Journal of Surgical Research最新文献

{"title":"Lycopene Inhibits Postoperative Abdominal Adhesion Formation in a Mice Model","authors":"HaoChongyang Tong MD ,&nbsp;ChangChun Ye MD ,&nbsp;Lei Fu MD ,&nbsp;Chao Qu MD ,&nbsp;WenHao Lin MD ,&nbsp;Ni Yang MD ,&nbsp;QingGuo Du MD","doi":"10.1016/j.jss.2024.10.007","DOIUrl":"10.1016/j.jss.2024.10.007","url":null,"abstract":"<div><h3>Introduction</h3><div>The prevention of postoperative abdominal adhesions is one of the top concerns of surgeons after abdominal surgery. Therefore, identifying effective interventions to reduce postoperative abdominal adhesions are essential.</div></div><div><h3>Methods</h3><div>Fifty male Bagg’s albino/c mice were randomly divided into five groups, and all groups underwent postoperative adhesion model surgery, except for the sham group. The sham and control groups were gavaged with saline solution. Based on the control group, the sodium hyaluronate group was treated with 1 mL sodium hyaluronate (smeared on the modeling site and the abdominal cavity was closed). The other two groups were gavaged with different doses of lycopene (10 μg/kg and 20 μg/kg). Seven d after surgery, the mice were sacrificed and adhesion conditions were assessed using Nair's scoring system. Subsequently, adherent tissues were harvested and the inflammation was assessed by using haematoxylin and eosin staining and enzyme linked immunosorbent assay for interleukin-6 and transforming growth factor-β1. Oxidative stress and collagen deposition condition were also detected in each mouse. Furthermore, a lycopene-induced HMrSV5 cell model was used to explore the possible functional mechanisms.</div></div><div><h3>Results</h3><div>20 μg/kg of lycopene-treated group had a lower Nair's and inflammation score, both with an average score of 1.75. Also, the level of transforming growth factor -β1 and interleukin-6 in the 20 μg/kg of lycopene-treated group was lower than others. Furthermore, 20 μg/kg of lycopene had reduced the reactive oxygen species and malondialdehyde levels in adhesion tissues compared to other groups. Fiber thickness and α-smooth muscle actin expression in adherent tissues were significantly reduced after lycopene treatment. Besides, 20 μg/kg of lycopene treatment can promote the expression of nuclear factor erythroid 2-related factor 2 and silent information regulator 1. In in-vitro studies, lycopene protected mesothelial cells from H₂O₂ -induced oxidative stress injury.</div></div><div><h3>Conclusions</h3><div>Lycopene can attenuate abdominal adhesion in the mice model by reducing inflammation and oxidative stress, and the possible mechanism may rely on promoting the expression of nuclear factor erythroid 2-related factor 2 and silent information regulator 1.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 126-135"},"PeriodicalIF":1.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasmas From Patients With Burn Injury Induce Endotheliopathy Through Different Pathways","authors":"John W. Keyloun MD ,&nbsp;Edward J. Kelly MD ,&nbsp;Bonnie C. Carney PhD ,&nbsp;Saira Nisar MBBS, MS ,&nbsp;Sindhura Kolachana BS ,&nbsp;Lauren T. Moffatt PhD ,&nbsp;Thomas Orfeo PhD ,&nbsp;Jeffrey W. Shupp MD","doi":"10.1016/j.jss.2024.10.011","DOIUrl":"10.1016/j.jss.2024.10.011","url":null,"abstract":"<div><h3>Introduction</h3><div>The contribution of endothelial injury to the pathogenesis of burn shock is not well characterized. This work investigates potential mechanisms underlying dysregulation of endothelial barrier function by burn patient plasmas.</div></div><div><h3>Methods</h3><div>Plasma was collected from burn-injured patients (<em>n</em> = 8) within 4 h of admission. Demographic and injury characteristics were collected and markers of injury severity including international normalized ratio, activated partial thromboplastin time, and levels of syndecan-1 and interleukin (IL)-6, IL-1B, IL-10, Il-12p70, and tumor necrosis factor-α measured. Human umbilical vein endothelial cell monolayers (HUVEC-m) exposed to either burn patient plasma or multidonor plasma (HHP) were assessed for permeability (40 kDa fluorescein isothiocyanate (FITC)-Dextran diffusion), intercellular gap area (F-actin staining) and incidence of apoptosis (TUNEL assay). Post plasma exposure, RNA was isolated and used in polymerase chain reaction (PCR) arrays targeting genes relevant to cytoskeletal structure or apoptosis. Differences between HHP and burn plasma-treated HUVEC-m were analyzed.