Journal of Pediatric Surgery Open最新文献

{"title":"The surgical management of peripheral IV extravasation injuries in infants and children","authors":"Genevieve Kierulf ,&nbsp;Nicole Becher ,&nbsp;Adam Goldsmith ,&nbsp;Young Mee Choi ,&nbsp;Steven Moulton","doi":"10.1016/j.yjpso.2024.100150","DOIUrl":"https://doi.org/10.1016/j.yjpso.2024.100150","url":null,"abstract":"<div><h3>Introduction</h3><p>Peripheral IV extravasation (PIVE) injuries are a common cause of skin injury in infants and children. Although most PIVE injuries are minor and self-limited, severe PIVE injuries associated with calcium deposition and/or full-thickness skin injury will require surgical management.</p></div><div><h3>Methods</h3><p>This is a retrospective review of children with PIVE injures who required surgical management at our institution from 2012 to 2022. Data collected included demographics, substance infiltrated, immediate management, surgical history, and long-term outcomes. Immediate management for those at imminent risk for skin loss or circulation impairment involved treatment with hyaluronidase to minimize tissue damage, followed by removal of the IV catheter. PIVEs involving calcium containing infiltrates were observed for 2–4 weeks to allow the calcium to precipitate, before undertaking surgical debridement of calcium deposits.</p></div><div><h3>Results</h3><p>There were 11 PIVE injuries requiring surgery during the 10-year study period, of which 7 (63.6 %) were infants (&lt; 30 days old). Surgery was delayed 2–4 weeks for those whose infiltrate contained calcium, to allow for precipitation and coalescence of the calcium in the soft tissue. Nine patients required debridement with skin grafting. One patient underwent debridement with wound closure, and one underwent needle decompression alone. Eight patients (72.7 %) received follow-up from OT/PT services, and most (75 %) achieved optimal functional outcomes including full range of motion and age-appropriate motor skills.</p></div><div><h3>Conclusions</h3><p>Most IV infiltrate injuries self-resolve with no sequelae. Those injuries caused by calcium containing fluids or caustic medications can result in significant tissue destruction requiring operative intervention.</p></div><div><h3>Level of Evidence</h3><p>Treatment Study, Level IV</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100150"},"PeriodicalIF":0.0,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000352/pdfft?md5=6ed25579ffdc74b160a2487300f865e0&pid=1-s2.0-S2949711624000352-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141244505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rebooting the anal sphincter: A retrospective cohort of children with intractable constipation receiving intrasphincteric botox injections","authors":"Luke Uden ,&nbsp;Mansha Jiwane ,&nbsp;Jyoti R Sharma ,&nbsp;Ajay Sharma ,&nbsp;Daisy Evans ,&nbsp;Britta S von Ungern-Sternberg ,&nbsp;Parshotam Gera","doi":"10.1016/j.yjpso.2024.100147","DOIUrl":"10.1016/j.yjpso.2024.100147","url":null,"abstract":"<div><h3>Background</h3><p>Chronic childhood constipation is a common problem that severely impacts quality of life. Recently, the efficacy of intrasphincteric botulinum toxin (botox) injection in breaking the cycle of constipation has been demonstrated. The current study aims to investigate response rate to treatment, symptom and examination finding associations, and identify associations between patient characteristics and outcome.</p></div><div><h3>Methods</h3><p>Parental consent was given for the review of medical records. This retrospective cohort included paediatric patients, under 16 years old, presenting to Perth Paediatrics, in Western Australia, from August 2017 to June 2022, who received botox injections (10 IU/kg, at 3, 6, and 9 o'clock) for intractable constipation. Patients required a negative diagnosis of Hirschsprung's disease for inclusion. A successful outcome was defined by a reduction in related symptoms and dosage of aperients at a post-operative consultation at least two weeks following injection, compared to those prior.</p></div><div><h3>Results</h3><p>Of 81 patients, 83 % experienced an overall improvement in symptoms following their first injection. 