نشریه جراحی ایران
سال بیستم شماره 2 (تابستان 1391)

Introduction & Axillary lymph node status is one of the most important prognostic factors and also part of the surgical challenge in Breast Cancer. Recent changes in the treatment of axillary lymph node dissection، and compare the results of the sentinel lymph node (SLND) and Axillary Lymph Node Dissection (ALND) in breast cancer has been investigated in the literature. Using the PubMed، Medescape، Medline، going through 3422 articles، and selecting 372 ones، since 1980 to 2011، we referred to 100 articles in this paper. Recent concept on reviewing the ALND and SLND methods leads to reduce axillary dissection. Finding axillary Sentinel Lymph nodes and its pathology during the operation is the standard method in the treatment of most breast cancer.

Introduction & Epidermolysis bullosa is a genetic disease، belonging to mechanobullosa family، It has 3 types: simplex، junctional، and dystrophic، It is characterised by easy detachment of epidermis from dermis، and mouth، teeth، esophagus، perineal area and other organs are involved، hand involvement is very severe، and it leads to mitten hand. The treatments performed in these patients consist of using skin graft of the patient himself، apligraft، keratinocyte، amnotic membrane، etc. Considering the brilliant effects of omniotic membrane and fibroblast in wound healing، both of them are used for hand coverage after the surgery. This study is a clinical trial on 10 patients with Epidermolysis bullosa with age within range of 5 to 30 years these patients were divided in 2 groups: one group using amniotic membranes only. The second group used amniotic membranes in combination with fibroblast. Skin samples from patient’s of posterior auricule، and fibroblasts were isolated، and were cultured and transferred to amniothic membrane. Then after operation and releasing the palm and finger and placing the krischner wire، to cover their hands، of amniotic membrane was used in the first group and amniotic membranes with fibroblasts were used in the second group. Then the two groups were followed and compared regarding the status of wound healing، graft take success، wound healing time، the number amniotic membranes، duration of hospitalization، number of surgeries and of total range of movement in at intervals of 1، 3 and 6 months. Comparing the two groups، it become evident that the quality of wound healing، graft take rate، wound healing time were much better in fibroblastic group، and the duration of hospitalization and number of surgeries performed in the group using fibroblast and amniotic membranes was much smaller than group one which used amniotic membrane alone. There is various methods of treatment for EB including taking Graft from the patient، and using apligraft grafts، keratinocyte Biobrane، and amniotic membranes. Because of useful and interesting properties of amniotic membranes and fibroblasts in wound healing، the combination of both was used for the treatment of EB and significant benefits and effects were found in wound healing.

Introduction & Inguinal hernia repair is one of the most common surgeries in general surgery field. Lichtenstein Hernioplasty is the most popular method for this repair. Inguinal hernia repair is a clean operation but because of using mesh (a prosthetic device)، prophylactic antibiotic is routinely used to reduce the incidence of wound infection. The aim of this study is the evaluation of the role of prophylactic antibiotic in the prevention of wound infection in patients undergoing elective mesh repair of inguinal hernia. This is an interventional study in which 270 patients (15-50yr) who underwent elective inguinal hernia repair with LichtenStein method at Shahid Beheshti Hospital in Kashan were selected. 135 of patient (50%) s received 1g intravenous Cefazolin، 30 minutes before the operation while 135 patients (50%) did not receive any antibiotic prophylaxis. In the 7th and 30th days after the operation، patients were followed up to investigate the wound infection rate. For analyzing of quantitative variables we used mean، standard deviation، t-test and for qualitative variables chi square test was applied. In both groups، no wound infection was observed (neither superficial nor deep) in the patients، after one week and one month of the operation. The application of the prophylactic antibiotic in a routine manner and particularly in low risk patients operated on for elective hernioplasty with mesh is not recommended. Different studies showed no general agreement on this subject. Hence، further studies with larger sample size، in this field is recommended.

Introduction & Urinary retention، with incidence rate of nearly %70، is one of the most complications after anorectal surgery and is dependent on the type of surgery، local anesthetic properties and type of analgesic drug. There is a constant relation between autonomic response and urinary retention. The aim of this study was to determine effect of intratechal lidocaine and pethidine on urinary retention in elective anorectal surgery. Sixty patients، being scheduled for nonemergency anorectal surgery، were divided into 2 groups. The standard group received 50 mg of lidocaine 5% and the case group received 50 mg of pethedine intrathecally. Data collection included blood pressure، heart rate، oxygen saturation، time of first urine passing and pain score were collected. All data underwent analysis with SPSS 16، and also qualitative tests، NPAR، Mann-Whitney U at the meaningful level of 0. 05. There were no significant differences between the two groups in the blood pressure change، pulse rate، oxygen saturation، first urine passing، shivering and patient satisfaction. Bowel movement and first gas passing was more rapid in the pethedine group (P-value=0. 029). There is no significant difference between lidocaine 5% and pethedine on urinary retention in anorectal surgery.

