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PurposeTo compare reinforced tension line (RTL) and mesh techniques in the onlay position for preventing abdominal wound dehiscence (AWD) in a noninferiority clinical trial.MethodsPatients > 18 years old who underwent midline laparotomy and who were considered at high risk on the modified Rotterdam risk scale were included. The outcomes analyzed were the incidence of AWD and surgical site occurrence (SSO).Results239 patients were included: 121 mesh group and 118 RTL group. Five (4.1%) of the 121 patients in the mesh group and 7 (5.9%) of the 118 patients in the RTL group presented with AWD (p = 0.56, RR = 0.69, 95% CI = 0.22–2.13) in the per-protocol analysis. The median time of presentation was 6 days. The 95% CI (−0.0567, 0.0231) for the difference in incidence between the two groups was entirely within the predefined noninferiority margin of 5%. The incidence of complications did not significantly differ between the two groups: the mesh group (27, 22.3%) and the RTL group (16, 12.8%) (p = 0.09, RR (95% CI) = 1.64 (0.93–2.89)).ConclusionThe use of the RTL technique for preventing AWD was not inferior to the use of mesh in the onlay position, nor did it increase the risk of complications. This study was registered on clinicaltrials.gov: Mesh-RTL Project (NCT04134455).

PurposeThe potential impact of abdominal wound dehiscence on long-term survival after elective abdominal surgery is largely unknown. The aim of this study was to examine the impact of abdominal wound dehiscence on survival and incisional hernia repair after elective, open colonic cancer resection.MethodsThis was a nationwide cohort study based on merged data from Danish national registries, comprising patients subjected to elective, open resection for colonic cancer between May 1, 2001 and January 1, 2016. Multivariable Cox Regression analysis and propensity score matching was applied to adjust for confounding. The associations of abdominal wound dehiscence with 90-day mortality and subsequent incisional hernia repair were also examined.ResultsA total of 14,169 patients were included in the cohort, of which 549 (3.9%) developed abdominal wound dehiscence. The 5-year survival was significantly decreased in patients with abdominal wound dehiscence (42.4%, 95% CI 38.1–46.7 vs. 53.4%, 52.6–54.3, P < 0.001), which was confirmed in the multivariable analysis (HR 1.22, CI 1.06–1.39, P = 0.004). Abdominal wound dehiscence was significantly associated with increased risk of 90-day mortality (OR 1.60, CI 1.12–2.27, P = 0.009) as well as subsequent incisional hernia repair (HR 1.80, CI 1.07–3.01, P = 0.026).ConclusionsAbdominal wound dehiscence was significantly associated with decreased survival. Fascial closure after open colonic cancer resection should be given high priority to improve the long-term survival.

Purpose Postoperative complications can affect recovery after colorectal cancer surgery. Elevated C-reactive protein (CRP) levels have been studied as a predictor of anastomotic dehiscence, but evidence regarding its association with overall complications is limited. This study aimed to explore the link between CRP levels on the fourth postoperative day and overall postoperative complications using the comprehensive complication index (CCI). Methods The observational study included 935 patients who underwent colorectal cancer surgery between 2015 and 2022. Patients were categorized into three groups: no complications, complications excluding dehiscence, and complications with dehiscence. The relationship between CRP levels and postoperative complications was analyzed, and the optimal CRP cutoff point was determined. Results The median CRP values were 34.3 (20.4–54.0) mg/L in the group with no complications, 69.9 (43.2–112.9) mg/L in the group with complications excluding dehiscence, and 167.6 (69.7–239.5) mg/L in patients with dehiscence. A significant correlation between CRP levels and postoperative complications was found ( p  < 0.001). Based on the identified cutoff points, CRP levels above 58 mg/L suggest the presence of any complication, including dehiscence. Levels between 42 and 58 mg/L suggest complications excluding dehiscence, and levels below 42 mg/L strongly exclude complications, with a negative predictive value of 82%. Conclusions Elevated CRP on postoperative day 4 is associated with overall postoperative complications, not just dehiscence. A positive correlation exists between CCI score and CRP levels. A CRP value < 42 mg/L on day 4 allows clinicians to reliably exclude the presence of any complication.

