareon) contained in automated preloaded delivery system (AutonoMe). Setting: 18 surgical sites in Japan. Design: Observational study. Methods: In patients undergoing phacoemulsification and IOL implantation of a new hydrophobic acrylic IOL using an automated injector, clinical data were collected preoperatively and at 1 day, 1 week, and 1 month, 6 months, and 12 months postoperatively. The degree of glistenings was graded on a 4-point scale. The surgeons rated usability and performance of the IOL delivery system on a 5-point scale. Results: The study enrolled 384 eyes of 384 patients, ranging in age from 41 to 93 (73.8 +/- 8.2, mean +/- SD) years. The percentage of eyes with corrected distance visual acuity of 20/25 or better at 1 day, 1 week, and 1 month, 6 months, and 12 months postoperatively was 82.6%, 91.9%, 92.8%, 96.6%, and 95.2%, respectively. Refractive error was within 1.0 diopter in approximately 90% of cases. No glistenings were found in all cases throughout the study period. The rate of Nd:YAG laser posterior capsulotomy was 0.9% at 1 year. The IOL delivery system received high ratings on its usability and performance by the surgeons. Conclusions: The new hydrophobic acrylic IOL with HEMA showed excellent visual and refractive outcomes without developing glistenings throughout the 1-year study period. The surgeons gave high marks for usability and performance of the automated preloaded delivery system. [ABSTRACT FROM AUTHOR]

Study Design: This is a retrospective, cohort analysis of multi-institutional database.Objective: This study was designed to analyze the impact of drain use following elective anterior cervical discectomy and fusion (ACDF) surgeries.Summary Of Background Data: After ACDF, a drain is often placed to prevent postoperative hematoma. However, there has been no high quality evidence to support its use with ACDF despite the theoretical benefits and risks of drain placement.Methods: The Michigan Spine Surgery Improvement Collaborative database was queried to identify all patients undergoing elective ACDF between February 2014 and October 2019. Cases were divided into two cohorts based on drain use. Propensity-score matching was utilized to adjust for inherent differences between the two cohorts. Measured outcomes included surgical site hematoma, length of stay, surgical site infection, dysphagia, home discharge, readmission within 30 days, and unplanned reoperation.Results: We identified 7943 patients during the study period. Propensity-score matching yielded 3206 pairs. On univariate analysis of matched cohorts, there were no differences in rate of postoperative hematoma requiring either return to OR or readmission. We noted patients with drains had a higher rate of dysphagia (4.6% vs. 6.3%; P = 0.003) and had longer hospital stay (P < 0.001). On multivariate analysis, drain use was associated with significantly increased length of stay (relative risk 1.23, 95% confidence interval [CI] 1.13-1.34; P < 0.001). There were no significant differences in other outcomes measured.Conclusion: Our analysis demonstrated that drain use is associated with significant longer hospital stay.Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective chart review.Objective: To determine risk factors for postoperative otolaryngologic complications among patients who undergo primary and revision anterior cervical discectomy and fusion (ACDF).Summary Of Background Data: Swallowing and voice dysfunction are frequent postoperative complaints after ACDF surgery with a published incidence varying between 1.2% and 60%. A thorough understanding of the incidence and risk factors for these complications is needed.Methods: Electronic medical records of adults who underwent ACDF with predicted difficult surgical site exposure performed by two-surgeon approach between 2008 and 2018 were reviewed. Patients were categorized by primary or revision ACDF status and by the number of levels addressed during the operation. Associations with postoperative otolaryngologic symptoms were assessed using simple and multivariable logistic regression.Results: Participants included 718 adults with an average age of 55.8 years and 45% female sex. One hundred seventy-five patients (27%) underwent revision ACDF; ACDF status was unidentifiable for 74 patients. Seventy-nine cases (12%) involved one spinal level. New postoperative otolaryngologic symptoms among those who underwent primary and revision ACDF were 12.6% and 10.9% respectively. No evidence was found of an association between postoperative otolaryngologic symptoms and revision ACDF (OR, 0.84 [95% CI, 0.48-1.49]; P  = 0.55), but evidence was found of an association with prior thyroidectomy (aOR, 3.8 [95% CI, 1.53-8.94], P  = 0.0003). Significant evidence was found of increased odds for new postoperative dysphagia with increasing number of surgical levels (aOR, 1.5 [95% CI, 1.09-2.07]; P = 0.01).Conclusion: Prior thyroidectomy and number of spinal levels addressed during ACDF were identified as risk factors for postoperative otolaryngologic complications including dysphagia. Revision ACDF was not associated with increased odds of postoperative otolaryngologic symptoms or dysphagia.Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Purpose: To investigate complications and outcomes of clear corneal incision cataract surgery in patients with thrombocytopenia. Setting: 1 veterans hospital and 2 academic medical centers. Design: Multicenter retrospective chart review. Methods: All eyes of thrombocytopenic patients that underwent clear corneal incision cataract surgery with a platelet count of 100 x 103/[mu]L or less measured within 30 days prior to surgery were included. Subject demographics, intraoperative complications, use of pupillary expansion devices, use of local anesthetic injections, and change in corrected distance visual acuity were recorded. Results: 3 sites recorded 40 113 clear corneal incision cataract surgeries, of which 196 eyes (0.49%) of 150 thrombocytopenic patients were recorded. The mean platelet count in the study subjects was 73.0 +/- 20.5 x 103/[mu]L. Two cases of intraoperative iris hemorrhage that were readily and controlled occurred in conjunction with pupillary expansion. There were no bleeding complications associated with retrobulbar, peribulbar, or sub-Tenon anesthetic injections. There was a statistically significant improvement (P <.0001) in visual acuity post-operatively. Conclusions: Clear corneal incision cataract surgery with pupillary expansion devices and local anesthetic injections can be safely performed in patients with thrombocytopenia. [ABSTRACT FROM AUTHOR]

