Surface landmarks of the facial nerve trunk: a prospective measurement study

Background: Facial nerve identification and preservation is the key to safe parotidectomy in most clinical situations. Traditional approaches to the main trunk have depended solely on internal landmarks but localization may further be enhanced if data are avail­able on its position with reference to neighbouring external features. Methods: Prospective measurements were taken on a series of parotidectomy patients intraoperatively. Using that spot on the main trunk 10 mm proximal to its bifurcation as the reference point, the depth from the skin and its cranio‐caudal distance from the summit of the tragus were measured. Results: Thirty‐three patients were included, whose body mass index showed that they had average body build. The reference point nerve was 23.6 mm (SD = 5.1 mm) from the skin surface, and 18.8 mm (SD = 6.0 mm) caudal to the tragus. Conclusion: Measurements relating to the siting of the facial nerve trunk were obtained live at operation. This information should be helpful in the initial mobilization of the parotid gland from its posterior relations and in facilitating the classical internal landmarks in the 3‐D localization of the main trunk, thereby allowing quicker and safer parotidectomy.     

Recurrent pleomorphic adenoma of the parotid gland: analysis of 108 consecutive patients

BACKGROUND: Surgery for recurrent parotid pleomorphic adenoma is a challenging problem. METHODS: One hundred eight patients who underwent 134 reoperations for recurrent parotid pleomorphic adenoma (follow-up, 22 years) were evaluated for histopathologic features and risk factors for recurrence. RESULTS: The number of reoperations for tumor recurrence ranged from 1 to 10. Twenty-seven patients (25%) developed permanent facial nerve weakness. The risks for clinically evident rerecurrence after 1, 5, and 15 years were 16%, 42%, and 75%, respectively. Female sex, young age at initial treatment, and enucleation instead of parotidectomy for treatment of the first recurrence were significant risk factors for rerecurrence. The mean number of recurrent tumor nodules was 26. CONCLUSIONS: Surgery for recurrent parotid pleomorphic adenoma has a high rate of facial nerve morbidity. The chance of rerecurrence is high. Extended parotidectomy seems to be the best approach for the reoperation to reduce the risk of rerecurrence.     

Smoking increases the risk of postoperative wound complications: A propensity score-matched cohort study

Cigarette smoking is associated with surgical complications, including wound healing and surgical site infection. However, the association between smoking status and postoperative wound complications is not completely understood. Our objective was to investigate the effect of smoking on postoperative wound complications for major surgeries. Data were collected from the 2013 to 2018 participant use files of the American College of Surgeons National Surgical Quality Improvement Program database. A propensity score matching procedure was used to create the balanced smoker and nonsmoker groups. Multivariable logistic regression was used to calculate the odds ratios (ORs) with 95% confidence intervals (CIs) for postoperative wound complications, pulmonary complications, and in-hospital mortality associated with smokers. A total of 1 156 002 patients (578 001 smokers and 578 001 nonsmokers) were included in the propensity score matching analysis. Smoking was associated with a significantly increased risk of postoperative wound disruption (OR 1.65, 95% CI 1.56-1.75), surgical site infection (OR 1.31, 95% CI 1.28-1.34), reintubation (OR 1.47, 95% CI 1.40-1.54), and in-hospital mortality (OR 1.13, 95% CI 1.07-1.19) compared with nonsmoking. The length of hospital stay was significantly increased in smokers compared with nonsmokers. Our analysis indicates that smoking is associated with an increased risk of surgical site infection, wound disruption, and postoperative pulmonary complications. The results may drive the clinicians to encourage patients to quit smoking before surgery.     

Sensation recovery improved by great auricular nerve preservation in parotidectomy: a prospective double-blind study

BACKGROUND: The great auricular nerve (GAN) is frequently sacrificed during parotidectomy and causes sensory disturbance of the auricle. Our study is to investigate whether GAN preservation can improve the sensory recovery. METHODS: Patients undergoing superficial or total conservative parotidectomy for benign tumours were recruited consecutively from November 1998 to September 2001. Different sensory methods (light touch, two-point discrimination and sharp pain) of the auricle were evaluated by a designated physiotherapist preoperatively as well as at 1, 3, 6 and 12 months postoperatively. The patients and the physiotherapist were blinded to the integrity of the GAN. Long-term subjective assessment was also carried out beyond 2 years postoperatively. RESULTS: A total of 21 patients were recruited for the study. GAN were preserved in 10 patients. The mean follow up was 16 months (12-42 months). There was no difference in sex distribution, type of operation and pathology of parotid tumour between the two groups. No postoperative mortality occurred and postoperative morbidity did not differ between the two groups. Patients with GAN preserved had significantly better light touch and sharp pain recovery at 1 year postoperatively. Subjective assessment of sensory dysfunction also favoured GAN preservation. CONCLUSION: Great auricular nerve preservation minimizes the postoperative sensory disturbance and should be considered whenever tumour clearance is not compromised.     

