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Sample records for open surgical wounds

  1. Surgical wound care - open

    MedlinePlus

    Surgical incision care; Open wound care ... your wound again with sutures, you need to care for it at home, since it may take ... Your health care provider will tell you how often to change your dressing . To prepare for the dressing change: Clean your ...

  2. Simulation of carbon dioxide insufflation via a diffuser in an open surgical wound model.

    PubMed

    Cater, John E; van der Linden, Jan

    2015-01-01

    Flow within a model surgical opening during insufflation with heated carbon dioxide was studied using computational fluid dynamics. A volume of fluid method was used to simulate the mixture of ambient air and carbon dioxide gas. The negative buoyancy of the carbon dioxide caused it to fill the wound and form a protective layer on the internal surfaces for a range of flow rates, temperatures, and angles of patient inclination. It was observed that the flow remained attached to the surface of the model due to the action of the Coanda effect. A flow rate of 10 L/min was sufficient to maintain a warm carbon dioxide barrier for a moderately sized surgical incision for all likely angles of inclination. PMID:25103346

  3. Simulation of carbon dioxide insufflation via a diffuser in an open surgical wound model.

    PubMed

    Cater, John E; van der Linden, Jan

    2015-01-01

    Flow within a model surgical opening during insufflation with heated carbon dioxide was studied using computational fluid dynamics. A volume of fluid method was used to simulate the mixture of ambient air and carbon dioxide gas. The negative buoyancy of the carbon dioxide caused it to fill the wound and form a protective layer on the internal surfaces for a range of flow rates, temperatures, and angles of patient inclination. It was observed that the flow remained attached to the surface of the model due to the action of the Coanda effect. A flow rate of 10 L/min was sufficient to maintain a warm carbon dioxide barrier for a moderately sized surgical incision for all likely angles of inclination.

  4. Wound Edge Protectors in Open Abdominal Surgery to Reduce Surgical Site Infections: A Systematic Review and Meta-Analysis

    PubMed Central

    Mihaljevic, André L.; Müller, Tara C.; Kehl, Victoria; Friess, Helmut; Kleeff, Jörg

    2015-01-01

    Importance Surgical site infections remain one of the most frequent complications following abdominal surgery and cause substantial costs, morbidity and mortality. Objective To assess the effectiveness of wound edge protectors in open abdominal surgery in reducing surgical site infections. Evidence Review A systematic literature search was conducted according to a prespecified review protocol in a variety of data-bases combined with hand-searches for randomized controlled trials on wound edge protectors in patients undergoing laparotomy. A qualitative and quantitative analysis of included trials was conducted. Findings We identified 16 randomized controlled trials including 3695 patients investigating wound edge protectors published between 1972 and 2014. Critical appraisal uncovered a number of methodological flaws, predominantly in the older trials. Wound edge protectors significantly reduced the rate of surgical site infections (risk ratio 0.65; 95%CI, 0.51–0.83; p = 0.0007; I2 = 52%). The results were robust in a number of sensitivity analyses. A similar effect size was found in the subgroup of patients undergoing colorectal surgery (risk ratio 0.65; 95%CI, 0.44–0.97; p = 0.04; I2 = 56%). Of the two common types of wound protectors double ring devices were found to exhibit a greater protective effect (risk ratio 0.29; 95%CI, 0.15–0.55) than single-ring devices (risk ratio 0.71; 95%CI, 0.54–0.92), but this might largely be due to the lower quality of available data for double-ring devices. Exploratory subgroup analyses for the degree of contamination showed a larger protective effect in contaminated cases (0.44; 95%CI, 0.28–0.67; p = 0.0002, I2 = 23%) than in clean-contaminated surgeries (0.72, 95%CI, 0.57–0.91; p = 0.005; I2 = 46%) and a strong effect on the reduction of superficial surgical site infections (risk ratio 0.45; 95%CI, 0.24–0.82; p = 0.001; I2 = 72%). Conclusions and Relevance Wound edge protectors significantly reduce the rate of