47 % noted a reduced laxative requirement, with no patients reporting any adverse effects. Twelve patients received a second injection, of which 58 % reported a successful outcome afterward. Across all variables, the majority of patients experienced a positive response. In this retrospective cohort, there were no associations demonstrated between comorbidities, age, sex, symptomatology, or examination findings, and positive response.</p></div><div><h3>Conclusions</h3><p>These results suggest that, in managing intractable constipation in children, intrasphincteric botox injection may be beneficial in reducing symptoms, with no reported adverse events in this cohort.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100147"},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000327/pdfft?md5=440447d85d6ed24c8bbd2002b557a537&pid=1-s2.0-S2949711624000327-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141037147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a tool to assess patient and caregiver satisfaction for minor pediatric surgical procedures","authors":"Karan Gandhi ,&nbsp;Jacob Davidson ,&nbsp;Camille Duggal ,&nbsp;Vanessa Fantillo ,&nbsp;Julie E. Strychowsky","doi":"10.1016/j.yjpso.2024.100145","DOIUrl":"10.1016/j.yjpso.2024.100145","url":null,"abstract":"<div><h3>Introduction</h3><p>Patient satisfaction questionnaires offer valuable perspectives on patient experiences and the quality of healthcare received. Despite their importance, a gold standard for measuring patient satisfaction in pediatric surgery remains elusive. This study introduces a patient satisfaction questionnaire designed to fill the gap in evaluating patient experiences specifically in pediatric surgical settings, aiming to create a standardized measure for assessing patient satisfaction.</p></div><div><h3>Methods</h3><p>The think-aloud method was used with patient advisors and an expert panel of hospital stakeholders to refine a novel patient and caregiver satisfaction tool. Through an iterative process, data was gathered, analyzed and the survey progressively revised. The final survey was then pilot tested.</p></div><div><h3>Results</h3><p>Three patient advisors and seven hospital stakeholders participated in the study. The think-aloud method was used to establish cognitive, content, and face validity. There were five distinct satisfaction domains established. Pilot testing included 30 participants and was used to establish construct validity and test-retest reliability.</p></div><div><h3>Conclusions</h3><p>This study addresses the existing gap in measuring patient satisfaction in pediatric surgery settings. The think-aloud method was used to ensure cognitive, content, and face validity ensuring multiple domains are addressed. Pilot testing of the tool showed feasibility in both the operating room and minor procedure room setting while also demonstrating test re-test validity. These results indicate that this questionnaire holds promise for use in a variety of pediatric surgical settings. Further research is necessary to confirm these findings in larger, more diverse populations and to assess its impact on improving patient care and experiences.</p></div><div><h3>Type of Study</h3><p>Survey Development and Validation Study.</p></div><div><h3>Level of Evidence</h3><p>III</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100145"},"PeriodicalIF":0.0,"publicationDate":"2024-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000303/pdfft?md5=7eaa504cc593bfe3d07aed1f41c7b11e&pid=1-s2.0-S2949711624000303-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141031138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can ERAS help reduce health disparities and overcome barriers to equitable surgical care in marginalized communities?","authors":"Chirag Ram ,&nbsp;Ruoying Li ,&nbsp;Andrew D. Franklin ,&nbsp;Kurt Heiss ,&nbsp;Carmelle Romain ,&nbsp;Irving J. Zamora","doi":"10.1016/j.yjpso.2024.100141","DOIUrl":"10.1016/j.yjpso.2024.100141","url":null,"abstract":"<div><p>Health inequities persist in surgical outcomes between different races and ethnicities. Enhanced Recovery after Surgery (ERAS) protocols are innovative perioperative management strategies that have improved outcomes and reduced costs of delivering care. Quality improvement tools embedded in the protocols allow for sequential improvements in compliance and outcomes. Standardization of perioperative care may reduce healthcare inequities and improve outcomes in marginalized communities. In this review, we describe the benefits of ERAS in surgical outcomes, discuss how implementation of ERAS could potentially reduce health disparities in pediatric surgical patients, demonstrate the barriers present in ERAS implementation, propose solutions to these implementation barriers (Table 1).