结直肠癌肝转移切除术后并发症对生存影响

目的 探讨围手术期并发症对接受根治性结直肠癌肝转移灶切除患者生存影响.方法 回顾性分析自2000年1月至2012年3月在我科接受结直肠癌肝转移灶切除患者临床病理资料及围手术期并发症,并发症按Dindo-Clavien分级分为无并发症、轻度(Ⅰ～Ⅱ级)并发症、重度(Ⅲ～Ⅳ级).并探讨不同分级并发症与总生存及无病生存关系.结果 本组173例结直肠癌肝转移患者接受根治性肝转移灶切除术,其中59例患者术后存在手术并发症.这些患者中37例为轻度并发症,22例为重度并发症.单因素(x2 =8.106,P=0.004)及多因素分析(x2=8.006,P=0.005)提示术后并发症会降低患者总生存.但进一步分析提示重度并发症显著降低患者无病生存(x2＝4.216,P =0.04)及总生存(x2=9.588,P=0.002),轻度并发症并未影响患者无病生存(x2 =1.313,P =0.252)及总生存(x2 =3.199,P=0.074).结论 围手术期并发症是结直肠癌肝转移患者独立预后因素.     

Therapeutic options and postoperative wound complications after extremity soft tissue sarcoma resection and postoperative external beam radiotherapy

Soft tissue sarcomas occur most commonly in the lower and upper extremities. The standard treatment is limb salvage surgery combined with radiotherapy. Postoperative radiotherapy is associated with wound complications. This systematic review aims to summarise the available evidence and review the literature of the last 10 years regarding postoperative wound complications in patients who had limb salvage surgical excision followed by direct closure vs flap coverage together with postoperative radiotherapy and to define the optimal timeframe for adjuvant radiotherapy after soft tissue sarcomas resection and flap reconstruction. A literature search was performed using PubMed. The following keywords were searched: limb salvage, limb‐sparing, flaps, radiation therapy, radiation, irradiation, adjuvant radiotherapy, postoperative radiotherapy, radiation effects, wound healing, surgical wound infection, surgical wound dehiscence, wound healing, soft tissue sarcoma and neoplasms. In total, 1045 papers were retrieved. Thirty‐seven articles were finally selected after screening of abstracts and applying dates and language filters and inclusion and exclusion criteria. Plastic surgery provides a vast number of reconstructive flap procedures that are directly linked to decreasing wound complications, especially with the expectant postoperative radiotherapy. This adjuvant radiotherapy is better administered in the first 3–6 weeks after reconstruction to allow timely wound healing and avoid local recurrence.     

A prospective study of sternal wound complications

Eight hundred seventy patients were enrolled in a prospective study to identify risk factors for sternal wound complications following open-heart operations. The 0.8% incidence of major sternal complications was similar to that reported in the literature by other centers. The effects of age, sex, weight, operative time, type of procedure, resident versus attending surgeon, prolonged ventilatory support, reoperation for bleeding, external cardiac massage, and Dacron versus wire suture for sternal closure were assessed by stepwise logistic regression. Prolonged ventilation and female sex both strongly increased the risk of major sternal complications. Age and weight exerted lesser, but statistically significant, effects on the incidence of such complications. None of the other factors was associated with an increased risk of major sternal complications.     

老年人胰十二指肠切除术后并发症的临床分析

目的 探讨老年人胰十二指肠切除术(PD)后主要的并发症及防治方法.方法 回顾性分析我院采用PD术治疗的61例老年人胰胆管疾病患者的临床资料.结果 术后并发症发生率为29.51％( 18/61),死亡率为3.28％( 2/61).主要并发症为胰瘘2例(3.28％),上消化道出血3例(4.92％),腹腔内感染10例(16....     

