Floating aortic thrombus with celiac artery embolus presenting with chronic epigastric and right upper quadrant pain: A case report

Arterial occlusion may be the cause of chronic pain, and vascular diagnostic procedures should be a part of the workup in patients with unexplained chronic visceral pain. © 2021 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd

Determinants of Success After Metatarsal Head Resection for the Treatment of Neuropathic Diabetic Foot Ulcers

Metatarsal head resection (MHR) is an effective option for the treatment of nonhealing neuropathic diabetic foot ulcers. The present study aimed to identify factors that predict treatment success for neuropathic diabetic foot ulcers undergoing metatarsal head resection. In this prospective interventional case series, 30 consecutive diabetic patients with documented nonischemic neuropathic plantar diabetic foot ulcers beneath the metatarsal head who underwent MHR were included. The study endpoint was demographic indicators of early and late postoperative outcomes. Patients were followed up for 1 to 66 months (mean 37.6 months). Except for 1 patient, all subjects� wounds (96.6) healed after metatarsal head resection within an average of 35 days. One of the operated patients (3.4) suffered short-term complications; long-term complications occurred in 23.3 of the patients. One patient (3.4) experienced ulcer recurrence, 3 patients (10) developed wound infection, and transfer lesions occurred in 3 other patients (10) during the follow-up period. Using 3 estimators including ordinary least squares (OLS), White's heteroscedastic standard errors, and bootstrapping procedure, we could not find any statistically significant demographic feature related to ulcer healing. Using regression modeling, we could not find any evidence for a role of age, sex, weight, height, BMI, duration of ulcer until MHR, and duration of diabetes mellitus (years since diabetes diagnosis) affecting the outcome of MHR. Hence, demographic features, duration of ulcer until MHR, and years with diabetes did not affect the outcome of MHR. In conclusion, the authors believe that MHR will have a high rate of success for neuropathic wound healing in this specific subset of patients regardless of demographic features, as long as there is no ischemia to impair healing by secondary intention. © 2020 the American College of Foot and Ankle Surgeon

Cosmetic Surgical Repair of Contaminated Wounds Versus Traditional Loose Approximation: Does It Increase the Rate of Wound Infections?

Background:The cosmetic result of the surgical scar has long been considered by surgeons as an important factor for patient satisfaction.On the other hand,there has been an old teaching that perfect closure of contaminated wounds increases the rate of infection. We decided to look into this matter and see if this is a fact or a myth. Methods: In this prospective randomized study conducted on 200 patients with suppurative or gangrenous appendicitis,we closed the wounds with a cosmetic subcuticular suture of 4/0 nylon in 100 patients and in the other 100 patients the wound was approximated loosely with a few stitches of 3/0 nylon in vertical mattress fashion during a 14-month period.Results:There was no significant difference in the rate of wound infection between these two groups.Conclusions:This study shows that perfect closure of the wound with subcuticular closure,which gives a very good cosmetic result in comparison with traditional loose closure, does not increase the rate of wound infection

An Easy Solution For The Diverting Loop Colostomy: Our Technique

Background: The loop colostomy is one of the most popular techniques used as a protective maneuver for a distal anastomosis and/or temporary fecal diversion. We are introducing the use of a full thickness skin bridge under the large bowel instead of a glass rod which alleviates problems such as protrusion of the large bowel, retraction of the bowel into the abdomen after removing the rod and hindering proper application of a colostomy bag over the stoma. Methods: Seventeen patients needing double barrel colostomy for complete diversion of fecal material were selected using loop colostomy with skin bridge. Three patients had Fournier's gangrene and 14 had penetrating rectal injury. Omega loop colostomy with a full thickness skin bridge was performed for fecal diversion. Results: All of the 17 patients had gas passing and full passage of fecal material within 3 days postoperatively. No case of skin necrosis and stitch abscess was encountered. No parastomal hernia or large prolapse was noted until healing was completed and patients were discharged and after at least 8 weeks and in Fournier's gangrene somewhat longer, the loop colostomy was closed without the need for formal laparotomy and without any case of anastomotic leak. Conclusion: In this study we confirmed that diverting loop colostomy using a skin bridge is a safe, rapid and easy to manage colostomy technique which gives complete diversion similar to double barrel colostomy without the need of performing a laparotomy for closure of the colostomy