</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100141"},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000261/pdfft?md5=b0c2ec020de44043076229908693f717&pid=1-s2.0-S2949711624000261-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140757178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The learning curve of single-incision pediatric endosurgery","authors":"Noémie Wildschutz ,&nbsp;Nathalie Brewer ,&nbsp;Oliver J. Muensterer","doi":"10.1016/j.yjpso.2024.100144","DOIUrl":"https://doi.org/10.1016/j.yjpso.2024.100144","url":null,"abstract":"<div><h3>Background</h3><p>Single incision pediatric endosurgery (SIPES) has been established in some pediatric surgery centers for certain operations. A concern in implementing these technically challenging procedures is the associated learning curve. This study describes the learning curve associated with the 3 most common procedures appendectomy, cholecystectomy, and pyloromyotomy.</p></div><div><h3>Methods</h3><p>All SIPES appendectomies, cholecystectomies, and pyloromyotomies performed by an academic pediatric surgeon in the first 14 months of performing SIPES were chronologically divided into thirds of equal number, groups A (first), B (middle), and C (last). The learning curve for each operation was assessed by comparing operating times, conversion rates (defined as adding additional trocars) and complication rates among these groups.</p></div><div><h3>Results</h3><p>During the study period, 183 appendectomies, 51 cholecystectomies, and 49 pyloromyotomies using SIPES technique were performed. With increasing experience, operating times (mean±standard deviation) decreased significantly for all 3 operations (42±14 to 36±13 min for appendectomies, <em>p</em> = 0.015; 78±20 to 59±18 for cholecystectomies, <em>p</em> = 0.004; 26±7.7 to 20±5.5 min for pyloromyotomies, <em>p</em> = 0.015). The number of additional trocars placed during appendectomies declined steadily from 21 % in group A to 0 % in group C (<em>p</em> &lt; 0.001). There were more complications during appendectomy in groups A versus B (8 % versus 0 %, <em>p</em> = 0.03), but no other differences in complication rates were found.</p></div><div><h3>Conclusion</h3><p>Operating times for all SIPES operations declined throughout the study period. With experience, the need for additional trocars and the complication rate during appendectomy approaches zero. We have shown that it is feasible to safely and effectively transition to the new surgical technique.</p></div><div><h3>Level of evidence</h3><p>II - prospective cohort study</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100144"},"PeriodicalIF":0.0,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000297/pdfft?md5=72a970b8bf6dd10663ec7ad1e15e6914&pid=1-s2.0-S2949711624000297-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140644961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Approaches to starting and growing ERAS at a Children's Hospital","authors":"Kyle O. Rove ,&nbsp;Megan A. Brockel","doi":"10.1016/j.yjpso.2024.100140","DOIUrl":"https://doi.org/10.1016/j.yjpso.2024.100140","url":null,"abstract":"<div><p>Enhanced Recovery After Surgery is a multi-disciplinary, multi-modal, evidence-based approach to perioperative care that is known to improve outcomes for adult patients and has more recently been shown to lead to similar improvements for children. Its success in adult patients has led to growing interest in the adoption of ERAS in the pediatric population. Successful ERAS implementation hinges on strong leadership, provider and patient education and engagement, and continuous audit with the use of quality improvement methodology. The electronic health record is an invaluable tool that can be leveraged to not only aid in delivering standardized care through order sets for medications, fluids, and daily cares, but also to document and audit process measures and outcomes. In this paper, the authors describe our 10-year journey at a free-standing children's hospital from initial “baby steps” implementing individual elements for a single surgery to 11 active, comprehensive protocols spanning eight specialties and growing.