  5. Evidence-based surgical wound care on surgical wound infection.

    PubMed

    Reilly, Jaqueline

    2002-09-01

    Surgical wound infection is an important outcome indicator in the postoperative period. A 3-year prospective cohort epidemiological study of 2202 surgical patients from seven surgical wards across two hospitals was carried out using gold standard surveillance methodology. This involved following patients up as inpatients and postdischarge surveillance to 30 days by an independent observer. The results led to the development of a mathematical model for risk of clean, elective surgical wound infection. Risk of surgical wound infection was increased by smoking, higher body mass index, presence of malignancy, haematoma formation, increasing numbers of people in theatre, adherent dressing usage, and higher times to suture removal (P<0.05). The results show that this type of surveillance is an effective way of collecting accurate data on wound infection rates. It was noted that patient care practices affected the surgical wound infection rate and the surveillance was used to facilitate the adoption of evidence-based practice, through recommendations for clean surgery, to reduce the risk from extrinsic risk factors for wound infection. As a result of the implementation of this evidence-based practice there was a significant reduction (P<0.05) in the clean wound infection rate.

  6. Surgical wound infection - treatment

    MedlinePlus

    ... wounds heal, you may have a wound VAC (Vacuum Assisted Closure) dressing. It increases blood flow in ... helps with healing. This is a negative pressure (vacuum) dressing. There is a vacuum pump, a foam ...

  7. Does human immunodeficiency virus status affect early wound healing in open surgically stabilised tibial fractures?: A prospective study.

    PubMed

    Howard, N E; Phaff, M; Aird, J; Wicks, L; Rollinson, P

    2013-12-01

    We compared early post-operative rates of wound infection in HIV-positive and -negative patients presenting with open tibial fractures managed with surgical fixation. The wounds of 84 patients (85 fractures), 28 of whom were HIV positive and 56 were HIV negative, were assessed for signs of infection using the ASEPIS wound score. There were 19 women and 65 men with a mean age of 34.8 years. A total of 57 fractures (17 HIV-positive, 40 HIV-negative) treated with external fixation were also assessed using the Checkett score for pin-site infection. The remaining 28 fractures were treated with internal fixation. No significant difference in early post-operative wound infection between the two groups of patients was found (10.7% (n = 3) vs 19.6% (n = 11); relative risk (RR) 0.55 (95% confidence interval (CI) 0.17 to 1.8); p = 0.32). There was also no significant difference in pin-site infection rates (17.6% (n = 3) vs 12.5% (n = 5); RR 1.62 (95% CI 0.44 to 6.07); p = 0.47). The study does not support the hypothesis that HIV significantly increases the rate of early wound or pin-site infection in open tibial fractures. We would therefore suggest that a patient's HIV status should not alter the management of open tibial fractures in patients who have a CD4 count > 350 cells/μl. PMID:24293603

  8. Surgical wound infections after peripheral vascular surgery.

    PubMed

    Turtiainen, J; Hakala, T

    2014-12-01

    Surgical wound infection is one of the most common complications after peripheral vascular surgery. It increases the affected patient's risk for major amputation as well as mortality. Furthermore, surgical wound infection is an additional cost. Wound infections after vascular surgery are of multifactorial nature and generally result from the interplay of patient- and procedure-related factors. The use of systemic antibiotic prophylaxis may be the most important method in preventing surgical wound infections. In this review article, we report the current literature of surgical wound infections after peripheral vascular surgery.

  9. Open-label clinical trial comparing the clinical and economic effectiveness of using a polyurethane film surgical dressing with gauze surgical dressings in the care of post-operative surgical wounds.

    PubMed

    Arroyo, Ana Abejón; Casanova, Pabló López; Soriano, José Verdú; Torra I Bou, Joan-Enric

    2015-06-01

    Surgical site infection (SSI) is a common postoperative complication and can cause avoidable morbidity and excessive costs for the health service. Novel dressings, designed specifically for postoperative wounds, can help to reduce the risk of SSI and other complications such as blistering. This study compared the use of a new polyurethane film surgical dressing (Opsite Post-Op Visible, Smith & Nephew, Hull, UK) with gauze and tape in the management of postoperative wounds. The results show that the polyurethane film dressing results in a significant reduction in SSI (1·4% versus 6·6%, P = 0·006) as well as a reduction in other postoperative wound complications (e.g. blistering and erythema). Economic analysis conducted alongside the study suggests that these improved outcomes can be achieved at a lower treatment cost than gauze and tape dressings. The modest incremental cost of the polyurethane film surgical dressing is easily offset by the reduction in the costs related to treating SSI and other wound complications associated with gauze and tape dressings.

