Early wound complications after orthopaedic surgery for haemophilia: What can we do more

Abstract

Background: The characteristics of the haemophilia may endanger the patient with haemophilia (PWH) to higher ratio of wound complication, even lead to the refractory wound problem. The early wound complication in PWH has not been well studied in literature. Methods: Between the period from 2002 to 2018, 250 patients underwent 323 elective orthopaedic surgical procedures for the treatment of haemophilic musculoskeletal disorders. The medical records were retrospectively reviewed. The patients were evaluated for postoperative wound complications within 30 days. Risk factors related to wound complications were further analysed. The patients underwent vacuum sealing drainage (VSD) for refractory wound healing problem were further analysed. Results: Twenty-four patients of 250 patients experienced early wound complication within postoperative 30 days. The incidence of wound complication in the patients without preoperative infection was 6.5%. Positive inhibitor and surgery for pseudotumour were associated with higher rate of wound complication after logistic regression, with the odds ratios (OR) of 5.7 (95% CI, 1.08 to 30.3) and 4.9 (95% CI, 1.3 to 18.5), respectively. Eight patients underwent VSD treatment for refractory wound healing problem and recovered uneventfully. The total VSD treatment cycle was 2.25 (from 2 to 4). The average factor consumption was 26.1 IU kg −1 d −1. The patients complicated with infection had higher, but not statistically significantly, treatment duration, factor consumption and peri-VSD total blood loss than the patients without infection. Conclusions: PWH had an incidence of 6.5% of early wound healing problem after elective orthopaedic surgery for musculoskeletal disorder in the present study. The presence of positive inhibitor and surgical procedure for haemophiliac pseudotumour are associated with higher incidence of wound healing problem. The VSD is an effective alternative for the treatment of refractory wound healing problem for PWH, especially for the patients complicated with infection.

Application Effect of Silver-Containing Dressings in the Repair of Chronic Refractory Wounds

“…Once in contact with wound exudate, the hydrocolloid particle (CMC sodium carboxymethylcellulose) in the dressing swells after absorbing the exudate, forms a soft, cohesive hydrogel that allows it to absorb the wound exudate while locking it in within the gel, avoiding the risk of exudate leakage as well as the wound skin. Intrasite gel also creates a moist environment conducive to wound healing [20][21][22]. e results of this study showed that after treatment, the positive rate of wound bacterial culture in the observation group was significantly lower than that in the control group.…”

A Novel Surgical Classification for Extremity and Pelvic Hemophilic Pseudotumors

“…For an HPT with a large bone defect and/or pathological fracture, or when more than one-third of the bone diameter was involved, the HPT was curetted and osseous reconstruction was performed. For an HPT with an infected open wound, HPT excision and debridement were performed, followed by vacuum sealing drainage for wound management and infection eradication 19 . Amputation was performed only in patients with massive destruction of host tissue and in cases complicated by a refractory infection or wound problem.…”

“…T H E J O U R N A L O F B O N E & JOINT SURGERY d J B J S . O R G VOLUME 105-A d N U M B E R 8 d A P R I L19, 2023 …”

Management of surgery in persons with hemophilia A receiving emicizumab prophylaxis: data from a national hemophilia treatment center

“…Persons with hemophilia A (HA) may require surgical procedures to treat conditions both related (eg, insertion and removal of central venous access devices [CVADs], orthopedic surgery for the treatment of joint damage) and unrelated to the hemophilia. During the perioperative period, enhanced hemostatic support is essential to prevent bleeding complications, inadequate wound healing, and infections [ 1 ].…”