Search

Aim: Patients requiring CIED (PM, ICD, CRT) implantation are taking the oral anticoagulant warfarin for different indications such as valve replacement, atrial fibrillation or high risk of embolic stroke. Anticoagulation therapy expose a patient to pocket hematoma formation, which is associated with infection. In this study, we applied tachosil patch in the pacemaker implantation pocket, without interrupting warfarin medication, to investigate prevention of pocket hematoma. Method: 0 Years old, male patient arrived in ER, by syncope. He was high risk of pocket hematoma formation patient with A. fib, Heart failure, Aortic valve and Mitral Valve replacement surgery, high INR and warfarin medication history. During pacemaker insertion by cardiologist, half piece of tachosil patch was inserted to pocket. After that, Generator was inserted on the tachosil patch. And Half piece of tachosil patch was inserted on the generator again. The wound was closed in layers, and a sterile pressure dressing was applied. (Figure 1-4) Results / Discussion: He was discharge postoperative day 5, without any complication. Stitch-out was done at postoperative day 10 and the wound was clean, without interrupting warfarin medication. Conclusion: Tachosil was used as a topical hemostat in surgical filed. But it has not been used on CIED procedure. We used it first, to prevent pocket hematoma formation on pacemaker insertion. Tachosil could be a one way to reduce pocket hematoma formation, in patient at the high risk of thromboembolism, who can't interrupt oral anticoagulant warfarin therapy. [ABSTRACT FROM AUTHOR]

The optimal management of dural closure is unclear; therefore, we aimed to survey current common practices among Italian practitioners. The Delphi method was used to achieve a consensus on dura mater closing techniques in Italy. A steering committee decided 3 major topics to be investigated: pre- and postoperative conditions associated with cerebrospinal fluid (CSF) leak, indications to perform watertight dural closure, and dural closure technique. A questionnaire containing 12 statements was then submitted to Italian neurosurgeons. The response rate was 60%. Among 60 items, 36 reached a positive consensus, 5 reached a negative consensus, and 19 did not reach consensus. Intrathecal hypertension, arachnoid opening, previous treatments, spinal incidental durotomy, wide size of osteo-dural defect, and lack of nasoseptal flap were considered major risk factors for CSF leak. Early mobilization, avoidance of stress maneuvers, and use of CSF external drainage were considered to reduce CSF leak rate. Italian neurosurgeons always attempt watertight dural closure, ideally with monofilament nonabsorbable sutures. Both autologous and heterologous dural grafts are used. Among dural sealants, fibrin glues are preferred, which are used most commonly in transsphenoidal surgery. This study elucidates the areas of consensus and uncertainty on dural closure management among a group of Italian neurosurgeons. It provides reliable and comparable data for the investigation of the departments' daily practice in dural closure. Given the lack of solid evidence, there is a need for further comparative studies of dural repair strategies. [ABSTRACT FROM AUTHOR]

Aim: We present one patient of 93 years old, with arthrosis, hypertension and fracture of the right femour, due to an accidental fall, which forced her to a two-month hospitalization, bedridden. For this reason, she came home with one pressure sore on the right heel (III degree) and a trauma+c injuries on the right calf. Our treatment schedule includes, in the first phase of treatment, three +mes a week visits. Starter Pain scale NRS=4. Method: The wound dressing was changed 3 times a week by: Cleaning with physiological solution, and then applied a pad of polyacrylate poly-absorbent fibers, and a low-adherence bandage from the popliteal fossa to the toes. The fibrinous wound bed proves very difficult to dissolve so we decided to change the dressing with highly cohesive poly-absorbent fibers rope. Results: The lesion decreased, the fibrin has reduced. There is no edema and the patient doesn't complain pain (NRS=0). Conclusion: We observed that in the case of cavitary lesions, with a fibrinous wound bed, we have a better result with highly cohesive poly-absorbent fibers in cavity lesions compared to the polyacrylate poly-absorbent fibers pad. Also, we analyzed the importance of patient compliance with bandage and dressing management as well as injury prevention education, these are essential for wound healing. [ABSTRACT FROM AUTHOR]

Aim: Topical hemostatic agents can interfere with the wound healing process by causing foreign body reactions, inflammation, and infection since they are foreign entities. We analyzed the effect of Genta-Coll on wound healing by inducing muscle defects in the rectus abdominis muscle of rats. We also assessed the effectiveness of Genta-Coll in preventing surgical site infections (SSIs) by countering nosocomial bacteria and performed a zone of inhibition test to determine the sensitivity of pathogenic bacteria. Method: Twelve Sprague Dawley® rats were subjected to creation of a 6X6mm detect in the rectus abdominis muscle and divided into four groups: control; A, Tachosil® fibrin sealant patch; B, Surgicel® Fibrillar™ oxidized regenerated cellulose; and C, Surgicel® Snow™ oxidized regenerated cellulose. For the histologic analysis, biopsies were performed on the 3rd, 7th, and 28th days. Results / Discussion: The foreign body reaction was the weakest in group A and most significant in group C. The inflammatory cell infiltration was the weakest in group A and similar in groups B and C. The amount of extracellular matrix was initially high in group A but ultimately similar. Muscle regeneration differed among periods. The rats in group A were the most active initially, while those in group C showed prolonged activity. Conclusion: Tachosil® and Surgicel® administration increased inflammation via foreign body reactions, but the overall wound healing process was not significantly affected. We recommend using Tachosil®, because it results in less intense foreign body reactions than Surgicel® and faster wound healing due to the fibrin action. [ABSTRACT FROM AUTHOR]

Background: Laparoscopy has increasingly become the standard of care for patients who undergo colorectal surgery for both benign and malignant diseases. This growing experience has also resulted in more reports of postoperative complications from the minimally invasive approach to primary colorectal resection. Small bowel obstruction from internal hernias and pre-sacral adhesions is an uncommon but not negligible complication. However, there is little literature specific to this topic with recommendations for different methods to prevent it. We report our original technique of closing the mesenteric defect and covering the pre-sacral fascia by using fibrin sealant to prevent this complication.Methods: From January 2005 to December 2014, a total of 1079 patients underwent elective laparoscopic left colorectal resection (left hemicolectomy or anterior rectal resection) in our department. In the first 298 procedures, the mesenteric defect was left open, while in the following 781 procedures, it was closed using fibrin sealant with the aim of preventing postoperative small bowel obstruction.Results: Among the first 298 patients, three (1%) required reoperation for small bowel obstruction due to internal hernia (0.33%) or critical pre-sacral adhesions (0.66%). These complications did not occur in the subsequent series in which all 781 patients were treated with fibrin sealant prophylactic closure of the mesenteric defect.Conclusion: In our experience, fibrin sealant closure of the mesenteric defect has demonstrated to be safe and effective in preventing postoperative small bowel obstruction that remains a complication both in open and in laparoscopic colorectal surgeries. [ABSTRACT FROM AUTHOR]

The authors report the indications for and methods of application of fibrin glue in reconstructive microsurgery of the middle ear. On the basis of 180 interventions, they describe in detail the use of fibrin glue in myringo- and tympanoplasty for correct fixing of grafts. Furthermore, they illustrate the particular use of fibrin glue in reconstruction of the incudostapedial joint, in covering eroded areas of the lateral semicircular canal and in one case of perilymph gusher.