• Archives of Plastic Surgery
• /
• v.42 no.2
• /
• pp.194-200
• /
• 2015

Background Surgical site infections (SSIs) result in significant patient morbidity following immediate tissue expander breast reconstruction (ITEBR). This study determined a single institution's 30-day SSI rate and benchmarked it against that among national institutions participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Methods Women who underwent ITEBR with/without acellular dermal matrix (ADM) were identified using the ACS-NSQIP database between 2005 and 2011. Patient characteristics associated with the 30-day SSI rate were determined, and differences in rates between our institution and the national database were assessed. Results 12,163 patients underwent ITEBR, including 263 at our institution. SSIs occurred in 416 (3.4%) patients nationwide excluding our institution, with lower rates observed at our institution (1.9%). Nationwide, SSIs were significantly more common in ITEBR patients with ADM (4.5%) compared to non-ADM patients (3.2%, P=0.005), and this trend was observed at our institution (2.1% vs. 1.6%, P=1.00). A multivariable analysis of all institutions identified age ${\geq}50$ years (odds ratio [OR], 1.4; confidence interval [CI], 1.1-1.7), body mass index ${\geq}30kg/m^2$ vs. < $25kg/m^2$ (OR, 3.4; CI, 2.6-4.5), and operative time >4.25 hours (OR, 1.9; CI, 1.5-2.4) as risk factors for SSIs. Our institutional SSI rate was lower than the nationwide rate (OR, 0.4; CI, 0.2-1.1), although this difference was not statistically significant (P=0.07). Conclusions The 30-day SSI rate at our institution in patients who underwent ITEBR was lower than the nation. SSIs occurred more frequently in procedures involving ADM both nationally and at our institution.

• Journal of Korean Neurosurgical Society
• /
• v.63 no.4
• /
• pp.487-494
• /
• 2020

Objective : To analyze the incidence and characteristics of delayed postoperative fever in posterior cervical fusion using cervical pedicle screws (CPS). Methods : This study analyzed 119 patients who underwent posterior cervical fusion surgery using CPS. Delayed fever was defined as no fever for the first 3 postoperative days, followed by an ear temperature ≥38℃ on postoperative day 4 and subsequent days. Patient age, sex, diagnosis, laminectomy, surgical level, revision status, body mass index, underlying medical disease, surgical duration, and transfusion status were retrospectively reviewed. Results : Of 119 patients, seven were excluded due to surgical site infection, spondylitis, pneumonia, or surgical level that included the thoracic spine. Of the 112 included patients, 28 (25%) were febrile and 84 (75%) were afebrile. Multivariate logistic regression analysis showed that laminectomy was a statistically significant risk factor for postoperative non-pathological fever (odds ratio, 10.251; p=0.000). In contrast, trauma or tumor surgery and underlying medical disease were not significant risk factors for fever. Conclusion : Patients who develop delayed fever 4 days after posterior cervical fusion surgery using CPS are more likely to have non-pathologic fever than surgical site infection. Laminectomy is a significant risk factor for non-pathologic fever.

• Archives of Plastic Surgery
• /
• v.40 no.5
• /
• pp.522-529
• /
• 2013

Background Despite advances in surgical techniques, sterile protocols, and perioperative antibiotic regimens, surgical site infections (SSIs) remain a significant problem. We investigated the relationship between wound classification (i.e., clean, clean/contaminated, contaminated, dirty) and SSI rates in plastic surgery. Methods We performed a retrospective review of a multi-institutional, surgical outcomes database for all patients undergoing plastic surgery procedures from 2006-2010. Patient demographics, wound classification, and 30-day outcomes were recorded and analyzed by multivariate logistic regression. Results A total of 15,289 plastic surgery cases were analyzed. The overall SSI rate was 3.00%, with superficial SSIs occurring at comparable rates across wound classes. There were similar rates of deep SSIs in the clean and clean/contaminated groups (0.64%), while rates reached over 2% in contaminated and dirty cases. Organ/space SSIs occurred in less than 1% of each wound classification. Contaminated and dirty cases were at an increased risk for deep SSIs (odds ratios, 2.81 and 2.74, respectively); however, wound classification did not appear to be a significant predictor of superficial or organ/space SSIs. Clean/contaminated, contaminated, and dirty cases were at increased risk for a postoperative complication, and contaminated and dirty cases also had higher odds of reoperation and 30-day mortality. Conclusions Analyzing a multi-center database, we found that wound classification was a significant predictor of overall complications, reoperation, and mortality, but not an adequate predictor of surgical site infections. When comparing infections for a given wound classification, plastic surgery had lower overall rates than the surgical population at large.