</div></div><div><h3>Results</h3><div>Five plasmas promoted significant increases in HUVEC-m permeability. When plasmas were grouped based on their capacity to increase permeability, no differences in age, %total body surface area, gender, hospital mortality, international normalized ratio, activated partial thromboplastin time, or cytokine concentration were observed; however, significantly higher syndecan-1 levels were seen in the plasmas inducing increased permeability. Increases in intercellular gap area and apoptosis and relevant gene expression were observed after exposure to patient plasmas but none of these metrics correlated completely with the pattern or magnitude of the changes in permeability.</div></div><div><h3>Conclusions</h3><div>Burn patient plasmas variably disrupt HUVEC-m homeostasis, differentially inducing changes in permeability, intercellular gap area, and apoptosis. Neither increases in intercellular gap size nor apoptosis appear sufficient to explain the pattern of changes in permeability.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 90-100"},"PeriodicalIF":1.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low Rates of Short-Term Anastomotic Complications After Kono-S versus Side-to-Side Stapled Anastomosis","authors":"Olivia Ziegler MD ,&nbsp;Amber M. Moyer MD ,&nbsp;Ji Ho Park MD ,&nbsp;Mckell Quattrone MD ,&nbsp;Audrey S. Kulaylat MD, MSc ,&nbsp;Michael J. Deutsch MD ,&nbsp;N. Arjun Jeganathan MD ,&nbsp;Walter A. Koltun MD ,&nbsp;Jeffrey S. Scow MD","doi":"10.1016/j.jss.2024.10.015","DOIUrl":"10.1016/j.jss.2024.10.015","url":null,"abstract":"<div><h3>Introduction</h3><div>The Kono-S (KS) anastomosis for Crohn's disease (CD) is associated with improved endoscopic and clinical long-term outcomes. Ileocolonic anastomoses in CD are associated with an unacceptable anastomotic complication rate - up to 40%. Investigation of short-term benefits of KS is thus warranted. Here, we evaluate 90-d postoperative complications following KS <em>versus</em> side-to-side stapled anastomosis in patients with CD.</div></div><div><h3>Methods</h3><div>This is a retrospective case-control conducted at our tertiary medical center; data retrieved are from cases between January 2019 and May 2023. Thirty-eight consecutive patients with CD who underwent KS were matched with 38 patients who underwent side-to-side stapled anastomosis. Patients were initially age and sex matched; then, characteristics including body mass index, American Society of Anesthesiologists class, and disease severity indicated by inpatient status, preoperative laboratory values, steroid and disease modifying drug use were compared between cases and controls, using chi square, <em>t</em>-test, or Mann–Whitney <em>U</em> test.</div></div><div><h3>Results</h3><div>Cohorts did not differ in the aforementioned characteristics with the exception of higher preoperative erythrocyte sedimentation rate in the KS group. There was no difference in operative approach, or complications between groups; one patient undergoing KS required return to operating room for fascial dehiscence, while two in the side-to-side stapled group required return to operating room for anastomotic complications. KS operative times were significantly longer.</div></div><div><h3>Conclusions</h3><div>KS is associated with an acceptable rate of short-term complications. In our matched series of 38 patients, we had no anastomotic leaks or bleeds in our KS group. Adoption of this technique may provide immediate postoperative benefits in addition to long-term disease reduction.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 74-80"},"PeriodicalIF":1.