  10. Prevention of post-operative infections after surgical treatment of bite wounds

    PubMed Central

    Kramer, Axel; Assadian, Ojan; Frank, Matthias; Bender, Claudia; Hinz, Peter

    2010-01-01

    After reviewing the literature about the microbial spectrum, the risk factors of post-operative infections, and the results of surgical interventions, the following recommendation can be made for the management of bite wounds: fresh, open wounds: surgical debridement, if appropriate, then an antiseptic lavage with a fluid consisting of povidone iodine and ethanol (e.g., Betaseptic®), no antibiotics, primary wound closure nearly closed fresh wounds (e.g., cat bites): surgical debridement, if appropriate, dressing with an antiseptic-soaked compress for ~60 minutes with repeated soaking (e.g., Betaseptic®), no antibiotics older wounds after ~4 hours: surgical debridement, if appropriate, dressing with an antiseptic-soaked compress or bandage for ~60 minutes with repeated soaking (e.g., Betaseptic®), at the same time intravenous or dose-adapted oral antibiotics (Amoxicillin and/or clavulanic acid) older wounds after ~24 hours: surgical debridement, then antiseptic lavage (Betaseptic®), in case of clinically apparent infection or inflammation surgical revision with opening of wound and treatment with antibiotics according to resistogram (empirical start with Amoxicillin and/or clavulanic acid). For each kind of bite wound, the patient’s tetanus immunization status as well as the risk of exposure to rabies have to be assessed. Similarly, the possibility of other infections, such as lues (Syphilis), hepatitis B (HBV), hepatitis C (HBC), hepatitis D (HDV) and HIV, in the rare case of a human bite wound, has to be taken into account. PMID:20941334

  11. Supplemental Intravenous Crystalloid Administration Does Not Reduce the Risk of Surgical Wound Infection

    PubMed Central

    Kabon, Barbara; Akça, Ozan; Taguchi, Akiko; Nagele, Angelika; Jebadurai, Ratnaraj; Arkilic, Cem F.; Sharma, Neeru; Ahluwalia, Arundhathi; Galandiuk, Susan; Fleshman, James; Sessler, Daniel I.; Kurz, Andrea

    2005-01-01

    Wound perfusion and oxygenation are important determinants of the development of postoperative wound infections. Supplemental fluid administration significantly increases tissue oxygenation in surrogate wounds in the subcutaneous tissue of the upper arm in perioperative surgical patients. We tested the hypothesis that supplemental fluid administration during and after elective colon resections decreases the incidence of postoperative wound infections. Patients undergoing open colon resection were randomly assigned to small (n=124, 8 mL·kg-1·h-1) or large volume (n=129, 16-18 mL·kg-1·h-1) fluid management. Our major outcomes were two distinct criteria for diagnosis of surgical wound infections: 1) purulent exudate combined with a culture positive for pathogenic bacteria and 2) Center for Disease Control criteria for diagnosis of surgical wound infections. All wound infections diagnosed using either criterion by a blinded observer in the 15 days following surgery were considered in the analysis. Wound healing was evaluated with the ASEPSIS scoring system. Of the patients given small fluid administration, 14 had surgical wound infections; 11 given large fluid therapy had infections, P=0.46. ASEPSIS wound healing scores were similar in both groups: 7±16 (small volume) vs. 8±14 (large volume), P=0.70. Our results suggest that supplemental hydration in the range tested does not impact wound infection rate. PMID:16244030

  12. Meta‐analysis of negative‐pressure wound therapy for closed surgical incisions

    PubMed Central

    Birke‐Sorensen, H.; Kruse, M.; Vinter, C.; Joergensen, J. S.; Sorensen, J. A.; Mogensen, O.; Lamont, R. F.; Bille, C.

