Plastic and Thoracic Surgery, Orthopedics and Ophthalmology (eBook)

Foreword 5
Preface 7
Contents 8
Part I: Orthopedics 11
Management of Complex Distal Lower Extremity Wounds Using a Porcine Urinary Bladder Matrix (UBM-ECM) 12
1 Introduction 12
2 Topical Wound Healing 28
3 Evolution of Orthopedic Management of Lower Extremity Injuries 29
4 Wound Bed Preparation 30
5 UBM-ECM Wound Treatment 30
6 Secondary Dressings 30
7 Clinical Series Report 31
8 Discussion 32
Conclusions 35
References 35
Uses of Negative-Pressure Wound Therapy in Orthopedic Trauma 39
1 Introduction 39
2 Components 39
3 Mechanism of Action 41
4 Application of the VAC Device 41
5 Clinical Indications 41
6 Complications and Recommendations 44
7 Authors’ Preferred Treatment/Use 45
7.1 Cost 45
Conclusions 45
References 45
Prevention of Prosthetic Joint Infections 47
1 Prophylaxis 47
2 Preoperative Considerations 47
2.1 Medical Risk Factors 48
2.1.1 Diabetes 48
2.1.2 Obesity 48
2.1.3 Malnutrition 48
2.1.4 Tobacco Use 49
2.1.5 Alcohol Abuse 49
2.1.6 Immunosuppression 49
2.1.7 Oral Hygiene 50
2.1.8 Staphylococcus aureus Screening 50
2.1.9 Urine Screening 52
3 Perioperative Considerations 53
3.1 Patient Preparation 54
3.2 Skin Disinfection 54
3.3 Surgical Site Skin Preparation 54
3.4 Surgical Team Handwash 55
3.5 Prophylactic Antibiotics 55
3.5.1 Systemic Antibiotics 55
3.5.2 Antibiotic-Loaded Bone Cement 58
3.6 Operating Room Conditions 58
3.7 Surgical Team Equipment 59
3.8 Laminar Air Flow and Ultraviolet Lighting 59
3.9 Patient Homeostasis 60
3.10 Duration of Surgery 60
4 Postoperative Considerations 60
4.1 Drains and Blood Management 60
4.2 Wound Care 61
4.3 Urinary Catheter 62
4.4 Duration of Hospital Stay 62
5 Prevention of Late Haematogenous Infections 62
References 63
Greater Wound and Renal Complications in Gout Patients Undergoing Total Joint Arthroplasty 72
1 Introduction 72
2 Gout Definition and Risk Factors 72
3 Gout Epidemiology 73
4 Gout Comorbidities 73
5 Total Joint Arthroplasty Complications 74
6 Gout and Total Joint Arthroplasty Complications 74
7 Wound Complications in Gout TJA Patients 74
8 Renal Complications in Gout TJA Patients 76
Conclusions 76
References 76
Augmentation of Bone Healing in Delayed Union and Atrophic Nonunion of Fractures of Long Bones by Partially Decalcified Bone Allograft 78
1 Introduction 78
2 Bone Grafting 78
3 Biology of Incorporation of Bone Grafts 79
4 Preparation of Partially Decalcified Bone Allograft 79
5 Authors’ Results 80
References 84
Part II: Ophthalmology 85
Corneal Wound Healing and Laser Refractive Surgery 86
1 Introduction 86
2 Corneal Wound Healing: An “Epithelium-Stroma” Interaction 86
3 Several Clinical Factors Have Been Correlated with Haze Formation 89
3.1 Degree of Myopia 89
3.2 Stromal Surfaces Irregularities After Treatment 89
3.3 Type of Laser 89
3.4 Ablation Procedure 89
3.5 Debridement Technique 90
3.6 UV Radiation Exposure 90
4 Pharmacological Modulation of Corneal Wound Healing 90
References 91
Corneal Epithelial Wound Healing and Management Strategies 95
1 Introduction 95
2 Corneal Structure 95
2.1 Tear Film 96
2.2 Corneal Epithelium 96
2.3 Stroma 97
2.4 Dua’s Layer 97
2.5 Endothelium and Descemet’s Membrane 97
2.6 The Limbus 98
3 Corneal Epithelial Wound Healing 98
3.1 Latency 98
3.2 Migration 98
3.3 Proliferation 99
3.4 Attachment 99
4 Regulation of Corneal Epithelial Wound Healing 99
5 Treatment of Corneal Epithelial Wounds 99
5.1 Aggressive Lubrication 100
5.2 Discontinuation of Medications 100
5.3 Punctal Occlusion 100
5.4 Bandage Soft Contact Lens 100
5.5 Pressure Patching 101
5.6 Debridement 101
5.7 Tarsorrhaphy 101
5.8 Growth Factors 101
5.9 Cytokines 102
5.10 Proteins, Glycoproteins and Saccharides 102
5.11 Antioxidants 102
5.12 Human Serum-Derived and Plasma-Derived Therapies 103
5.13 Human Breast Milk Drops (HBMD) 104