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma Inclusive Resuscitation is Not Associated With Transfusion-Related Acute Lung Injury Under Updated Guidelines","authors":"Desiree N. Pinto MD, MPH ,&nbsp;Caitlin Mehta BS ,&nbsp;Edward J. Kelly MD ,&nbsp;Shane K. Mathew MD ,&nbsp;Bonnie C. Carney PhD ,&nbsp;Melissa M. McLawhorn RN, BSN ,&nbsp;Lauren T. Moffatt PhD ,&nbsp;Taryn E. Travis MD ,&nbsp;Jeffrey W. Shupp MD ,&nbsp;Shawn Tejiram MD","doi":"10.1016/j.jss.2024.08.011","DOIUrl":"10.1016/j.jss.2024.08.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Plasma inclusive resuscitation (PIR) uses fresh frozen plasma as an adjunct to crystalloid in the management of burn shock and has potential benefits over other colloids. Yet, safety concerns for transfusion-related acute lung injury (TRALI) exist. The aim of this study evaluated the association between TRALI and PIR in a cohort of severely burn-injured patients using the updated Canadian Blood Services Consensus definitions.</div></div><div><h3>Methods</h3><div>Burn-injured patients requiring PIR at a burn center from 2018 to 2022 were retrospectively reviewed. To assess for TRALI, data related to acute hypoxemia, bilateral pulmonary edema, left atrial hypertension, and changes to respiratory status up to 6 h after PIR were recorded. To identify other risks and benefits associated with PIR timing, resuscitative volumes and outcomes were compared between early (0-8 h) and late PIR (8-24 h) initiation.</div></div><div><h3>Results</h3><div>Of the 88 patients included for study, no patient developed TRALI type I or II under the updated definitions. Early (<em>n</em> = 39) compared to late PIR (<em>n</em> = 49) was associated with a higher percent total body surface area (TBSA, 36.3%, 26.0%, <em>P</em> = 0.01). The predicted 24-h volume was higher for early PIR (10.1 L, 6.3 L, <em>P</em> = 0.049), but the observed 24-h volume (cc/kg/%TBSA) was not significantly different (5.2, 5.3, <em>P</em> = 0.62).</div></div><div><h3>Conclusions</h3><div>In a cohort of severely burn-injured patients undergoing PIR, no patient developed TRALI type I or type II under the updated Canadian Blood Services Consensus definitions. Earlier use of PIR was not associated with higher resuscitative volumes despite higher TBSA. Further studies are necessary to better ascertain the potential risks and benefits associated with PIR.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 81-89"},"PeriodicalIF":1.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Postoperative Serum Sirtuin 1 Predicts Postoperative Cognitive Dysfunction in Elderly Patients","authors":"Jinshan Shi MD ,&nbsp;Haibo Chen MD ,&nbsp;Yujie Zhang MD ,&nbsp;Ke Jiang MD","doi":"10.1016/j.jss.2024.10.006","DOIUrl":"10.1016/j.jss.2024.10.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Postoperative cognitive dysfunction (POCD) is a common complication following cardiac surgery, particularly in elderly patients undergoing cardiopulmonary bypass (CPB). While Sirtuin 1 (SIRT1) has been implicated in the mitigation of POCD, its potential as a predictive biomarker for POCD remains unclear.</div></div><div><h3>Methods</h3><div>Patients undergoing CPB cardiac surgery were evaluated for POCD using the Montreal Cognitive Assessment. Based on the assessment results, patients were divided into two groups, with further stratification by key factors. The correlation between these risk factors and POCD incidence was analyzed. Odds ratios were calculated for six risk factors, and the receiver operating characteristic curve analysis was used to evaluate the predictive power of early postoperative serum SIRT1 levels for POCD.</div></div><div><h3>Results</h3><div>Six risk factors—including age, education level, CPB duration, aortic occlusion duration, anesthesia duration, and early postoperative serum SIRT1—were strongly associated with POCD incidence. Patients with POCD had decreased early postoperative serum SIRT1 levels. SIRT1 was found to be a significant predictor of POCD, with high sensitivity and specificity. Additionally, neuron-specific enolase and S100β levels were elevated in POCD patients and negatively correlated with early postoperative serum SIRT1 levels.