    2016-01-01

    Abstract Background Postoperative wound complications are common following surgical procedures. Negative‐pressure wound therapy (NPWT) is well recognized for the management of open wounds and has been applied recently to closed surgical incisions. The evidence base to support this intervention is limited. The aim of this study was to assess whether NPWT reduces postoperative wound complications when applied to closed surgical incisions. Methods This was a systematic review and meta‐analysis of randomized clinical trials of NPWT compared with standard postoperative dressings on closed surgical incisions. Results Ten studies met the inclusion criteria, reporting on 1311 incisions in 1089 patients. NPWT was associated with a significant reduction in wound infection (relative risk (RR) 0·54, 95 per cent c.i. 0·33 to 0·89) and seroma formation (RR 0·48, 0·27 to 0·84) compared with standard care. The reduction in wound dehiscence was not significant. The numbers needed to treat were three (seroma), 17 (dehiscence) and 25 (infection). Methodological heterogeneity across studies led to downgrading of the quality of evidence to moderate for infection and seroma, and low for dehiscence. Conclusion Compared with standard postoperative dressings, NPWT significantly reduced the rate of wound infection and seroma when applied to closed surgical wounds. Heterogeneity between the included studies means that no general recommendations can be made yet. PMID:26994715

  13. Postoperative radiation of open head and neck wounds

    SciTech Connect

    Isaacs, J.H. Jr.; Thompson, W.B.; Cassisi, N.J.; Million, R.R.

    1987-03-01

    Complication rates are lower using postoperative radiation therapy and cure rates at least compatible to preoperative radiation therapy. However, one of the concerns with postoperative radiation treatment is the possibility of delay in beginning the treatment because of an unhealed surgical wound. A delay of more than 6 weeks is detrimental. In order to study the effect of radiation therapy on incompletely healed wounds, a retrospective chart review of such cases during the period 1977 to 1984 was undertaken. One hundred and eighty-five patients had planned postoperative radiation therapy, and 13 of these began radiation therapy with an unhealed wound or fistula. Six of 10 wounds closed spontaneously, 4 required surgical closure, and 3 failed to heal. Seven patients in this study died with cancer, 2 died of other causes, 3 are alive without disease, and 1 patient remains alive with disease. We conclude that giving radiation therapy to an open wound with appropriate precaution can be done without serious complications.

  14. Antiseptic wound ventilation with a gas diffuser: a new intraoperative method to prevent surgical wound infection?

    PubMed

    Persson, M; Flock, J-I; van der Linden, J

    2003-08-01

    Postoperative wound infections are often a result of peri-operative contamination by Staphylococcus aureus. With a new insufflation device, a gas diffuser, it has become possible to establish a local micro-environment of almost 100% carbon dioxide in an open surgical wound. The device enables ventilation of the wound with an antiseptic agent, which in gaseous form can be delivered as a low uniform dose to all parts of the wound. The use of carbon dioxide (CO2) as a carrier gas eliminates possible inflammability of an antiseptic agent and helps to concentrate it to the site of interest by gravity. Using the above delivery system we have demonstrated the antibacterial effect of gaseous ethanol on S. aureus inoculated on sterile filter disks and blood agar plates, respectively. Ethanol is a very potent antiseptic agent with known properties, which makes it suitable for testing the maximal decontamination level. On filter disks, CO2 carrying vapour from a 95% ethanol solution decreased the number of colony-forming units after 5 min of exposure (P=0.04), and killed all bacteria within 10-15 min (P<0.001). In the presence of organic material, i.e. on exposed blood agar plates, the colony size decreased with exposure time, and no colonies were detected after 60 min of exposure (P<0.001). Antiseptic gas derived from 70% ethanol solution was less effective than that from 95% ethanol (P<0.001). CO2 humidified with water did not have a significant effect on number or size of the colonies. Our findings suggest that intraoperative wound antisepsis with a gas mixture of CO2 and an antiseptic agent delivered with a gas diffuser, may be a simple method to reduce the risk of postoperative wound infection.

  15. Flavimonas oryzihabitans infection of a surgical wound.

    PubMed

    Munro, R; Buckland, G; Neville, S

    1990-10-01

    An unusual case of a post operative wound infection involving Flavimonas oryzihabitans is described. This organism is rarely isolated from human sources. It can cause infections in patients having continuous ambulatory peritoneal dialysis. Our patient developed a wound infection 2 months after femoro-popliteal bypass grafting. The source of the organism was unknown.