Four patients with pseudophakic corneal edema were subjected to pre-Descemet endothelial keratoplasty (PDEK) under the direct guidance of microscope-integrated optical coherence tomography (i-OCT). i-OCT facilitated successful type 1 big bubble formation during donor preparation, debridement of the hypertrophic epithelium, planning and placement of surgical wounds, descemetorrhexis with removal of remnant Descemet membrane tags, and identification of correct donor orientation and interface details. It was also possible to discern the stability of intraocular lens, flat iris configuration, adequate stromal hydration, and wound apposition on i-OCT. Preoperative visual acuity was counting fingers (50%), 0.78 logMAR (25%), and 1.48 logMAR (25%), whereas postoperative visual acuity was 0.6 logMAR (50%) and 0.3 logMAR (50%). At 6-months of follow-up, all grafts were clear and well attached, the mean central corneal thickness, graft size, graft thickness, and endothelial cell loss were 557.25 +/- 13.45 [mu]m, 7.75 +/- 0.20 mm, 25.5 +/- 2.64 [mu]m, and 21.6 +/- 0.02%, respectively. To conclude, i-OCT helped during various surgical steps of PDEK. [ABSTRACT FROM AUTHOR]

Study Design: A laboratory study performed in a self-controlled fashion.Objective: The aim of this study was to examine whether "surgical smoke" generated by using the electrocautery on porcine spinal tissues could contain viable bacteria.Summary Of Background Data: The year 2020 has seen a surge in legislation regarding surgical smoke evacuation in the operating room across the United States. Surgical smoke contains numerous toxic and carcinogenic substances, which spine surgeons and operating room staff are regularly exposed to. Although the smoke's chemical toxicity has been extensively studied, little is known about its biohazard level.Methods: The electrocautery was used to "operate on" 20 segments of porcine spinal tissues on a clean bench. In each operation, the generated smoke was captured with a swab, which was positioned above the surgical site and within the smoke, to obtain bacteria cultures. Two other swabs-a tissue swab (swabbing the porcine tissue itself) and a blank swab (swabbing an empty sterile bowl)-were collected as controls. The culture results were compared among the three groups. An additional experiment was conducted to see whether using a mask can reduce the "infection rate" of the swab.Results: Although all blank swabs tested negative, 95% (19/20) of the smoke swabs tested positive, with a total of nine bacteria species identified. The most prevalent species observed in the smoke swabs included Serratia liquefaciens, Lactococcus garvieae, and Hafnia alvei, and so on. Among the positive smoke swabs, 84% (16/19) had one or more bacteria species that were consistent with the cultures of their corresponding tissue swabs. Using a surgical or N95 mask reduced the "infection rate" of the swab.Conclusion: "Surgical smoke" generated by electrocauterization of porcine spinal tissues contains viable bacteria. Further research in actual spine surgery is needed next.Level of Evidence: N/A. [ABSTRACT FROM AUTHOR]