</div></div><div><h3>Conclusions</h3><div>Early postoperative serum SIRT1 serves as an effective biomarker for predicting POCD, offering both high sensitivity and specificity, and could be used to anticipate the onset of clinical POCD.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 112-120"},"PeriodicalIF":1.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TAVI in Patients With Severe Aortic Stenosis and Coexisting Mitral Valve Regurgitation","authors":"Mohammed Salem MD ,&nbsp;Tomasz Stankowski MD ,&nbsp;Sleiman Sebastian Aboul-Hassan MD ,&nbsp;Anja Muehle MD ,&nbsp;Axel Harnath MD ,&nbsp;Kristin Rochor MD ,&nbsp;Claude Tshibangu Lukusa MD ,&nbsp;Volker Herwig MD ,&nbsp;Temirlan Erkenov MD ,&nbsp;Barłomiej Perek MD ,&nbsp;Dirk Fritzsche MD","doi":"10.1016/j.jss.2024.10.012","DOIUrl":"10.1016/j.jss.2024.10.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Severe aortic stenosis with coexisting mitral regurgitation (MR) of various severity is a common finding. The goal of our study was to evaluate the relation between transcatheter transfemoral aortic valve implantation (TAVI) on coexisting MR and compare the outcome in MR improvement and nonimprovement groups.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 252 patients who underwent TAVI with associated at least moderate MR between January 2018 and December 2020. Effect of changes in MR grade at discharge and 6-12 mo follow-up were compared.</div></div><div><h3>Results</h3><div>Echocardiography was performed at discharge in 245 patients and at follow-up in 154 patients. MR improvement was seen in 60.8% patients and nonimprovement in 39.2%. Overall survival was significantly higher in the MR improvement group (<em>P</em> = 0.020). There was a statistically significant effect on MR grade with a significant increase in the proportion of patients with mild MR at follow-up compared to discharge (58.4% versus 38.3%, <em>P</em> &lt; 0.001). A similar positive effect was seen on left ventricular ejection fraction (LVEF) at follow-up compared to discharge (<em>P</em> &lt; 0.001). LVEF in the MR improvement group was significantly higher at follow-up versus discharge (<em>P</em> &lt; 0.001), but there was no statistically significant change in LVEF in the nonimprovement group at follow-up versus discharge (<em>P</em> &lt; 0.722).</div></div><div><h3>Conclusions</h3><div>TAVI in severe aortic stenosis with coexisting significant mitral valve regurgitation decreases MR severity in more than 60% of patients and improved LVEF as well as mortality.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 101-111"},"PeriodicalIF":1.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Asymmetrical Linear Stapler: Safety Test and Pathological Assessment in a Porcine Model","authors":"Yong Chae Jung MD ,&nbsp;Wen Xue Piao MD ,&nbsp;Ji-yeon Kim MD, PhD ,&nbsp;Sang-il Lee MD, PhD ,&nbsp;Ying Jie Cui MD ,&nbsp;Yooyoung Chong MD ,&nbsp;Hyun Jin Cho MD, PhD ,&nbsp;Min-Woong Kang MD, PhD","doi":"10.1016/j.jss.2024.10.003","DOIUrl":"10.1016/j.jss.2024.10.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Prognosis in patients undergoing resection for lung and gastrointestinal cancers may differ, depending on the microscopic involvement of surgical margins. Linear staplers, widely used for pulmonary or bowel resection, consist of three rows of fasteners on both sides of a resection line. Although multiple rows of fasteners ensure stump and specimen closure, specimen could compromise accurate pathological evaluation of the true surgical margin. We aimed to compare the novel asymmetrical linear stapler (NALS) with the symmetrical linear stapler (SLS) in a porcine model for stump security and accurate pathological evaluation.</div></div><div><h3>Materials and Methods</h3><div>We used the NALS with three and two rows of staples on the stump and specimen sides, respectively. We performed small bowel resection in a porcine model using the NALS and examined hemostasis of resection margin, tightness of stumps under a specific burst pressure, distances between the true resection margin and staple line, and pathology of the resection margin. An SLS was used as the control.