Interest in Superior Semicircular Canal Dehiscence (SSCD) has increased, but its diagnosis and management remain challenging. Despite advances in imaging and electrophysiological tests, many patients face long diagnostic delays and significant distress due to unclear symptom severity. While some patients show no symptoms despite radiological evidence, others experience disabling effects. This research aims to bridge the gap between objective tests and symptom severity, improving the understanding and management of SSCD. This is a prospective, non-randomized, longitudinal observational clinical study including repeated measures. It is part of the inter-regional hospital research program \"INTEX-DEHI\", involving five university hospitals. Patients diagnosed with unilateral superior semicircular canal dehiscence via CT scan will be followed over four weeks with three visits spaced 15 days apart. The main objective is to describe the clinical and paraclinical characteristics of SSCD and analyze their correlation. Electrophysiological, functional, and clinical measurements will be collected at each visit. The relationship between electrophysiological tests and the symptomatic impact of superior semicircular canal dehiscence remains underexplored. This research aims to bridge this gap by studying both common and specific VEMP frequencies, as well as EcoG and WBT, to assess their sensitivity, specificity, and diagnostic value. While this study proposes innovative tools to objectively assess symptoms, challenges remain, particularly the underdiagnosis of the syndrome and selection biases, especially in patients with fluctuating symptoms. Additionally, the diversity of clinical presentations and the absence of symptoms in some patients complicate the interpretation of results. Clinicaltrials.gov, NCT06170398.

Objective Timely and complete surgical wound healing substantially affects the patient’s performance and satisfaction with surgery outcomes. Sutures and staples are two common wound closure methods in total knee arthroplasty; however, their role in reducing the rate of surgical wound infections and dehiscence in diabetic patients is unclear. Therefore, this study was conducted to investigate the rate of infection and post-closure dehiscence in wounds closed with either nylon sutures or skin staples in diabetic patients undergoing total knee arthroplasty (TKA). Methods This is a single-blind randomized clinical trial including 70 diabetic mellitus patients undergoing TKA. Patients were selected using a restricted random sampling method and haphazardly assigned to study groups using the permuted block randomization technique, including the suture-closed ( n  = 35) and staple-closed ( n  = 35) groups. The follow-up was 2 to 8 weeks after the surgery, evaluation of wound infection and dehiscence was performed. Results The present study showed that there was no significant correlation between wound infection rate (P-value = 0.254) and wound dehiscence (P-value = 0.324) with the method of wound closure (i.e., sutures or staples). However, surgical wound dehiscence revealed a significant correlation with body mass index (BMI) (P-value = 0.044), Glycosylated hemoglobin (HbA1c) (P-Value = 0.001), and fasting blood glucose (FBS) (P-Value = 0.012) in diabetic mellitus patients. Conclusion The use of the staple technique compared to suture had no difference in the rate of wound opening and infection, but from a clinical point of view, the prevalence of wound opening after TKA in patients with the suture method was higher than that of staples. Further research is needed to confirm these findings and the long-term efficacy of each method. Clinical trial registration The present study was registered at the Iranian Registry of Clinical Trails (No. IRCT20230928059543N1, Trial Id:74754, approved on 12/01/2024, https://irct.behdasht.gov.ir/user/trial/74754/view ) and conducted according to Consolidated Standards of Reporting Trials (CONSORT) guidelines.