  16. Flavimonas oryzihabitans infection of a surgical wound.

    PubMed

    Munro, R; Buckland, G; Neville, S

    1990-10-01

    An unusual case of a post operative wound infection involving Flavimonas oryzihabitans is described. This organism is rarely isolated from human sources. It can cause infections in patients having continuous ambulatory peritoneal dialysis. Our patient developed a wound infection 2 months after femoro-popliteal bypass grafting. The source of the organism was unknown. PMID:2091006

  17. Prophylactic antibiotics in surgery and surgical wound infections.

    PubMed

    Polk, H C; Christmas, A B

    2000-02-01

    Wound infection remains a considerable cause of morbidity and mortality among surgical patients, despite the relative success of prophylactic antibiotics. In modern efforts to control healthcare costs while improving the quality of patient care, we must not overlook the basic principles of wound infections and their appropriate treatment. Predisposing factors for the development of surgical wound infection include the creation of a surgical wound, the presence of bacteria, and a susceptible host. The selection of an appropriate antimicrobial drug depends on the identification of the most likely pathogens associated with a given procedure, as well as the expected antibiotic susceptibility of those pathogens. Ideally, a prophylactic antibiotic should achieve high peak tissue concentration at the site of the wound before the first incision and should be maintained until the time of closure. Currently, the administration of prophylactic antibiotics is indicated for contaminated and clean-contaminated wounds. Despite the proven effectiveness of antibiotic prophylaxis, many researchers would argue that contemporary dosing regimens should be reevaluated. The debates concerning the dosage and timing of ideal prophylactic administration are likely to continue.

  18. Peripheral Surgical Wounding and Age-Dependent Neuroinflammation in Mice

    PubMed Central

    Wang, Hui; Culley, Deborah J.; Marcantonio, Edward R.; Crosby, Gregory; Tanzi, Rudolph E.; Zhang, Yiying; Xie, Zhongcong

    2014-01-01

    Post-operative cognitive dysfunction is associated with morbidity and mortality. However, its neuropathogenesis remains largely to be determined. Neuroinflammation and accumulation of β-amyloid (Aβ) have been reported to contribute to cognitive dysfunction in humans and cognitive impairment in animals. Our recent studies have established a pre-clinical model in mice, and have found that the peripheral surgical wounding without the influence of general anesthesia induces an age-dependent Aβ accumulation and cognitive impairment in mice. We therefore set out to assess the effects of peripheral surgical wounding, in the absence of general anesthesia, on neuroinflammation in mice with different ages. Abdominal surgery under local anesthesia was established in 9 and 18 month-old mice. The levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), Iba1 positive cells (the marker of microglia activation), CD33, and cognitive function in mice were determined. The peripheral surgical wounding increased the levels of TNF-α, IL-6, and Iba1 positive cells in the hippocampus of both 9 and 18 month-old mice, and age potentiated these effects. The peripheral surgical wounding increased the levels of CD33 in the hippocampus of 18, but not 9, month-old mice. Finally, anti-inflammatory drug ibuprofen ameliorated the peripheral surgical wounding-induced cognitive impairment in 18 month-old mice. These data suggested that the peripheral surgical wounding could induce an age-dependent neuroinflammation and elevation of CD33 levels in the hippocampus of mice, which could lead to cognitive impairment in aged mice. Pending further studies, anti-inflammatory therapies may reduce the risk of postoperative cognitive dysfunction in elderly patients. PMID:24796537

  19. Case 7: highly infected post-surgical wound.

    PubMed

    von Hallern, Bernd

    2016-03-01

    Following treatment with antibiotics and surgical incision, which resulted in the release of putrid exudate, the wound was rinsed thoroughly with octenisept and covered with an antimicrobial dressing. This regimen successfully eradicated the infection, with full healing occurring in 6 weeks. PMID:26949851

  20. Assessment of surgical wounds in the home health patient: definitions and accuracy with OASIS-C.

    PubMed

    Trexler, Rhonda A

    2011-10-01

    The number of surgical patients receiving home care continues to grow as hospitals discharge patients sooner. Home health clinicians must gain knowledge of the wound healing stages and surgical wound classification to collect accurate data in the Outcome and Assessment Information Set-C (OASIS-C). This article provides the information clinicians need to accurately assess surgical wounds and implement best practices for improving surgical wounds in the home health patient.