• Journal of Gastric Cancer
• /
• v.14 no.3
• /
• pp.156-163
• /
• 2014

Purpose: Information regarding antimicrobial prophylaxis (AMP) for gastric cancer surgery is limited. The present study investigated the efficacy of single-dose AMP for the prevention of surgical site infection (SSI) in patients undergoing gastrectomy for gastric carcinoma. Materials and Methods: Between 2011 and 2013, 1,330 gastric carcinoma surgery patients were divided into two AMP administration groups depending on the duration of treatment. Postoperative outcomes including morbidity and SSI were compared between the two groups overall and in matched patients. Risk factors for SSI were analyzed. Results: The extended group (n=1,129) received AMP until postoperative day 1 and the single-dose group (n=201) received single-dose AMP only during an operation. Postoperatively, there were no significant differences between the two groups with respect to overall morbidity, mortality, or length of hospital stay. The SSI rate of the single-dose group was not significantly different from that of the extended group overall (4.5% vs. 5.5%, respectively, P=0.556) or in matched patients (4.5% vs. 4.0%, respectively, P=0.801). There was no increase in the SSI rate of the single-dose group compared to the extended group in subgroups based on different clinicopathological and operative factors. Univariate and multivariate analyses revealed male gender, open surgery, and operating time (${\geq}180$ minutes) as independent risk factors for SSI. Conclusions: Single-dose AMP showed no increase in the postoperative SSI rate compared to postoperative extended use in patients undergoing gastrectomy for gastric carcinoma. The efficacy of single-dose AMP requires further investigation in randomized clinical trials specific to gastric cancer surgery.

• Archives of Plastic Surgery
• /
• v.37 no.1
• /
• pp.71-74
• /
• 2010

Purpose: Nowadays spinal cord stimulator is frequently used for the patients diagnosed as complex regional pain syndrome. The lead is placed above the spinal cord and connected to the stimulation generator, which is mostly placed in the subcutaneous layer of the abdomen. When the complication occurs in the generator inserted site, such as infection or generator exposure, replacement of the new generator to another site or pocket of the abdomen would be the classical choice. The objective of our study is to present our experience of the effective replacement of the existing stimulation generator from subcutaneous layer to another layer in same site after the wound infection at inexpensive cost and avoidance of new scar formation. Methods: A 50-year-old man who was diagnosed as complex regional pain syndrome after traffic accident received spinal cord stimulator, Synergy$^{(R)}$ (Medtronic, Minneapolis, USA) insertion 1 month ago by anesthetist. The patient was referred to our department for wound infection management. The patient was presented with erythema, swelling, thick discharge and wound disruption in the left upper quadrant of the abdomen. After surgical debridement of the capsule, the existing generator replacement beneath the anterior layer of rectus sheath was performed after sterilization by alcohol. Results: Patient's postoperative course was uneventful without any complication and had no evidence of infection for 3 months follow-up period. Conclusion: Replacement of existing spinal cord stimulation generator after sterilization between the anterior layer of rectus sheath and rectus abdominis muscle in the abdomen will be an alternative treatment in wound infection of stimulator generator.

• Journal of Convergence for Information Technology
• /
• v.10 no.10
• /
• pp.80-87
• /
• 2020

The purpose of this study was to compare in antiseptic effect between povidone-iodine and chlorhexidine-ethanol for laparoscopic cholecystectomy on the port site. A total of 46 patients admitted to surgery at one university hospital in Seoul were included in the study. A study group was randomly assigned using a random number table. The antiseptic effect was evaluated and compared to povidone-iodine and chlorhexidine-ethanol by using a culture and identification of bacteria, measurement of the number of bacteria (CFU/ml) and incidence of surgical site infection. Our results show that povidone-iodine and chlorhexidine-ethanol have no statistically significant difference in the incidence rate of bacteria after 3 minutes of disinfection and before removal of the trocar and in the number of bacteria and the incidence of surgical site infection. Thus, in order to select an efficient and appropriate skin antiseptics, we suggest that it is necessary to consider not only the disinfectant effect but also cost and convenience. In this research, our results about effect and usage of skin antiseptics can be used as basic data and educational resource, and this is expected to improve comprehension of skin antiseptics.