</div></div><div><h3>Results</h3><div>No bleeding was observed at the tissue site after initial blotting of the stapler line with either stapler type. The staplers endured a burst pressure of 3.6 kPa for 15 s without leakage. The distance between the cutting edge and staple line for two rows was significantly greater than the distance between the cutting edge and the nearest staple line for three rows.</div></div><div><h3>Conclusions</h3><div>The NALS is safe and may be more accurate than is SLS for the pathological evaluation of true surgical margins.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 58-66"},"PeriodicalIF":1.8,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psoas Muscle Volume as an Indicator of Sarcopenia and Disposition in Traumatic Hip Fracture Patients","authors":"Sahak E. Hovsepian MS ,&nbsp;Catherine H. Zwemer BS ,&nbsp;Alex I. Halpern MD ,&nbsp;Sophia H. Wu BS ,&nbsp;Christian M. Farag BA ,&nbsp;Aalap Herur-Raman MS ,&nbsp;Ahmed Ismail BS ,&nbsp;Aneil P. Srivastava BS ,&nbsp;Oleksiy Melnyk BS ,&nbsp;Mary Baginsky MS, RD ,&nbsp;Susan Kartiko MD, PhD","doi":"10.1016/j.jss.2024.10.005","DOIUrl":"10.1016/j.jss.2024.10.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Sarcopenia, or the loss of lean muscle mass, is associated with increased morbidity and mortality as well as poor surgical outcomes. The aim of our study was to utilize computed tomography imaging to obtain the total psoas volume (TPV) as a potential marker of sarcopenia. We then investigated the relationship between TPV and outcomes in surgically managed hip fracture patients, particularly their discharge disposition.</div></div><div><h3>Methods</h3><div>A retrospective review of surgically managed hip fracture patients at a single institution level one American College of Surgeons verified trauma center between 2017 and 2022 was performed. The primary endpoint was patient disposition after hospitalization. TPV was collected via three dimension reconstruction of computed tomography images. Student's <em>t</em>-test was used to assess for association between TPV and demographic variables. Binary logistic regressions were performed to examine variables that could predict patient disposition among the patients.</div></div><div><h3>Results</h3><div>We identified 64 surgically managed hip fracture patients, 57.8% of whom were males, with a median age of 74 (IQR: 62, 88). Black race (244.4 vs. 190.3, <em>P</em> = 0.032) and younger age (252.2 vs. 181.8, <em>P</em> = 0.004) were associated with higher TPV. Male patients with higher TPV had a higher likelihood of being discharged home as opposed to a skilled nursing or rehabilitation facility (251.3 vs. 191.1, <em>P</em> = 0.02). In multivariable analysis adjusting for sex, race, body mass index, and age, males with a higher TPV were more likely to be discharged home (odds ratio: 1.012; 95% confidence interval: 1.004 1.020; <em>P</em> = 0.028).</div></div><div><h3>Conclusions</h3><div>Psoas muscle volume can be used to predict which male patients are likely to be discharged home postoperatively after surgically managed traumatic hip fracture.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 67-73"},"PeriodicalIF":1.8,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylactic Sartorius Flap Reconstruction is Associated With Reduced Vascular Graft Infection","authors":"Young Kim MD, MS,&nbsp;Roberto S. Loanzon MD,&nbsp;Christina L. Cui MD, MAS,&nbsp;Kevin W. Southerland MD,&nbsp;Zachary F. Williams MD","doi":"10.1016/j.jss.2024.10.004","DOIUrl":"10.1016/j.jss.2024.10.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Complications in the femoral area following vascular surgery are frequent and linked to considerable morbidity, including the risk of underlying graft infection. Sartorius muscle flaps are an important adjunct for the treatment of wound complications. In this study, we examined our experience with prophylactic sartorius muscle flap coverage and its association with prosthetic vascular graft infection.