References 105
Traumatic Wound Dehiscence Following Penetrating and Deep Anterior Lamellar Keratoplasty 107
1 Introduction 107
2 Epidemiology and Risk Factors 107
3 Pathophysiology/Wound Healing 108
4 Outcomes 110
5 Prevention 111
Conclusions 111
References 111
Boston Type I Keratoprosthesis in Ocular Chemical Burns 114
1 Introduction 114
2 Surgical Indications 115
3 Contraindications 115
4 Preoperative Assessment 116
5 Preoperative Procedures 117
6 Surgical Technique 117
6.1 Technique of Implantation 117
7 Postoperative Management 118
8 Outcomes 119
9 Complications 120
9.1 Retroprosthetic Membrane 120
9.2 Corneal Melt 120
9.3 Glaucoma 122
9.4 Retinal Detachment 123
10 Discussion 124
References 124
Part III: Plastic Surgery 126
Variations in Treatment of Plastic Aesthetic Surgery Complications 127
1 Introduction 127
2 Abdominoplasty 127
3 Blepharoplasty 128
4 Breast Augmentation 128
5 Facelift 129
6 Nose 129
Reconstructive Surgery Following Bisphosphonate-Related Osteonecrosis of the Jaws: Evolving Concepts 131
1 Introduction 131
2 Diagnostic Criteria 132
3 Osteonecrosis Management 132
4 Reconstructive Microsurgery 136
5 Outcome Measurements 138
6 Proposed Flowchart 139
7 Future Research 142
References 144
Antibiotic Susceptibility of Wound Isolates in Plastic Surgery Patients at a Tertiary Care Centre 146
1 Introduction 146
1.1 Background 146
2 Collecting the Sample from the Wound 147
2.1 Technique 147
3 Wound in Plastic Surgery Patients 147
4 Discussion 148
4.1 Wound Infection in Plastic Surgery Patients 148
4.2 Antibiotic Susceptibility 149
4.3 Understanding the Pharmacokinetics 149
4.4 Understanding the Pharmacodynamics 150
4.5 Wound Isolates in Plastic Surgery Patients and Experience at the Authors’ Centre 150
References 152
Reconstructive Management of Facial Gunshot Wounds 154
1 Introduction 154
1.1 Case 1 154
1.2 Case 2 157
1.3 Case 3 157
1.4 Case 4 159
1.5 Case 5 159
2 Discussion 162
References 165
The Role of Negative Pressure Wound Therapy for Salvaging Implant-Based Breast Reconstruction 167
1 Introduction 167
2 Cases with Complications 167
2.1 Case 1 167
2.2 Case 2 167
2.3 Case 3 168
2.4 Case 4 168
2.5 Case 5 168
3 Treatment 168
4 Discussion 169
References 170
Intraoperative Treatment with 5-FU 171
1 Introduction 171
2 Patients and Methods 172
3 Results 174
4 Discussion 176
References 176
Treatment of Subacute Traumatic Lower Limb Wounds by Assisted Healing and Delayed Selective Reconstruction 177
1 Introduction and Background 177
2 Patients and Methods 179
3 Results 181
References 186
Partial Chemical Capsulectomy and Closing of the Mammary Capsule with Anchoring Flaps 187
1 Introduction 187
2 Materials 189
2.1 In the Presence of a Residual Capsule, What Are the Options? 190
2.1.1 Total or Partial Surgical Capsulectomy 190
2.1.2 Capsulorrhaphy with Sutures 190
2.1.3 Radiated Capsulotomy 190
2.1.4 Proposed Is a New Option of Total or Partial Chemical Capsulectomy and Closure of the Cavity with Anchoring Flaps 190
3 Surgical Technique 191
4 Histology 193
5 Indications for This Technique 194
6 Results 197
References 197
An Approach to Keloid Reconstruction with Dermal Substitute and Epidermal Skin Grafting 199
1 Introduction 199
2 Classification of Dermal Substitute 200
2.1 Natural Organic Derivatives 200
2.2 Synthetic Biological Derivatives 200
2.3 Synthetic Derivatives 202
3 Available Commercials Products 202
3.1 Alloderm® Natural Biologic Derivatives (KCI/Life Cell©) 202
3.2 Glyaderm® (Euro Skin Bank) 202
3.3 GammaGraft™ (Promethean LifeSciences, Inc.) 203
3.4 EZ Derm™ Porcine Xenograft (Brennen Medical, LLC) 203
3.5 Integra® Bilayer and Single-Layer (Integra Lifesciences) Biological Derivatives 203
3.6 Matriderm® Bilayer and Single-Layer (Dr. Suwelack Skin & Health Care AG)
3.7 Hyalomatrix® PA (Fidia Advanced Biopolymers S.R.L.) 204