BACKGROUND: Surgical site infection (SSI) is the most common complication for Mohs micrographic surgery (MMS). Lower extremity surgical sites are at an increased risk for developing SSI. OBJECTIVE: This study aimed to evaluate lower extremity SSI rates post-MMS based on closure type and antibiotic usage. MATERIALS AND METHODS: A retrospective review was performed of all lower extremity MMS cases from 2011 to 2016 at Vanderbilt University Medical Center. Patient history, surgical details, and follow-up appointments were reviewed. RESULTS: Six hundred twenty MMS lower extremity surgeries were eligible. Review identified an overall lower extremity SSI rate of 7.4%. Infection rates were significantly increased in wound closed by flaps/grafts (p <.001). Although wound size and preoperative antibiotic prophylaxis were initially associated with increased infection rate (p =.03, p =.015), the associations were fully attenuated when adjusting for closure type. CONCLUSION: More complicated repair techniques (flap/graft) for larger wound sizes contribute to increased SSI risk among lower extremity MMS cases. Providers can use this information to guide antibiotic prophylaxis. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate outcomes of manual small-incision cataract surgery (MSICS) and phacoemulsification in eyes with chorioretinal coloboma. Setting: Tertiary eye center, South India. Design: Retrospective study. Methods: Electronic medical records of 71 patients with chorioretinal coloboma undergoing cataract surgery from January 2017 to December 2019 were evaluated. Demographics, corrected distance visual acuity (CDVA), slitlamp biomicroscopy findings, grade of cataract, type of coloboma and associated posterior segment pathology, outcomes of different surgical techniques and risk factors for poor visual outcomes, and intraoperative complications were analyzed. Results: Among the 78 eyes studied, 53.9% eyes achieved visual outcome of 20/40 or greater and 20.5% eyes achieved CDVA less than 20/200. For the MSICS group, the median preoperative CDVA was 1.78 (interquartile range [IQR] 1.08 to 2.60) logMAR), which improved to 0.60 (IQR 0.30-1.08) logMAR postoperatively. In phacoemulsification group, the CDVA improved from 0.78 (IQR 0.60-1.00) logMAR to 0.18 (IQR 0.18-0.30) logMAR. Statistically significant visual improvement was noticed in both groups (P <.001 in both). However, eyes that underwent phacoemulsification showed better visual recovery (P <.001). The mean age at presentation was 49.7 +/- 10.8 years. MSICS was the most commonly performed surgery (61.54%), and 62 eyes had uneventful cataract surgery. Twelve eyes in MSICS group and 4 eyes in phacoemulsification group had intraoperative complications. Poor visual outcome was associated with male sex, microcornea, hard cataracts, and macular involvement of coloboma. Conclusions:. MSICS is an alternative to phacoemulsification in colobomatous eyes with advanced cataract. Hard cataract and microcornea were risk factors for intraoperative complications. Significant postoperative improvement in CDVA was noticed in both macula involved and macula not involved groups. [ABSTRACT FROM AUTHOR]

BACKGROUND Electrosurgery is used to achieve hemostasis during surgery. There are no studies exploring the effects of the use or avoidance of electrodessication during Mohs micrographic surgery (MMS) repair. Given the growing concerns for tissue aerosolization, occupational smoke exposure, and spread of infectious diseases, it is important to determine the importance of electrical hemostasis. MATERIALS AND METHODS In this retrospective study, electronic medical records of a single, tertiary, academic dermatology practice were reviewed. All MMS cases that underwent surgical repair from January 1 to December 31, 2019, by 2 dermatologic surgeons (one who used electrodessication during repair and one who did not) were included. Patient demographic data, information regarding the procedures, and complications occurring 90 days after MMS were recorded. RESULTS One hundred ninety-eight cases of MMS repair used electrodessication, whereas 193 cases did not. There was no significant difference in the demographic makeup, MMS procedure, or 90-day complication rates between the 2 groups. No major adverse events were MMS-related. CONCLUSION The use or avoidance of electrodessication during MMS repair was not associated with increased 90-day postoperative complications, suggesting that a greater tolerance of moderate oozing at a surgical site duringMMSrepair is reasonable to minimize electrosurgical tissue damage and occupational smoke exposure. [ABSTRACT FROM AUTHOR]