• Journal of Korean Dental Science
• /
• v.16 no.1
• /
• pp.99-103
• /
• 2023

McCune-Albright syndrome (MAS) is a disease with clinical features such as fibrous dysplasia in which normal bone tissue is replaced with abnormal fibrous tissue, abnormalities in the endocrine system, and cafe-au-lait spots on the skin. Although MAS patients are generally known to have reduced bone healing ability, postoperative healing after invasive surgical extraction is still not clearly known due to its relatively rare occurrence. In this report, a 25-year-old female patient, who had been diagnosed with MAS and had a history of abnormal bone healing after fractures of her extremities, underwent surgical extraction of the mandibular third molar with surrounding bone removal. Postoperatively, the patient showed favorable soft tissue and bone healing at the surgical site without abnormal findings such as newly developed fibro-osseous lesions, postoperative infection, or osteomyelitis.

• Journal of Yeungnam Medical Science
• /
• v.26 no.2
• /
• pp.137-142
• /
• 2009

Nontuberculous mycobacterial infections are a rare, but clinically important cause of infections in continuous ambulatory peritoneal dialysis (CAPD) patients. This is typically suspected when a patient does not respond to treatment with the usual antibiotics. We describe here a case of $Mycobacterium$ $abscessus$ exit site infection with abdominal wall abscess formation that was associated with CAPD, which required peritoneal catheter removal, surgical debridement of the abscess and long term antibiotic therapy.

• Archives of Plastic Surgery
• /
• v.41 no.6
• /
• pp.759-767
• /
• 2014

Background Infection caused by nontuberculous mycobacteria (NTM) has been increasing. Awareness of this infection is crucial yet problematic. Delayed management may lead to destructive results. We empirically treated a series of patients with clinical suspicion of NTM infection prior to the identification of the pathogen. Methods A total of 12 patients who developed surgical site infections between January 2011 and February 2014 were reviewed. Patients with a skin and subcutaneous infection resistant to standard management over two weeks, and previous history of aesthetic procedures within three months were regarded as highly suspected of having an NTM infection. A variety of diagnostic modalities were examined simultaneously, along with starting empirical treatment including a combination of clarithromycin and moxifloxacin, and surgical debridement. Results All wounds healed completely within 4 weeks. The mean follow-up duration was 7.2 months, and none of the patients developed relapse. Specific NTM pathogens were identified in six patients. Eight patients showed caseating granuloma implying an NTM infection. One patient showed an uncommon Stenotrophomonas infection, which was successfully treated. Three patients had no evidence of a pathogen despite repeated microbial tests. Complications such as scarring, pigmentation, and disfigurement were common in all the patients. Conclusions NTM should be considered in the differential diagnosis of an unusual skin and soft-tissue infection. We propose an empirical regimen of clarithromycin and moxifloxacin as an efficient treatment option for an NTM infection.

• Journal of Chest Surgery
• /
• v.22 no.3
• /
• pp.416-424
• /
• 1989

We have performed eight, single transplantations of right lung in dogs from September, 1988 to March 1989 at the Thoracic & Cardiovascular Surgical department, Yonsei University, College of Medicine, Seoul, Korea. We wrapped bronchial anastomosis site with great omentum and used cyclosporin in preoperative and postoperative periods in seven cases except one. The one without wrapping the bronchial anastomotic site with omentum and using cyclosporin died due to bronchial anastomotic site rupture in postoperative fourth day. If there is no reason to choose one side over the other, we would generally choose to do left-sided transplant as this is technically somewhat easier because of the long length of recipient bronchus and the ease of clamping the left atrium proximal to the pulmonary veins. The right atrium limits the amount of left atrium that can have incorporated into the clamp proximal to the pulmonary veins on the right side. But we had chosen to do right-sided transplant of lung because we must take variable technical experiences on right sided lung transplant in dogs. We have to anastomose one of pulmonary vein and left atrial wall on right-sided transplant easily only with double ligation of one pulmonary vein because right atrium limited the clamp of left atrium proximal to pulmonary veins with decreased venous return and cardiac output in some dogs. All seven dogs with right-sided lung transplant had survived more than one day with good condition except one. The one dog have to be sacrificed to evaluate the difference between the gas analysis in pulmonary venous and arterial blood in post-operative eight hours. We found hemorrhagic pulmonary edematous changes of contralateral left lung in this dog. And also all dogs have to be sacrificed for the evaluation of surgical problems, anytime in post-operative periods without any cardiopulmonary resuscitative efforts when the general condition would be worse progressively. We found no any surgical technical errors in seven dogs except one with thrombi in suture site of left atrium. There were hemorrhagic pulmonary edematous changes of transplanted right lung in one, of contralateral left lung in one, of contralateral left lung with double ligation of its pulmonary artery in one, thrombi around left atrial sutures sites in one, multiple air leakage in one bronchial rupture in one due to rejection or infection. There were accidental extubation and delayed intubation in one and unknown cause of death in one.