  1. Predictors of intraoperative-acquired surgical wound infections.

    PubMed

    Garibaldi, R A; Cushing, D; Lerer, T

    1991-06-01

    During a 4-year period, we collected prospective epidemiological data and intraoperative wound cultures from 1852 surgery patients at a university-affiliated community hospital in order to identify the critical risk factors for postoperative wound infections and study the impact of perioperative antibiotics on the bacteriology of infected wounds. Stepwise logistic regression analysis revealed four risk factors that were independent of each other and highly predictive for subsequent wound infection. These were the surgical wound class, American Society of Anesthesiology (ASA) physical status grouping, duration of surgery and results of intraoperative cultures. Addition of other variables to our model did not increase the predicted probability of infection. Even though patients with positive intraoperative cultures had an increased rate of infection, this information had limited clinical utility because of its low predictive value, high false-positive rate and poor concordance with isolates from infected wounds. Patients who had received perioperative antibiotics and who developed infections were frequently infected with organisms that were resistant to the perioperative drug regimen, compared with patients who had not received antibiotics.

  2. Hip arthroscopy versus open surgical dislocation for femoroacetabular impingement

    PubMed Central

    Zhang, Dagang; Chen, Long; Wang, Guanglin

    2016-01-01

    Abstract Background: This meta-analysis aims to evaluate the efficacy and safety of hip arthroscopy versus open surgical dislocation for treating femoroacetabular impingement (FAI) through published clinical trials. Methods: We conducted a comprehensive literature search using PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials databases for relevant studies on hip arthroscopy and open surgical dislocation as treatment options for FAI. Results: Compared with open surgical dislocation, hip arthroscopy resulted in significantly higher Nonarthritic Hip Scores (NAHS) at 3- and 12-month follow-ups, a significant improvement in NAHS from preoperation to 3 months postoperation, and a significantly lower reoperation rate. Open surgical dislocation resulted in a significantly improved alpha angle by the Dunn view in patients with cam osteoplasty from preoperation to postoperation, compared with hip arthroscopy. This meta-analysis demonstrated no significant differences in the modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, or Hip Outcome Score-Sport Specific Subscale at 12 months of follow-up, or in complications (including nerve damage, wound infection, and wound dehiscence). Conclusion: Hip arthroscopy resulted in higher NAHS and lower reoperation rates, but had less improvement in alpha angle in patients with cam osteoplasty, than open surgical dislocation. PMID:27741133

  3. Responsiveness of Experimental Surgical-Wound Infections to Topical Chemotherapy

    PubMed Central

    McRipley, R. J.; Whitney, R. R.

    1976-01-01

    Topical agents freshly formulated in a cream base vehicle as well as commercial topical preparations were used to evaluate in mice the responsiveness of experimental surgical wounds infected with Staphylococcus aureus or Pseudomonas aeruginosa to chemotherapy. The responsiveness of the infections to therapy or the efficacy of a topical agent was assessed primarily by means of wound counts of the infecting organism before and after the employment of an immediate (prophylactic) or delayed (therapeutic) treatment regimen. From tests of several concentrations of an agent formulated in the vehicle, a median effective dose could be determined. In the case of the lethal P. aeruginosa infection, a median protective dose could be determined. Both infections were found to be quite susceptible to treatment with those topical agents that demonstrated good activity in vitro against the test organisms. The results of the investigation indicated that the model infections were suitable for the screening of potential topical agents in vivo. PMID:984757

  4. Negative pressure wound therapy combined with skin grafting improves surgical wound healing in the perianal area.

    PubMed

    Jia-Zi, Shi; Xiao, Zhai; Jun-Hui, Li; Chun-Yu, Xue; Hong-da, Bi

    2016-08-01

    Management of large tissue defects resulting from local wide resection of perianal is a clinical challenge for surgeons. The aim of the present study was to investigate the efficacy of negative pressure wound therapy (NPWT) following skin grafting on perianal surgical wound healing.Included in this study were 12 patients with perianal tumors who received skin grafting after perianal tumor resection between December 2012 and December 2014. A self-designed negative pressure drainage device was then applied to maintain a standard negative pressure at -150 mm Hg and removed on day 8 postoperation. The outcome was recorded immediately after NPWT and at 6-month follow-up.All skin grafts survived without infection, hematoma, and necrosis in all 12 patients. No tumor recurrence was detected during 6-month follow-up. Natural folds were observed around the anus. All patients showed normal bowel movements.NPWT following skin grafting was effective for perianal surgical wound healing and infection prevention, thus benefiting anatomical and functional recovery of the anus. PMID:27583890