BackgroundIncisional hernia (IH) is the main complication after laparotomy. In an attempt to reduce this complication, mesh techniques and studies in which the closure technique is modified have been proposed. Both types are characterized by comparison with the closure described as standard or conventional: 1 × 1, mass, and continuous closure. For this study, modified closure techniques (MCTs) were considered as those techniques in which an extra suture is placed (reinforced tension line (RTL), retention), the closure point is modified in distance (small bites) or shape (CLDC, Smead Jones, interrupted, Cardiff point) and which aim to reduce these complications. The objective of this network meta-analysis (NMA) was to evaluate the effectiveness of MCTs for reducing the incidence of IH and abdominal wound dehiscence (AWD) to provide objective support for their recommendation.MethodsAn NMA was performed according to the PRISMA-NMA guidelines. The primary objective was to determine the incidence of IH and AWD, and the secondary objective was to determine the incidence of postoperative complications. Only published clinical trials were included. The risk of bias was analyzed, and the random-effects model was used to determine statistical significance.ResultsTwelve studies comparing 3540 patients were included. The incidence of HI was lower in RTL, retention suture, and small bites, these techniques showed statistical differences with pooled ORs (95% CI) of 0.28 (0.09–0.83), 0.28 (0.13–0.62), and 0.44 (0.31–0.62), respectively. Associated complications, including hematoma, seroma, and postoperative pain, could not be analyzed; however, MCTs did not increase the risk of surgical site infection.ConclusionSmall bites, RTL, and retention sutures decreased the prevalence of IH. RTL and retention suture decreased the prevalence of AWD. RTL was the best technique as it reduced both complications (IH and AWD) and had the best SUCRA and P-scores, and the number needed to treat (NNT) for net effect was 3.RegistrationThis study was prospectively registered in the PROSPERO database under registration number CRD42021231107.

Background Flap dehiscence is a common complication observed after Furlow palatoplasty, but its impact on speech outcome is unclear. This study aimed to test the hypothesis that flap dehiscence following Furlow palatoplasty significantly increases the risk of adverse long-term speech outcomes. Methods This retrospective cohort study reviewed patients with soft cleft palate (SCP), submucous cleft palate (SMCP), or secondary velopharyngeal incompetence (VPI) who underwent Furlow palatoplasty from 2013 to 2023 at a tertiary hospital-based cleft center. The exposure variable was wound healing status, categorized as primary healing (without flap dehiscence), secondary healing (with flap dehiscence), or persistent fistulae formation. The location, size, and healing duration of flap dehiscence were also documented. The primary outcome was postoperative velopharyngeal function, assessed through standardized speech evaluations. Associations were analyzed using univariate and multivariate logistic regression models. Results A total of 431 patients receiving Furlow palatoplasty were enrolled, with 12.5% reported flap dehiscence and 3.0% with persistent oronasal fistulae. For both primary cleft repair and secondary VPI correction, the occurrence of flap dehiscence and age at operation were identified as in significant correlation with postoperative velopharyngeal function. Patients with secondary healing demonstrated a higher rate of hypernasality and worse speech intelligibility. In addition, those with dehiscence size larger than 1cm 2 demonstrated significantly higher rate of VPI than those less than 1cm 2 . Conclusion Flap dehiscence is a significant prognostic factor in long-term speech outcomes following Furlow palatoplasty. Wound healing monitor is necessary for the comprehensive evaluation of cleft repair techniques.

Background Prophylactic mesh augmentation in emergency laparotomy closure is controversial. We aimed to perform a meta-analysis of randomized controlled trials (RCT) evaluating the placement of prophylactic mesh during emergency laparotomy. Methods We performed a systematic review of Cochrane, Scopus, and PubMed databases to identify RCT comparing prophylactic mesh augmentation and no mesh augmentation in patients undergoing emergency laparotomy. We excluded observational studies, conference abstracts, elective surgeries, overlapping populations, and trial protocols. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I 2 statistics. Risk of bias was assessed using the revised Cochrane risk-of-bias tool (RoB 2). The review protocol was registered at PROSPERO (CRD42023412934). Results We screened 1312 studies and 33 were thoroughly reviewed. Four studies comprising 464 patients were included in the analysis. Mesh reinforcement was significantly associated with a decrease in incisional hernia incidence (OR 0.18; 95% CI 0.07–0.44; p  < 0.001; I 2  = 0%), and synthetic mesh placement reduced fascial dehiscence (OR 0.07; 95% CI 0.01–0.53; p  = 0.01; I 2  = 0%). Mesh augmentation was associated with an increase in operative time (MD 32.09 min; 95% CI 6.39–57.78; p  = 0.01; I 2  = 49%) and seroma (OR 3.89; 95% CI 1.54–9.84; p  = 0.004; I 2  = 0%), but there was no difference in surgical-site infection or surgical-site occurrences requiring procedural intervention or reoperation. Conclusions Mesh augmentation in emergency laparotomy decreases incisional hernia and fascial dehiscence incidence. Despite the risk of seroma, prophylactic mesh augmentation appears to be safe and might be considered for emergency laparotomy closure. Further studies evaluating long-term outcomes are still needed.