Background: Metastatic bone disease in the periacetabular region represents a potentially devastating problem for patients. Surgical treatment can offer pain relief and restore function. We describe a series of patients treated with minimally invasive osteoplasty and screw fixation with or without ablation.Methods: Thirty-eight patients with 16 different metastatic tumor subtypes were managed with osteoplasty and screw fixation with or without ablation at a single institution. A retrospective review was performed to determine functional outcomes with use of the 1993 Musculoskeletal Tumor Society (MSTS) score as well as changes in narcotic usage.Results: MSTS scores improved for all patients following surgery. Narcotic usage decreased in >80% of patients. Approximately half of the operations were outpatient procedures. Complications were minimal, there were no delays in chemotherapy or radiation due to surgical wound concerns, and there were no surgery-related deaths. The mean duration of follow-up was 9 months, with a 39% survival rate at the time of writing. Six of the 12 patients who survived for >1 year required additional procedures at a mean of 12 months (range, 4 to 23 months).Conclusions: Treatment of periacetabular metastatic disease with minimally invasive stabilization with or without ablation provides pain relief and functional improvement with lower complication rates than previously reported open reconstruction techniques. The minimally invasive approach allows for rapid initiation of chemotherapy and radiation. Patients with particularly aggressive cancers that are poorly responsive to systemic therapies and radiation may have progression of disease and may require additional procedures. Conversion to total hip arthroplasty was uncomplicated, and the cement and screw constructs were retained, providing a stable base for the arthroplasty reconstruction.Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Lower extremity surgical defects pose a reconstructive challenge due to minimal tissue laxity, tension from transient edema, physical movement, and poor vascularity. Dermatol Surg. 2004; 30:, 1406-11. 3 Dixon AJ,, Dixon JB. Reducing opposed multilobed flaps results in fewer complications than traditional repair techniques when closing medium-sized defects on the leg after excision of skin tumor. Anecdotally, it appears that the dehiscence rate with this is lower than when allowing patients to change their bandage and wrap their legs themselves. [Extracted from the article]

Purpose: To investigate factors related to the rotational stability of an acrylic toric intraocular lens (IOL). Setting: Four ophthalmic surgical sites in Japan. Design: Prospective case series. Methods: The study included 120 eyes of 120 patients undergoing phacoemulsification and implantation of a toric IOL (AcrySof IQ, Alcon Laboratories, Inc.). At 1 hour postoperatively, the area of continuous curvilinear capsulorhexis (CCC) was measured, and the state of anterior capsule coverage on the IOL optic (total on or partial on) was recorded. The toric IOL axis orientation was assessed at the end of surgery and at 1 hour, 1 week, 1 month, and 6 months postoperatively. Multiple regression analysis was performed to explore any clinical factors relevant to IOL rotation from the end of surgery to 6 months postoperatively. The explanatory variables included age, anterior chamber depth preoperatively, axial length, type of corneal astigmatism (with-the-rule, against-the-rule, or oblique astigmatism), area of CCC, state of anterior capsule overlap on IOL optic (total coverage vs partial coverage), and surgical sites (surgeons). Results: The multiple regression analysis in 110 eyes of 110 patients indicated that anterior capsule overlap on the IOL optic was the only variable associated with IOL rotation at 6 months postoperatively (P =.0482). The mean absolute rotation at 6 months was 1.96 +/- 1.81 degrees in the total on group and 3.79 +/- 3.12 degrees in the partial on group (P =.0004). Conclusions: Rotational stability of a single-piece, acrylic toric IOL was better in eyes with total anterior capsule coverage than that in those with partial anterior capsule coverage on the IOL optic. [ABSTRACT FROM AUTHOR]

This project focused on adult lower extremity amputees from March 2017 through March 2019. The aim was to improve 30-day surgical site infection (SSI) rates by 10% in two orthopaedic populations. Subaims focused on 30-day readmission rates, length of stay, and 30-day mortality rates. The primary intervention of incisional negative pressure wound vac therapy (iNPWT) device application was instituted. This was supported by World Health Organization recommendations, meta-analyses, and consensus statements advising the utilization of iNPWT devices. Plan–Do–Study–Act cycles were aimed at education, operation efficiency, and patient engagement. By March 2019, goals were met for SSI and 30-day readmission rates in each division. Cost analysis showed a savings of $38,500. Improved clinical significance was noted in SSI rates, 30-day readmission rates, and cost in lower extremity amputees. It is unclear whether the innovation led to improvement in the other subaims; however, this revealed areas for additional areas for improvement. [ABSTRACT FROM AUTHOR]