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100140"},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294971162400025X/pdfft?md5=9326a87b8b4f1da49bbdeea1a5141786&pid=1-s2.0-S294971162400025X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140638643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Board Page","authors":"","doi":"10.1016/S2949-7116(24)00027-3","DOIUrl":"https://doi.org/10.1016/S2949-7116(24)00027-3","url":null,"abstract":"","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"6 ","pages":"Article 100142"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000273/pdfft?md5=a567b760e22d1a6a33d7b1caf00d0577&pid=1-s2.0-S2949711624000273-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140638609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management and outcomes of children with rhabdomyosarcoma in a low-to-middle-income country: A first report from Chris Hani Baragwanath Academic Hospital, South Africa","authors":"Jonathan Jacobson,&nbsp;Julia Jamieson,&nbsp;Sithandweyinkosi Mushunje,&nbsp;Derek Harrison","doi":"10.1016/j.yjpso.2024.100139","DOIUrl":"https://doi.org/10.1016/j.yjpso.2024.100139","url":null,"abstract":"<div><h3>Background</h3><p>Studies done in South Africa show that Rhabdomyosarcomas (RMS) comprises 6 % of childhood malignancies. Very few centres in South Africa (SA) have reported their management and outcomes of children with RMS, and as such, it is difficult to compare outcomes and come up with management protocols befitting our environment.</p></div><div><h3>Aim</h3><p>To describe the management and outcomes of children with RMS at Chris Hani Baragwanath Academic Hospital (CHBAH).</p></div><div><h3>Setting</h3><p>The Departments of Paediatric Surgery and Paediatric Oncology.</p></div><div><h3>Methods</h3><p>A retrospective review of clinical records of patients below 18 years of age with RMS, managed from 01 January 2008 to 31 December 2017.</p></div><div><h3>Results</h3><p>Fifty-eight patients had RMS, 77 % embryonal and 21 % alveolar subtypes. Primary tumour site was favourable in 48 %, and unfavourable in 45 %. Thirty-three patients (57%,) had surgery for the primary tumour, whilst 25 patients (43 %) did not have surgery. Post-operative clinical groups were 29 % group I, 9 % group II, 43 % group III, and 19 % group IV. The overall 5-year survival was 55%. Predictors for a good outcome included early disease stage at presentation, favourable site, embryonal subtype, and surgery for the primary tumour.</p></div><div><h3>Conclusion</h3><p>The 5-year survival of 55 % from this study is low when compared to high income countries but is comparable to middle income countries. The main factor contributing to mortality is patients presenting with unresectable advanced disease in unfavourable sites. Surgical resection plays a major role in improving outcomes.</p></div><div><h3>Level of evidence</h3><p>IV</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"6 ","pages":"Article 100139"},"PeriodicalIF":0.0,"publicationDate":"2024-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000248/pdfft?md5=01288073b9fe921453e9a750ba96fcec&pid=1-s2.0-S2949711624000248-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140327840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced recovery after surgery (ERAS) novel protocol for management of esophageal replacement in children: A single surgeon's experience of 116 cases","authors":"Rajendra Saoji ,&nbsp;Moreshwar S Desai ,&nbsp;Avanti Saoji ,&nbsp;Roshan Bhugaonkar ,&nbsp;Shweta Bhandarkar ,&nbsp;Anand Bhutada ,&nbsp;Dipty Jain","doi":"10.1016/j.yjpso.2024.100129","DOIUrl":"10.1016/j.yjpso.2024.100129","url":null,"abstract":"<div><h3>Background</h3><p>Perioperative management of esophageal replacement is challenging due to significant disturbance in internal milieu of the body. To mitigate mediastinal dissection induced systemic inflammatory response, there is an unmet need to design and test a goal directed, resource conscious protocol for enhanced recovery, which will serve as a template to reduce morbid surgical complications and length of hospital stay.