  5. Negative pressure wound therapy combined with skin grafting improves surgical wound healing in the perianal area

    PubMed Central

    Jia-zi, Shi; Xiao, Zhai; Jun-hui, Li; Chun-yu, Xue; Hong-da, Bi

    2016-01-01

    Abstract Management of large tissue defects resulting from local wide resection of perianal is a clinical challenge for surgeons. The aim of the present study was to investigate the efficacy of negative pressure wound therapy (NPWT) following skin grafting on perianal surgical wound healing. Included in this study were 12 patients with perianal tumors who received skin grafting after perianal tumor resection between December 2012 and December 2014. A self-designed negative pressure drainage device was then applied to maintain a standard negative pressure at −150 mm Hg and removed on day 8 postoperation. The outcome was recorded immediately after NPWT and at 6-month follow-up. All skin grafts survived without infection, hematoma, and necrosis in all 12 patients. No tumor recurrence was detected during 6-month follow-up. Natural folds were observed around the anus. All patients showed normal bowel movements. NPWT following skin grafting was effective for perianal surgical wound healing and infection prevention, thus benefiting anatomical and functional recovery of the anus. PMID:27583890

  6. Negative pressure wound therapy combined with skin grafting improves surgical wound healing in the perianal area.

    PubMed

    Jia-Zi, Shi; Xiao, Zhai; Jun-Hui, Li; Chun-Yu, Xue; Hong-da, Bi

    2016-08-01

    Management of large tissue defects resulting from local wide resection of perianal is a clinical challenge for surgeons. The aim of the present study was to investigate the efficacy of negative pressure wound therapy (NPWT) following skin grafting on perianal surgical wound healing.Included in this study were 12 patients with perianal tumors who received skin grafting after perianal tumor resection between December 2012 and December 2014. A self-designed negative pressure drainage device was then applied to maintain a standard negative pressure at -150 mm Hg and removed on day 8 postoperation. The outcome was recorded immediately after NPWT and at 6-month follow-up.All skin grafts survived without infection, hematoma, and necrosis in all 12 patients. No tumor recurrence was detected during 6-month follow-up. Natural folds were observed around the anus. All patients showed normal bowel movements.NPWT following skin grafting was effective for perianal surgical wound healing and infection prevention, thus benefiting anatomical and functional recovery of the anus.

  7. Evaluating and managing open skin wounds: colonization versus infection.

    PubMed

    Wysocki, Annette B

    2002-08-01

    Open skin wounds are colonized with bacteria, and optimal wound care is required to prevent progression to infection. Intact skin normally provides protection from external environmental assaults. Disruption of the skin or tissue creating an open skin wound can result in infection, dehydration, hypothermia, scarring, compromised immunity, and changes in body image. Biofilms and bacterial genomics are areas of intense scientific investigation in the face of the emerging threat of bacterial resistance. Optimal wound care to prevent progression from colonization to infection remains the foundation of good clinical practice. On the basis of wound conditions, cleansing, debridement, measures to increase oxygenation and perfusion, adequate nutrition, and appropriate use of topical agents and antibiotics, when indicated, are the keys to managing open skin wounds. This article provides a targeted review of normal skin flora, wound healing, prevention of skin infection, colonization versus infection, biofilms, genomics and infectious disease, and management of open skin wounds.

  8. Wound botulism after traumatic open fracture in Italy.

    PubMed

    De Rosa, Francesco Giuseppe; Stella, Maria Laura; Astegiano, Sara; Corcione, Silvia; Motta, Ilaria; Decastelli, Lucia; Di Perri, Giovanni

    2015-09-01

    Seventeen days after a traumatic open fracture, a Clostridium botulinum wound infection was diagnosed, with self-limiting symptoms. This is the first report of wound botulism in Italy and the authors discuss the possible role of aerosolized contamination of the wound prior to hospital admission. PMID:26397301

