Background: Posterior spinal instrumentation carries a significant risk of wound complications, including hardware exposure, which often requires flap coverage due to inadequate local tissue vascularity. The pedicled latissimus dorsi flap is a reliable option for posterior trunk reconstruction, though reports of its use in salvage of exposed spinal osteosynthesis following complex corpectomy remain limited. Methods: We present the case of a 69-year-old female who developed a persistent cutaneous fistula and exposed spinal hardware following L2 corpectomy and posterior instrumentation from T10 to S1. After partial improvement with debridement and negative pressure wound therapy, a V-Y advancement musculocutaneous latissimus dorsi flap was performed. The surgical technique focused on preservation of the thoracodorsal pedicle, release of muscular insertions, and tension-free closure. Results: The postoperative course was uneventful, with complete wound healing and stable soft tissue coverage. No flap complications or signs of infection were observed. Conclusion: The V-Y advancement musculocutaneous latissimus dorsi flap is an effective option for salvage of complex posterior spinal wounds with exposed hardware. Its versatility and robust vascular supply make it a valuable reconstructive tool.
Objective: Acute appendicitis is a prevalent surgical emergency that requires prompt diagnosis and intervention. Ultrasound is frequently utilized as a first-line diagnostic tool due to its accessibility and non-invasive nature. However, its diagnostic accuracy can vary due to several influencing factors. Histopathological examination remains the gold standard for confirming appendicitis. This study evaluates the compatibility between ultrasound findings and histopathological results in diagnosing acute appendicitis. Methods: A prospective cross-sectional study was conducted across three hospitals in Iraq Al-Turki Hospital, Al-Jumhori Hospital, and Al-Sadr Hospital from November 29, 2024, to February 3, 2025. A total of 158 patients clinically suspected of having acute appendicitis underwent abdominal ultrasound followed by surgical appendectomy. Histopathological examination of the removed appendix served as the reference standard. Statistical analysis was conducted to calculate sensitivity, Results: Out of 158 patients, 110 had positive ultrasound findings. The diagnostic performance of ultrasound revealed a sensitivity of 100%, specificity of 70%, positive predictive value of 82.4%, negative predictive value of 100%, and an overall diagnostic accuracy of 87.5%. There were no false negatives, indicating that ultrasound was highly effective in ruling out appendicitis when negative. Conclusions: Ultrasound proved to be a highly sensitive and effective diagnostic tool for detecting acute appendicitis, particularly valuable in ruling out the condition. Despite variability due to operator and patient-related factors, its strong correlation with histopathological results supports its role as a frontline diagnostic modality, especially in emergency and resource-limited settings.
Background: Accurate diagnosis of acute appendicitis remains challenging, particularly in emergency settings [1], and several clinical scoring systems have been developed to support decision-making, including Alvarado and RIPASA scores [2,3]. The RIPASA score has demonstrated favorable diagnostic performance, particularly in Asian and Middle Eastern populations [4]; however, data on clinicians' awareness and real-world utilization are limited. Objective: To assess awareness, utilization, and perceived barriers to the use of the RIPASA score among emergency and surgical physicians. Methods: A single-center cross-sectional survey was conducted among physicians involved in the assessment and management of suspected acute appendicitis. The total target population consisted of 128 physicians. A total of 119 responses were received (response rate 93.0%), of which 16 were excluded due to duplication, irrelevance, or incomplete data. The final analysis included 104 participants. Descriptive statistics were used, and comparisons between specialties were performed using the Chi-square test. Results: Overall, 85.6% of participants were aware of the RIPASA score, while 51.0% reported using it in clinical practice. Utilization of the RIPASA score was higher among surgical physicians than emergency physicians (55.9% vs 41.7%); however, the difference was not statistically significant (p = 0.24). The most commonly reported barriers were unfamiliarity with the score, lack of training, and perceived time constraints. Conclusion: Despite high awareness, utilization of the RIPASA score remains moderate. Although use appeared higher among surgical physicians, no statistically significant difference was observed between specialties. Targeted training and integration of RIPASA into clinical workflows may improve its adoption.
Objective: To study the characteristics of surgical site infections (SSI) in digestive surgery in Brazzaville. Patients and Methods: This was an analytical, cross-sectional, and multicenter study conducted from March 1 to September 30, 2024, in the digestive surgery departments of the University Hospital Center (CHU) and general surgery departments of five referral hospitals in Brazzaville. All hospitalized patients aged at least 18 years who underwent abdominal surgery were included in the study. Patients were followed up within 30 days of surgery. Results: During the study period, 493 patients were included, 73 cases of SSI were recorded, representing a frequency of 14.8%. Was the center with the most cases of SSI were found in the university hospital (58 patients or 79.4%). The median age was 41 years. Male sex was predominant with a sex-ratio of 1.35. Among the SSIs, 74% were superficial; 20.5% deep and 5.5% organ. Acute generalized peritonitis was the most common pathology of infected patients (60.3%). Of the 73 samples analyzed, 70 cultures were positive, representing 95.8%. Escherichia coli were the most identified microorganism (36.5%), followed by non-coagulase Staphylococcus (15%) and Klebsiella pneumoniae (12.2%). Multivariate analysis showed that SSI was statistically associated with ASA score, operative mode, and NNISS score. Conclusion: SSIs represent a major public health problem. Prevention relies on rigorous epidemiological surveillance and compliance with good perioperative hygiene practices.
Low-output enterocutaneous fistulas (ECFs) are challenging postoperative complications that can lead to significant morbidity due to nutritional depletion, infection, and prolonged hospitalization. Vacuum-assisted closure (VAC) therapy, also referred to as negative pressure wound therapy (NPWT), has shown promise as a valuable adjunct in the acute care setting. This narrative review explores the role of VAC therapy in the management of low-output abdominal fistulas, focusing on its physiological mechanisms, technical considerations, and clinical outcomes. Evidence suggests that VAC therapy enhances granulation tissue formation, controls effluent, and facilitates spontaneous closure in up to 70 - 100% of appropriately selected cases of low-output fistulas. Closure often occurs within two to eight weeks when VAC is applied properly. Despite concerns about potential complications such as bleeding or fistula worsening, VAC remains a safe and effective strategy, particularly when traditional wound care methods fail. While the current literature is largely composed of case series and observational reports, the cumulative experience supports VAC as a frontline therapy in the acute management of low-output ECFs upon conservative measure failure. More clinical trials are needed to establish standardized treatment protocols.