</div></div><div><h3>Methods</h3><div>In this single-center analysis, electronic medical records were retrospectively reviewed for all sartorius muscle flap procedures performed from 2012 to 2021. Prophylactic indication was defined as flap reconstruction during index revascularization in the absence of active inguinal infection.</div></div><div><h3>Results</h3><div>Over the 9-y period, a total of 54 prophylactic sartorius flaps were performed in 47 patients. The median patient age was 66 y (interquartile range [IQR] 61-77 y). Wound complications requiring reintervention occurred in 16 (29.6%) patients, including 6 (11.1%) surgical site infections, 5 (9.3%) wound dehiscence, and 5 (9.3%) infected seromata. Among patients suffering wound complications, 30-d readmission (75.0% <em>versus</em> 26.3%, <em>P</em> = 0.004) and reoperative flap creation rates (25.0% <em>versus</em> 2.6%, <em>P</em> = 0.010) were higher, whereas 30-d mortality rates (0.0% <em>versus</em> 5.3%, <em>P</em> = 0.51) were similar. Only one patient (1.9%) developed vascular graft infection over a median follow-up period of 2.4 y (IQR 0.9-4.0 y). On multivariate analysis, body mass index (adjusted odds ratio 1.23, 95% confidence interval, 1.12-1.35, <em>P</em> = 0.023) was associated with reoperative wound complications.</div></div><div><h3>Conclusions</h3><div>Wound complications were common after prophylactic sartorius flap creation in this high-risk population; however, infection of the underlying vascular graft was rare. These data suggest that sartorius flap may be effective in a prophylactic role.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 52-57"},"PeriodicalIF":1.8,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurologic Complications Associated With Burn Injury and Resuscitation","authors":"Connor L. Kenney MD ,&nbsp;Brian D. Stephens MD ,&nbsp;Kelsey A. Cacic MD ,&nbsp;Alicia M. Williams MD ,&nbsp;Steven G. Schauer DO ,&nbsp;Jan-Michael Van Gent DO ,&nbsp;Geoffrey W. Peitz MD ,&nbsp;Michael D. April MD ,&nbsp;Julie A. Rizzo MD","doi":"10.1016/j.jss.2024.09.086","DOIUrl":"10.1016/j.jss.2024.09.086","url":null,"abstract":"<div><h3>Background</h3><div>Treatment for large burn injuries relies on adequate fluid resuscitation secondary to the severe systemic inflammatory response. With improved critical care and better understanding of the complications of over and under resuscitation, morbidity and mortality rates are decreasing. Neurologic complications are not often considered as an over-resuscitation complication after burn injury but may be considered an additional form of compartment syndrome–intracranial compartment syndrome; however, it has not been evaluated for a possible threshold similar to the Ivy Index for abdominal compartment syndrome.</div></div><div><h3>Methodology</h3><div>This study was conducted as a single center, retrospective review of patients admitted to the Burn Intensive Care Unit within 24 h of injury and who received neuroimaging within 96 h. Patients were grouped based on the resuscitation volumes at ≤200 and &gt;200 mL/kg for evaluation of the development of worsening neurologic findings.</div></div><div><h3>Results</h3><div>Forty-one patients were available for review with 30 patients ≤200 mL/kg and 11 patients &gt;200 mL/kg. Twenty-one patients (70.0%) and 7 patients (63.6%), &lt; 200 and &gt; 200 mL/kg respectively, has repeat imaging. Follow-up imaging was found to be worse in patients receiving greater than 200 mL/kg (85.7% <em>versus</em> 47.6%, <em>P</em> value 0.064).</div></div><div><h3>Conclusions</h3><div>Providers should be aware of the potential for neurologic sequelae of resuscitation that is often only found on imaging in patients receiving high-volume resuscitation for their burn injury.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 36-40"},"PeriodicalIF":1.8,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}