</p></div><div><h3>Methods</h3><p>A retrospective cohort study was designed by convenience sampling method to group patients to compare outcomes of pediatric esophageal replacement using conventional protocol vs enhanced recovery after surgery novel protocol. Primary outcome measure was post-operative total length of stay in hospital. Secondary outcome measures were frequency of cardio-pulmonary complications, anastomotic leaks, infections, mortality, and initiation of early enteral jejunostomy feeding.</p></div><div><h3>Results</h3><p>A total of 116 children with corrosive esophageal injury [<em>n</em> = 21(19%)] and esophageal atresia [<em>n</em> = 95(81 %)] were analyzed in this study. Novel protocol group(<em>n</em> = 62) when compared to conventional protocol group (<em>n</em> = 54) had lower mean total length of stay days (13.05 ± 7.92 days vs.21.96 ± 6.5 days <em>p</em> &lt; 0.0001), shorter mean ICU days (5.74 ± 4.16 days vs 7.13 ± 3.16 days; <em>p</em> ≤ 0.048) and Novel protocol group had lower cardiac [3/62 (5 %) vs 12/54(22 %) <em>p</em> = 0.012]; and pulmonary [4/62 (6.5 %) vs 13/54(24 %) <em>p</em> = 0.007] complications. Novel protocol group had lower mean days to initiation of enteral feeding (3.13 ± 0.71 vs 5.45 ± 0.75 days; <em>p</em> &lt; 0.0001) and lower rates of post-operative infections [5/62(8 %) vs 18/54 (33 %); <em>p</em> = 0.001].</p></div><div><h3>Conclusions</h3><p>Enhanced recovery after surgery novel protocol has the potential to change clinical practice due to mitigation of major complications.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"6 ","pages":"Article 100129"},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000145/pdfft?md5=fab1d8c7525b8761457614da71625bed&pid=1-s2.0-S2949711624000145-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140277293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Staged surgical management and its impact on quality of life for stage 3 hidradenitis suppurativa in adolescents","authors":"Julia M. Power ,&nbsp;Anne F. Faulk ,&nbsp;India Hill ,&nbsp;Jessica A. Zagory","doi":"10.1016/j.yjpso.2024.100138","DOIUrl":"https://doi.org/10.1016/j.yjpso.2024.100138","url":null,"abstract":"<div><h3>Background</h3><p>Hidradenitis suppurativa (HS) can present significant physical, psychological, social, and financial burden. Here, we describe surgical and quality of life outcomes for adolescent patients with axillary Hurley stage 3 HS who underwent staged surgical management.</p></div><div><h3>Methods</h3><p>We performed a single-center, retrospective review of patients ≤21 years who had axillary Hurley stage 3 HS. A standardized, staged surgical approach was implemented. Primary outcomes were length of stay, length of negative pressure wound therapy (NPWT) use, number of operations, range of motion, and graft uptake. Secondary outcome was depression, suicidal ideation, and social changes including return to school or work.</p></div><div><h3>Results</h3><p>Nine adolescent female patients with axillary Hurley stage 3 HS were included, of whom 6 underwent surgery (9 total sites) and 3 remained on medical therapy. Patients had 6.5 ± 4.6 visits to the emergency department prior to surgery referral and had undergone 7.5 ± 5.1 incision and drainage procedures. For patients undergoing surgical management, NPWT duration was 23 ± 4 days, with 2–3 NPWT changes. Graft uptake was 80–100 % with 100 % return of full range of motion. No disease recurrence has been noted. All patients undergoing surgical management reported improvement in depression and suicidal ideation.</p></div><div><h3>Conclusion</h3><p>Well-defined staged surgical approach for axillary Hurley stage 3 HS can offer adolescent patients disease eradication, improvement in range of motion, and improvement in quality of life.</p></div><div><h3>Study type</h3><p>Retrospective review, case series.</p></div><div><h3>Level of evidence</h3><p>IV.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"6 ","pages":"Article 100138"},"PeriodicalIF":0.0,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000236/pdfft?md5=363ce7a20ec885c172f06c844c1ccb20&pid=1-s2.0-S2949711624000236-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140163637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}