Academic Journal of Surgery

The Comparison between the conservative approach and pectoralis major flap transposition in the treatment of mediastinitis following median sternotomy

Saviz Pejhan — 2024-08-24

Background: Mediastinitis is a significant complication of open heart surgery and other thoracic operations. Deep sternal wound complications notably increase morbidity and mortality. The optimal treatment for deep sternal wounds following sternotomy remains a topic of discussion. Options such as repeated irrigation and debridement of the wound, closed chest catheter irrigation, and recent plastic surgery approaches like pectoralis major flap transposition all have their proponents

Methods: Given the high prevalence of Deep Sternal Wound Infection (DSWI), we conducted this retrospective descriptive study. We used existing information to compare the conservative method of repeated irrigation and debridement with pectoralis major flap transposition. We presented the results using descriptive and analytic methods. We evaluated a total of 125 patient health records with deep sternal wound infection over a ten-year period (2003-2013).

Results: The results of this study showed that 83.2% of patients who developed DSWI after surgery suffered from underlying diseases such as diabetes, renal failure, etc. However, no relationship was found between the presence of an underlying disease and recovery. Furthermore, no significant relationship was observed between diabetes and recovery. Among the 125 assessed files, 50 patients received a pectoralis flap, among which 48 patients recovered with sternal stabilization and only 2 patients recovered without stabilization. Conversely, among cases without pectoralis flapping, records were available for only 67 patients, of whom only 35 patients recovered with sternal stabilization while 32 patients recovered without sternal stabilization. Recovery was significantly enhanced in the group receiving flapping.

Conclusions: The only factor that improved the outcome in our assessment was the use of pectoralis flapping. This is consistent with the results of studies published in recent years that used plastic surgery methods, i.e., pectorals muscle or omentum flapping, which are associated with a high success rate and reduced length of inpatient stay.

Conservative management of hematoma of the rectus sheath, unusual cause of acute abdomen: A case report

Jorge Aurelio Gutiérrez González — 2024-08-24

Rectus sheath hematoma (RSH) is an accumulation of blood within the rectus sheath, secondary to rupture of the epigastric arteries. It is a rare condition, accounting for 1.6-1.8% of abdominal pain cases. It is more frequently observed in women, over the age of 50. Predisposing factors include the long-term use of anticoagulants, antiplatelets, steroids or immunosuppressants, prolonged INR, pregnancy, cardiovascular disease, hematological disease, hypertension, and diabetes. The symptoms are typically described as persistent and non-radiating acute abdominal pain that classically worsens with movements involving the abdominal wall (Carnett’s sign). Cullen’s signs (periumbilical ecchymosis) and Gray Turner’s signs (flank ecchymosis) may also be present. In stable patients, the management is conservative

Applying Translaryngeal Ultrasonography in Unilateral Vocal Cord Paralysis before Thyroid Cancer Reoperation: A Single Center Study

Sam Moslemi — 2024-08-27

Background: One of the most dangerous complications of thyroid surgery is recurrent laryngeal nerve (RLN) paralysis. The gold standard method to assess this damage is Videolaryngoscopy. However, we aimed to modify this approach by using Translaryngeal Ultrasonography (TLUS). We performed TLUS with a highly trained thyroid sonographer and an endocrine surgeon in 47 patients with recurrent thyroid cancer and unilateral RLN paralysis preoperatively, and compared the results with Videolaryngoscopy. The experienced sonographer identified 45 injuries in 47 patients, and the endocrine surgeon found 39 vocal cord injuries. It appears that TLUS, when performed by experienced practitioners, is a more accurate and safe modality for assessing vocal cord function in the preoperative setting of thyroid cancer reoperation.

The Association of Abdominoplasty with Breast Reduction (Mommy Makeover): Experience in An African University Hospital

Zakia BerjaoBerjaouu — 2024-08-27

Background: The popularity of breast reduction and abdominoplasty has significantly increased over the years, according to statistics from the American Society of Plastic Surgeons 2022. As a result, the Mommy Makeover, a procedure combining breast surgery and abdominoplasty, is not uncommon. Patients and Methods: A retrospective descriptive study was conducted over a four-year period within the Plastic and Aesthetic Surgery Department of the IBN SINA University Hospital, Rabat, Morocco.

Results: Five cases of Mommy Makeover were operated on within the Plastic and Aesthetic Surgery Department of the IBN SINA University Hospital, Rabat, Morocco. One case was addressed two years after bariatric surgery. The procedure combined breast reduction with the superior-internal pedicle technique with Wise’s pattern and abdominoplasty. No major complications were observed.