血液透析动-静脉造瘘术后并发症的处理

目的 总结血液透析（血透）患者动静脉造瘘手术后并发症的处理经验。方法 收集我院120例患者,造瘘手术144例次,其中行内瘘134例次,人工血管瘘10例次。结果 术后扩要并发症：（1）血栓形成,AVF：17%、AVG：60%。内瘘血栓形成多发生于6周以内,治疗以重建新瘘道为主,或改建人工血管瘘;人工血管瘘血栓以取栓治疗为主,同时尽可能修复静脉流出道。（2）感染,AVG感染率为10%,行引流行移植物切除手术。（3）充血性心功能衰竭：3.5%,超滤、强心治疗。（4）窃血：1.4%,行血管成型和旁路架桥手术治疗。结论 积极预防和正确处理造瘘术后并发症可延长瘘道的通畅时间。     

Analysis of complications following surgical treatment of benign parotid disease

Background: The objective of the study was to study the incidence of, and risk factors for developing complications following parotidectomy for benign disease, to improve preoperative patient counselling and better inform future surgical management. Methods: An 11‐year retrospective review of 162 parotidectomies for benign disease, collecting and analysing data about presentation, investigations, surgical treatment, postoperative facial nerve function, Frey’s syndrome and other surgical complications. Results: The mean age at presentation was 58 years. The commonest pathology was benign pleomorphic adenoma (43%), followed by Warthin’s tumour (30%) and chronic sialadenitis (22%). Sialadenitis was a significant risk factor for facial nerve palsy and increased the incidence of salivary fistulas. Parotid duct ligation increased the risk of nerve palsy in the distribution of zygomatic and buccal branches. Operations for Warthin’s tumour were associated with an increased risk of dysfunction of the cervical branch of the nerve. Half the patients had intraoperative facial nerve stimulation and this did not influence the likelihood of facial paresis. The recovery of facial nerve function showed a biphasic distribution, with 90% of patients having normal function within 12 months, followed by a slower recovery rate for up to 2 years. Conclusion: The incidence of postoperative complications was influenced by the pathology, with inflammatory lesions significantly increasing the risk of facial nerve dysfunction and other complications, but also by variations in surgical practice, such as parotid duct ligation. Overall, the incidence of permanent facial paralysis was less than 2%, but temporary nerve palsy was common at 40%, with most patients regaining normal function within 1 year of the operation.     

Smoking increases the risk of postoperative wound complications: A propensity score‐matched cohort study

Cigarette smoking is associated with surgical complications, including wound healing and surgical site infection. However, the association between smoking status and postoperative wound complications is not completely understood. Our objective was to investigate the effect of smoking on postoperative wound complications for major surgeries. Data were collected from the 2013 to 2018 participant use files of the American College of Surgeons National Surgical Quality Improvement Program database. A propensity score matching procedure was used to create the balanced smoker and nonsmoker groups. Multivariable logistic regression was used to calculate the odds ratios (ORs) with 95% confidence intervals (CIs) for postoperative wound complications, pulmonary complications, and in‐hospital mortality associated with smokers. A total of 1 156 002 patients (578 001 smokers and 578 001 nonsmokers) were included in the propensity score matching analysis. Smoking was associated with a significantly increased risk of postoperative wound disruption (OR 1.65, 95% CI 1.56‐1.75), surgical site infection (OR 1.31, 95% CI 1.28‐1.34), reintubation (OR 1.47, 95% CI 1.40‐1.54), and in‐hospital mortality (OR 1.13, 95% CI 1.07‐1.19) compared with nonsmoking. The length of hospital stay was significantly increased in smokers compared with nonsmokers. Our analysis indicates that smoking is associated with an increased risk of surgical site infection, wound disruption, and postoperative pulmonary complications. The results may drive the clinicians to encourage patients to quit smoking before surgery.     

改良套入式胰肠吻合技术在胰十二指肠切除术中的临床应用研究

目的探究改良套入式胰肠吻合技术在胰十二指肠切除术中应用的安全性与可靠性。方法 2014年至2016年对33例接受胰十二指肠根治术的患者进行前瞻性研究,术中胰肠吻合采用改良套入式胰肠吻合技术。并记录其一般情况及术后胰瘘、胆瘘、延迟胃排空、切口延迟愈合、感染等并发症情况。数据分析用SPSS 19统计软件,根据数据变量类型以±s或X0.5(Q25,Q 75)表示,选择卡方检验(Chi-square test)计算不同胰腺质地与胰瘘关系。并根据统计学结果以Graphpad prism 5行统计图绘制。P0.05认为差异有统计学意义。结果总体并发症率为24.2%(8/33),胰瘘发生率为15.2%(5/33),A级胰瘘占总体胰瘘率的80.0%(4/5)。其中质软胰腺与质硬胰腺胰瘘发生概率差异无统计学意义(χ2=0.05,P=0.934)。胆瘘发生率3.0%(1/33),出血发生率6.1%(2/33),延迟胃排空发生率为3.0%(1/33),围手术期无二次手术及死亡病例。结论应用改良套入式胰肠吻合技术胰瘘发生概率较低,手术安全可靠,操作简便。