3.8 Oasis Wound Matrix: Oasis® Burn Matrix (HealthPoint) 205
3.9 Dermagraft® (Advanced BioHealing) 205
3.10 Dermagen® (Genevrier) 205
3.11 Biobrane® (Smith & Nephew)
4 One-Step Procedure 206
5 Clinical Application 206
References 209
Part IV: Thoracic Surgery 211
Sternotomy Techniques 212
1 Midline Sternotomy and Alternative Access to the Mediastinum 212
2 Midline Sternotomy Closure Techniques and Materials 213
2.1 Stainless Steel Wires 213
2.1.1 Transsternal Wires 214
2.1.2 Peristernal Wires 214
2.1.3 Pericostal Wires 214
2.2 Stainless Steel Bands 214
2.3 Other Techniques 214
2.4 Absorbable Sutures 214
3 Sternal Reinforcement Techniques 214
4 Sternal Wound Complications 215
4.1 Introduction 215
4.2 Risk Factors 216
4.2.1 Patient’s Related Risk Factors 217
Obesity 217
Diabetes Mellitus 217
Chronic Obstructive Pulmonary Disease 218
4.2.2 Other Risk Factors 218
4.3 Antibiotic Therapy 219
4.4 Risk Factors Related to Surgical Procedure 219
4.4.1 Faulty Sternotomy 219
4.4.2 Excessive Use of Electrocautery and Bone Wax 220
4.4.3 Iatrogenic Partial or Complete Sternum Fractures 220
4.4.4 Prolonged Surgical Time 220
4.4.5 Use of Bilateral Internal Thoracic Artery 220
4.4.6 Early Postoperative Blood Transfusion 220
4.4.7 Reoperation for Bleeding 221
4.4.8 Unappropriate Sternal Closure 221
5 Surgical Treatment 221
5.1 Topical Treatment and Delayed Surgical Closure 221
5.2 Topical Treatment with Secondary Wound Healing 222
5.3 Muscle and Omentum Flap Reconstruction 222
6 Clinical and Economical Consequences 223
References 223
Sternal Wound Complications 227
1 Introduction 227
2 Risk Factors 228
2.1 Patient’s Related Risk Factors 229
2.1.1 Obesity 229
2.2 Diabetes Mellitus 229
2.3 Chronic Obstructive Pulmonary Disease 230
2.4 Other Risk Factors 230
2.5 Antibiotic Therapy 231
2.6 Risk Factors Related to Surgical Procedure 231
2.6.1 Faulty Sternotomy 231
2.6.2 Excessive Use of Electrocautery and Bone Wax 232
2.6.3 Iatrogenic Partial or Complete Sternal Fractures 232
2.6.4 Prolonged Surgical Time 232
2.6.5 Use of Bilateral Internal Thoracic Artery (ITA) 232
2.6.6 Early Postoperative Blood Transfusion 232
2.6.7 Reoperation for Bleeding 233
2.6.8 Inappropriate Sternal Closure 233
3 Surgical Treatment 233
3.1 Topical Treatment and Delayed Surgical Closure 233
3.2 Topical Treatment with Secondary Wound Healing 234
3.3 Muscle and Omentum Flap Reconstruction 234
4 Clinical and Economical Consequences 235
References 235
Negative-Pressure Wound Therapy as Prevention Measure After Cardiac Surgery: Principles and Techniques 238
1 Introduction 238
2 Normal Wound Healing 238
3 Factors Affecting Wound Healing 238
3.1 Medication Use and Nicotine Usage 239
3.2 Malnutrition 239
3.3 Radiation Therapy 240
4 Wound Healing and Cardiac Surgery 240
5 History of Preventive Measures 240
6 Prevention and NPWT 241
6.1 Reduction of Lateral Forces 241
6.2 Reduction of Oedema, Haematoma and Seroma 241
6.3 Infection Prevention from Exogenous Sources 241
7 NPWT on Closed Wounds 242
7.1 Device Options 242
7.2 Technical Application 243
7.3 Level of Negative Pressure 244
7.4 Treatment Duration 244
7.5 Complications 244
7.6 Contraindications 244
7.7 Removal 244
8 Discussion 245
9 Tips for Use 245
9.1 Preoperative Phase 245
9.2 Operative Phase 246
9.2.1 Intraoperative Phase 246
9.3 Postoperative Phase 246
References 246
Surgical Management of Sternal Wound Dehiscence 248
1 Introduction 248
2 Pathogenesis 249
3 Risk Factors 250
4 Surgical Management 252
4.1 Closed Redon Catheter Drainage 253
4.2 VAC therapy 254
4.3 Thermo-reactive Nitinol clips 255
4.4 Flap Reconstruction 255
References 258
Sternal Wound Reconstruction Using Internal Mammary Artery Perforator Flaps 259
1 Introduction 259
2 Technique 259
2.1 Case Using IMAP Flap 260
3 Discussion 261
4 Cadaver Studies 261
5 Clinical Studies 261
References 263