ANZ Journal of Surgery最新文献

Objective: This randomized controlled trial (RCT) compared outcomes of absorbable and non-absorbable sutures for skin closure in open carpal tunnel decompression.

Methods: Patients diagnosed with bilateral carpal tunnel syndrome proceeding to staged open carpal decompression were invited to participate in the trial. Patients elected left or right hand for the first operation and were randomized to receive Prolene (non-absorbable) or Vicryl Rapide (absorbable) first, and the alternative suture to the contralateral side. Recorded pre-operative data included the Boston Carpal Tunnel Questionnaire (BCTQ) for each hand. At 2 weeks post-operatively the BCTQ, a Visual Analogue Score (VAS) for pain and Asepsis Wound Score were recorded. At 6 weeks, the BCTQ and VAS were repeated and a Patient and Observer Scar Assessment Scale (POSAS) was performed. Patients were asked preference for left or right suture. Statistical analysis using a linear mixed model assessed improvements in the BCTQ, as well as wound scores between sutures. The individual scales were compared using non-parametric Wilcoxon signed rank test. Specific patient factors including age, comorbidities, and previous steroid injections were evaluated for their impact on outcome.

Results: There was no significant difference between the two suture types in any of the overall recorded assessments, complications or patient preferences. BCTQ scores improved significantly post-operatively, P = 0.001. Previous steroid injection, diabetes and age over 65 did not affect outcomes.

Conclusions: Patients can be advised there is no difference in the outcome following open carpal tunnel decompression from using either absorbable or no-absorbable suture material for skin closure.

Background: This study explores a novel technique combining transposition flaps with Split-Thickness Skin Grafts (STSG) to enhance anastomosis site coverage in free tissue transfer surgeries, particularly in lower limb reconstructions using Thoracodorsal Artery Perforator (TDAP) free flap procedures. This method aims to alleviate tension at the anastomosis sites, a common issue affecting reconstructive surgery success.

Methods: A retrospective analysis was conducted on 20 patients who underwent TDAP free flap procedures. These cases were chosen due to the anticipated tension at anastomosis sites, necessitating the use of transposition flaps and STSG. Surgical procedures were meticulously documented, and postoperative outcomes were monitored, focusing on complications and overall surgical success.

Results: The study found no instances of complete flap failure, indicating the potential efficacy of the combined approach. Minor complications included two cases of partial tip necrosis in the transposition flaps and two cases of partial graft loss in the STSGs. These issues were resolved through secondary intention healing, demonstrating the technique's ability to manage minor postoperative challenges and maintain flap viability.

Conclusion: Integrating transposition flaps with STSG significantly improves tension management at anastomosis sites in TDAP free flap procedures. This technique not only reduces immediate postoperative complications but also supports the long-term success of reconstructive surgeries. The findings advocate for further research to confirm the efficacy of this approach in microsurgical applications, aiming to enhance patient outcomes and advance reconstructive microsurgery.

Background: Distal intestinal obstruction syndrome (DIOS) presents significant management challenges for people with cystic fibrosis (pwC). We evaluated the treatment outcomes and identified risk factors associated with the need for surgical intervention in patients admitted with DIOS.

Method: We conducted a retrospective case series of 96 encounters of DIOS over a 20-year period, observing outcomes between cases of medical management versus those requiring for operative intervention. To our knowledge, this is the largest Australian study to review intervention in DIOS.

Results: Among the patients studied, 94.8% were successfully treated non-surgically. Using computed tomography (CT) confirmation of DIOS as the gold standard, only 9.1% of abdominal x-rays were accurate in finding DIOS. Gastrografin was used in half of cases and was associated with a shorter recovery time. One in 16 patients required operative management, with two cases experiencing surgery following prolonged medical treatment. A history of previous laparotomy increased the odds of requiring surgical intervention by 16 times (95% CI: 1.2-209.9, P = 0.035), while a history of meconium ileus increased the odds by 15.6 times (95% CI: 1.2-204.8, P = 0.036). All patients who underwent surgery also had pancreatic insufficiency.

Conclusion: Medical management was successful in the majority of DIOS presentations. Our study emphasizes a low threshold for abdominal CT scans to identify complete DIOS in high-risk patients, particularly those with a history of laparotomy or meconium ileus, who may require surgical intervention. Furthermore, we advocate for the adjunctive use of Gastrografin alongside medical management. Future research should refine protocols for these high-risk groups to improve outcomes and reduce morbidity.

Rectovesical fistula (RVF) is defined as an extra-anatomic communication between the rectum and bladder. A multitude of approaches and techniques have been described; however, there is a lack of consensus regarding which of these procedures is the optimal cost-effective, appropriate treatment to perform. We describe the repair of a persistent RVF via a transperineal approach, utilizing the dartos fascia flap, a technique with minimal description in the literature.

Aim: Fournier gangrene disease (FGD) is a condition that requires emergent surgery due to its high risk of mortality. The use of biomarkers to predict outcomes after surgery for patients with FGD may be critical, as they assist in tailoring treatment approaches to individual needs. Our aim in our study is to investigate the presence of simple and easily accessible biochemical markers that can be used to predict early mortality.

Methods: The medical records of 100 patients diagnosed with FGD at our hospital between January 2015 and December 2023 were retrospectively reviewed. Clinical and laboratory variables were assessed, and predictive factors for mortality were analyzed using multivariate logistic regression.

Results: Demographics and perioperative clinical data of the whole study group, and subgroups according to the mortality status are evaluated. CRP was found to be independent predictor for 30-day mortality in FGD. In ROC curve analysis provided a cutoff value of 121.3 mg/L for CRP which was significantly associated with 30-day mortality for FGD.

Conclusion: Preoperative CRP ≥ 121.3 mg/L value could be predict 30-day mortality in patients diagnosed with FGD.