Background and objectivesAlthough rare, complications like skin dehiscence and necrosis after neurosurgery pose significant challenges by increasing the risk of infections spreading to the epidural, subdural, or intracerebral spaces. This retrospective, single-center study aims to assess the prior clinical courses, neuroplastic repair, and outcomes of patients with skin defects following cranial neurosurgical procedures, and to outline our interdisciplinary reconstructive protocol.MethodsA retrospective analysis was performed on cranial surgeries conducted at the Department of Neurosurgery, spanning from 2017 to 2023. Patients with skin defects requiring the combined expertise of neurosurgery and plastic surgery for effective treatment were included. The sizes of the skin defects were measured using intraoperative photographs analyzed with the freeware ImageJ software, version 2018. All patients provided informed consent for the surgeries. If informed consent was not possible due to neurological deterioration, consent was sought from adult representatives or next of kin except for acute circumstances. All patients admitted to our hospital agree to the pseudonymized use of their medical data and tissue specimens for research purposes in their treatment contract.ResultsA cohort of 24 patients experiencing wound healing complications after neurosurgical procedures underwent a total of 29 interdisciplinary surgeries for the reconstruction of skin, dural, and bone defects. After the neuroplastic surgery, 8 out of 24 patients (33.3%) developed surgical complications, with 6 of these requiring revision surgeries due to persistent cranial infection. In all cases, permanent wound closure was successfully achieved following adherence to the proposed treatment algorithm.ConclusionsOur study underscores the necessity of an integrated neurosurgical and plastic surgical approach to effectively manage wound healing complications in a single stage surgery. Key interventions include differentiation between necrosis and gaping lesions, alongside precise management of neurosurgical issues like cerebrospinal fluid fistulas and hydrocephalus. Plastic surgical expertise in assessing the possibilities and limitations of both local and free flap surgeries is essential.

Objective Long-term quality of life and body image of patients with abdominal wound dehiscence were assessed. Methods Thirty-seven patients with abdominal wound dehiscence from a prospectively followed cohort of 967 patients (2007–2009) were reviewed. Patients completed the Short Form 36 quality of life questionnaire and Body Image Questionnaire and participated in semi-structured telephone interviews. For each patient, four controls were matched by age and gender. Analyses were adjusted for age, gender, comorbidity, and follow-up length. Results Of the 37 patients with abdominal wound dehiscence, 23 were alive after a mean follow-up of 40 months (range 33–49 months). Nineteen patients developed incisional hernias (83 %). Patients with abdominal wound dehiscence reported significantly lower scores for physical and mental component summaries ( p  = 0.038, p  = 0.013), general health ( p  = 0.003), mental health ( p  = 0.011), social functioning ( p  = 0.002), and change ( p  = 0.034). No differences were found for physical functioning ( p  = 0.072), role physical ( p  = 0.361), bodily pain ( p  = 0.133), vitality ( p  = 0.150), and role emotional ( p  = 0.138). Patients with abdominal wound dehiscence reported lower body image scores (median 16.5 vs. 18, p  = 0.087), cosmetic scores (median 13 vs. 16, p  = 0.047), and total body image scores (median 30 vs. 34, p  = 0.042). Conclusions At long-term follow-up, patients with abdominal wound dehiscence demonstrated a high incidence of incisional hernia, low body image, and low quality of life.