Introduction & A patient''s skin is a major source of pathogens that cause surgical site infection. There are various techniques for preoperative skin preparation in this regard. The present study tries to compare the results of pre-operation skin cleaning using povidone-iodine 10% with skin cleaning using povidone-idone 7. 5% and green povidone-iodone. A total of 200 patients with clean surgery were randomly assigned to two groups: case (modified technique of skin preparation with aqueous povidone - iodine 10%) and control (standard technique with povidone -iodine soap 7. 5% and green povidone -iodine). Finally 111 patients in first group and Eighty-two patients in the second group completed the study period of 30- days. We compared surgical site infection and confounder variable between two groups such as age، immunity compromise، diabetes mellitus، obesity Body Mass Index، time of surgery and antibiotic consumption and analyzed the results by Chi-square test. There were no statistical difference between confounder variables in the two groups (P > 0. 05) and infections incidence in the first group was 2 patients (1. 8%) and in second group was 3 patients (3. 6%). The P-value was 0. 65. Preparation of the skin with both povidone iodine soap and then aqueous povidone iodine prior to clean surgeries can be replaced with aqueous povidone iodine alone.

Introduction & Corrective actions are a branch of applied science and include the identification، education، prevention، correction of wrong habits of body and motor abnormalities. In this study، the effectiveness of corrective actions on low back pain in female students 19-22 years with lumbar lordosis in isfahan university is evaluated. In this quasi-experimental study، 300 female students aged 19 to 22 years in Isfahan University were selected by stratified random sampling. All these individuals were initially screened to identify and select patients with lumbar lordosis using the New York organization test. Among of them، 120 people، who had hyperlordosis، were evaluated again by flexible ruler for precise measurement of lumbar lordosis. At the end، 44 people were selected who had >30 degree curving in lumbar and they were randomly assigned to case and control groups. For the case group corrective actions took place in 8 weeks، with 3 sessions in a week and each session having 60 minutes of exercise. Before and after the actions، the pre and post test were taken. Information was collected by Quebec Pain Questionnaire (to measure low back pain) and was analyzed by using independent and dependent t-tests were taken. People had mean age، height and weight of 21. 5 ± 1. 6، 160. 6 ± 5. 8، and 55. 4 ± 7. 8 respectively. Between lumbar lordosis and low back pain in the case group there was a statistically significant difference before and after the 8 weeks of corrective actions (P ≤ 0. 05). Between all physical variables of the case groups compared with the control group، there was a significant difference at the level of P ≤0. 05. Regular and correct exercises may lead to increase muscular power and decrease lordosis. This can decrease the recurrence of back pain and has a vital role in treating the patients with lordosis.

Introduction & Infection of the post orthopedic surgery is one of the most prevalent complications after surgery that causes the increase of bed occupancy، hospitalization time and costs for patient. Up to now، little study has been done on the prevalence of orthopedic surgical site infection. This study was done with purpose of “Assessment of the prevalence of post-operation orthopedic wound infection in the orthopedic surgical ward of Motahari hospital”. This is a descriptive- analytic study. Sampling was done with census method in 420 patients of orthopedic surgery in 2009-2010. We prepared a checklist with the use of brain storm، fishbone diagram، review article and group discussion methods in three parts which involved patient، accident and hospital and the computed its superficial reliability and durability (r = 0. 086). Data collected through interview and observation. SPSS 12 was used for data analysis. Patients mean age was 36. 47±23. 58 years، anesthesia time was 0. 17±0. 57 hr and days of hospitalize was 7. 02±4. 2. Chi-square test showed significant correlation between surgical site infection and fracture kind، smoking، operation time، operation kind، and days of hospitalization. Prevalence of orthopedic infection was 8. 8%. Preparation of a standard hospital performance protocol should be done with the purpose of decrease orthopedic infection prevalence via increasing the attention to leg and open fractures specially in smoking people.

Iliac artery aneurysm is a rare disease in vascular surgery and is often associated with abdominal aortic aneurysm and is abundant in men over 70 years of age who also have other risk factors for cardiovascular diseases. The solitary iliac artery aneurysm in young patients is very rare. This article reports the case of a 29 years male patient who referred to our clinic with a complaint about left flank pain and hydronephrosis، but the final diagnosis was isolated common iliac artery aneurysm which was compressed and obstructed the left ureter. The patient was treated with the resection of the aneurysm and he was discharged from our clinic without any complication.