Discussion: Since the introduction of abdominoplasties combined with breast surgery, several concerns have been associated with this combination. Venous thromboembolism is the most commonly discussed consequence in combined plastic surgery procedures. The risk of venous thromboembolism is not elevated when abdominoplasty and breast reduction are combined. The study emphasizes the importance of careful patient selection and attentive venous thromboembolism prevention. It assesses the validity of the Davison-Caprini framework for venous thromboembolism risk stratification and prophylaxis in plastic surgery. Other measures to prevent complications were cited in the literature and followed by our operating team.

Conclusion: With the help of a simple risk stratification tool that takes into account diabetes, age, BMI, and ASA status, we can guarantee favorable results for women who may want combined surgery.

To investigate the relation between LDH and CRP levels and mortality of COVID-19 (SARS-CoV-2) patients admitted in SURGERY ICU at Shariati Hospital from 19 February 2020 till 19 February 2021

Nima Mohammadi Afrakoti — 2024-08-27

Background: The aim of this study is to investigate the relationship between LDH and CRP levels and the mortality of COVID-19 (SARS-CoV-2) patients admitted to the SURGERY ICU at Shariati Hospital from 19 February 2020 to 19 February 2021.

Methods: Our study is a cross-sectional descriptive study. A total of 81 patients were enrolled in this study. We examined lab reports, including CBC parameters (WBC, neutrophil count, neutrophil percentage), other inflammatory markers ESR and CRP, and also studied the medical records of cases to collect details about age, gender, length of stay in SURGERY ICU, BMI, fever, survival status, comorbidity, intubation, and NIV. These patients were referred to Shariati Hospital, Tehran, from 19 February 2020 to 19 February 2021, regarding the relationship between LDH and CRP levels and the mortality of COVID-19 (SARS-CoV-2) patients admitted to the SURGERY ICU. The data obtained was analyzed using SPSS software, and a significance value of < 0.05 was considered.

Results: In this study, the data of 81 patients were considered. The data were obtained from the medical records of Shariati Hospital, Tehran. We used 11 variables to compare data from different patients that were recorded in the registry and system of medical records in Shariati Hospital, Tehran. The study population included 81 patients, of which 41 were female and 40 were male, ranging in age from 25 to 89. In total, 80.2% had mild disease versus 18.5% who had severe disease. Sixty-five patients survived, and 16 were admitted to the SURGERY ICU with endotracheal intubation and later died. The length of stay in the SURGERY ICU ranged from 1 to 25 days. Out of 81 patients, 52 (62.4%) had comorbidity, and 29 (35.8%) did not have comorbidity. Twelve patients (14.8%) received NIV, and 69 patients (85.2%) did not receive NIV. Most of the patients did not have a fever. The minimum and maximum levels of CRP were 4 and 416, respectively, and for LDH were 9 and 2401, respectively. The prognostic factors for the severity of COVID-19 infection identified in this study (CRP and LDH) help predict the course of the disease at an early stage. Elevated concentrations of CRP and LDH at admission were found to be associated with a higher risk for COVID-19 severity as they were significant (p-value =0.049 and 0.048, respectively).

Conclusions: This study’s laboratory investigation showed that the SURGERY ICU patients had significantly higher values of inflammatory markers CRP and LDH than the non-SURGERY ICU patients. LDH and CRP were superior and effective biomarkers in predicting the severity of COVID-19.

Sore Throat Patients After Oral And Maxillofacial Surgery with and without Pharyngeal Pack

Mana Aminaie — 2024-08-27

Background: Pharyngeal packing is now widely used in head and neck surgeries after induction of anesthesia. Therefore, the present study was designed to investigate the effect of pharyngeal packing on the occurrence of sore throat and other associated symptoms in comparison with patients without pharyngeal pack in orthognathic surgeries.

Methods: This study was a randomized clinical trial and the target population was patients undergoing maxillofacial surgery hospitalized in two centers, Shafa and Shahid Bahonar Hospitals in Kerman. Sixty patients assigned to two groups, including the group with saline-soaked pack and the group without pharyngeal pack, were evaluated for the severity of sore throat at time intervals of 2, 6, 12 and 24 hours after surgery as well as the occurrence of comorbid symptoms.

Results: There was no significant difference between the two groups in terms of demographic indicators, length of surgery and length of recovery. The severity of sore throat at all-time intervals was significantly higher in the pharyngeal pack group in comparison to the control group. Other symptoms such as dysphagia, hoarseness, nausea and vomiting, laryngeal spasm and cough were not significantly different between the two groups.

Conclusions: The findings of the present study showed that the use of pharyngeal was associated with an increase in the severity of sore throat but had no effect on the associated symptoms. These findings can be a guide to adopt the correct approach to the use of pharyngeal packs in patients undergoing maxillofacial surgery.