Prospective evaluation of pin site infections in 39 patients treated with external ring fixation

Introduction: Pin site infection is a common complication to external ring fixation. While the aetiology is well described, monitoring of onset, location, and the distribution of infection among the pin sites still needs further attention. The present pilot study evaluates the feasibility of a prospective registration procedure for reporting, evaluating, and monitoring of pin site infections in patients treated with external ring fixation. This may promote communication between team members and assist decision-making regarding treatment. Methods: A total of 39 trauma, limb deformity, and bone infection patients (15 female, 24 males; mean age 49 years (range: 12–88)) treated with external ring fixation were followed in the outpatient clinic using the pin site registration tool. Pin site infection (Checketts and Otterburn (CO) grade, onset, location), use of oral or intravenous antibiotics, and any unplanned procedures due to pin sites complications (wire removal and/or replacement, premature frame removal, amputation, etc.) were registered until frame removal. Results: The mean (SD) frame time was 164 (83) d (range: 44–499). We performed 3296 observations of 568 pin sites. Pin infection was registered in 171 of the 568 pin sites (30 %), of which 112 (65 %) were categorized as CO 1, 42 (25 %) as CO 2, 9 (5 %) as CO 3, and 8 (5 %) as CO 5. Neither CO 4 nor CO 6 was observed. A total of 35 patients (90 %) encountered CO 1–3 at least once during the observation time, while 1 patient (2.5 %) developed a major infection at eight pin sites (CO 5). Antibiotics were administered to 22/39 (56 %) of the patients. Conclusion: In an effort to monitor pin site infections in this complex patient group and to ensure the best clinical outcomes, our registration procedure in the outpatient clinic helped to recognize pin site infections early and eased communication between team members providing a concise overview of the treatment course.

Standardization of bicuspid valve repair with aortic annuloplasty provides similar results to tricuspid aortic valve repair

Background Bicuspid aortic valves (BAV) represent the main cause of severe dystrophic aortic insufficiency in young patients and are mostly replaced with high rates of valve-related events and altered quality of life in case of mechanical prosthesis. Valve repair is now recommended for root aneurysm and tricuspid aortic valves (TAV) when feasible. However, concerns remain regarding the long-term durability of BAV repair, compared to TAV. Purpose Our objective is to compare the long-term results of repair between TAV and BAV, in consecutive patients operated on with a standardized approach according to each phenotype of the dystrophic ascending aorta. Methods Data were prospectively collected into the multicenter international AVIATOR registry (AorticValve repair InternATiOnal Registry). Between 2003 and 2019, according to ascending aorta phenotypes, 226 patients with BAV and 309 patients with TAV underwent either isolated valve repair with external ring annuloplasty (26,2%), or root remodeling with external ring (59,4%), or a supra-coronary graft with external ring (14,4%). Results Cusp repair was performed in 95,1% patients in the BAV group and in 63,8% in the TAV group. The 30-day operative mortality was 0,93% (n=5). Mean follow-up was 5,5±4,4 years. The actuarial survival rate at 12 years was 93,2% in the BAV group and 87,8% in the TAV group (p=0,14). Freedom from reoperation at 12 years was similar between groups being 94,9% for bicuspid and 93,2% for tricuspid (p=0,75). Freedom from major adverse valve-related events at 12 years was 82,8% and 82,9% in BAV and TAV groups respectively (p=0,17). At 12 years, freedom from AI ≥Grade 2 or ≥Grade 3 was 68,7% and 94,3% for BAV and 76,5% and 94,7% for TAV group, with no significant difference (respectively p=0,16 and p=0,92). Conclusion Aortic valve repair with a standardized approach adapted to the aorta phenotype provides excellent long-term results with a low rate of valve-related events. Similar results were achieved between BAV and TAV patients. freedom from reoperation for BAV and TAV Funding Acknowledgement Type of funding source: None

Congenital inguinal hernia repair with and without opening the inguinal canal

Background Elective repair of congenital inguinal hernia is the most common surgery performed by pediatric surgeons and is considered the treatment of choice. The exact technique and steps involved in the repair differs widely among pediatric surgeons, many surgeons open the roof of inguinal canal while preserving the external ring or opening it, this is called the modified Ferguson, s technique. In infants, the inguinal canal is short and virtually the internal and external rings lie over each other so many surgeons also like to perform the whole operation without opening the external oblique aponeurosis distal to the external ring, this technique is called the Mitchell Banks technique. Objective To compare both techniques regarding intraoperative time, incidence of intraoperative and postoperative complications to pass our experience in a trial to reach an ideal surgical technique for congenital inguinal hernia repair. Patients and Methods In this study, 60 cases of congenital inguinal hernia were randomly selected and divided into two equal groups where group A underwent the repair with opening the external oblique aponeurosis and group B underwent the repair without opening the external oblique aponeurosis. Results As regard the postoperative complications, the patients who underwent the Ferguson’s technique experienced more postoperative pain with statistically significant more incidence of postoperative hydrocele than the Mitchell banks technique, no complications occurred postoperatively other than hydrocele in our study. Conclusion Our study results, we can approve that Mitchell Banks technique is easier, consumes less time than Ferguson’s technique with less incidence of postoperative complications and pain which can make this technique better for congenital inguinal hernia repair in children aging 2 years or less.