  9. The quality of measurement of surgical wound infection as the basis for monitoring: a systematic review.

    PubMed

    Bruce, J; Russell, E M; Mollison, J; Krukowski, Z H

    2001-10-01

    Comparison of postoperative surgical wound infection rates between institutions and over time is only valid if standard, valid and reliable definitions are used. The aim of this review was to assess evidence of validity and reliability of the definition and measurement of surgical wound infection. A systematic review was undertaken of prospective studies of surgical wound infection published over a seven-year period; 1993-1999. The information extracted from individual studies included: definition of surgical wound infection; details of wound assessment scale, scoring or grading scale systems; and evidence of assessment of validity, reliability and feasibility of identified definitions and grading systems. Two independent reviewers appraised 112 prospective studies, 90 of which were eligible for inclusion; eight studies assessed validity and/or reliability. Forty-one different definitions of surgical wound infection were identified, five of which were 'standard' definitions proposed by multi-disciplinary groups. Presence of pus was the most frequently used single component of any definition; the CDC definitions of 1988 and 1992 were the most widely implemented standard definitions; and the ASEPSIS wound assessment scale was the most frequently used quantitative grading tool. Only two formal validations of a definition were found, and six studies of reliability. This review highlights the extent of variation in definition of surgical wound infection used in clinical practice, and the need for validation of both content and organization of a surveillance system. However, realistically, there will have to be a balance between the quality of the measurement and the practicality of surveillance.

  10. Distant Healing Of Surgical Wounds: An Exploratory Study

    PubMed Central

    Schlitz, Marilyn; Hopf, Harriet W.; Eskenazi, Loren; Vieten, Cassandra; Radin, Dean

    2012-01-01

    Distant healing intention (DHI) is one of the most common complementary and alternative medicine (CAM) healing modalities, but clinical trials to date have provided ambivalent support for its efficacy. One possible reason is that DHI effects may involve variables that are sensitive to unknown, uncontrolled, or uncontrollable factors. To examine two of those potential variables – expectation and belief – the effects of DHI were explored on objective and psychosocial measures associated with surgical wounds in 72 women undergoing plastic surgery. Participants were randomly assigned to one of three groups: blinded and receiving DHI (DH), blinded and not receiving DHI (Control), and knowing that they were receiving DHI (Expectancy). Outcome measures included collagen deposition in a surrogate wound and several self-report measures. DHI was provided by experienced distant healers. No differences in the main measures were observed across the three groups. Participants’ prior belief in the efficacy of DHI was negatively correlated with the status of their mental health at the end of the study (p = 0.04, two-tailed), and healers’ perceptions of the quality of their subjective “contact” with the participants were negatively correlated both with change in mood (p = 0.001) and with collagen deposition (p = 0.04). A post-hoc analysis found that among participants assigned to receive DHI under blinded conditions, those undergoing reconstructive surgery after breast cancer treatment reported significantly better change in mood than those who were undergoing purely elective cosmetic surgery (p = 0.004). If future DHI experiments confirm the post-hoc observations, then some of the ambiguity observed in earlier DHI studies may be attributable to interactions among participants’ and healers’ beliefs, their expectations, and their motivations. PMID:22742672

  11. [Treatment of surgical wound dehiscence by topical negative pressure therapy: Clinical case].

    PubMed

    Fresno-García, Carmen; Alconero-Camarero, Ana Rosa; Fernández-Carro, Belén

    2015-01-01

    Topical negative pressure therapy is an alternative treatment for complex wounds that consists of the direct application of sub-atmospheric pressure, obtaining a number of effects that are beneficial for tissues, promoting the healing of both acute and chronic wounds and complementing surgical procedures. We report the case of a 75 year old man diagnosed with surgical wound dehiscence after a femorotibial bypass graft, who was hospitalized again with the aim to perform the implantation of a topical negative pressure therapy in the infected wound. We designed a care plan for this patient following the steps of the scientific method and basing ourselves on the NANDA, NIC, and NOC taxonomies.

  12. Post-surgical wound management of pilonidal cysts with a haemoglobin spray: a case series.

    PubMed

    Mustafi, N; Engels, P

    2016-04-01

    Painful acute cysts in the natal cleft or lower back, known as pilonidal sinus disease, are a severe burden to many younger patients. Although surgical intervention is the preferred first line treatment, postsurgical wound healing disturbances are frequently reported due to infection or other complications. Different treatment options of pilonidal cysts have been discussed in the literature, however, no standardised guideline for the postsurgical wound treatment is available. After surgery, a common recommended treatment to patients is rinsing the wound with clean water and dressing with a sterile compress. We present a case series of seven patients with wounds healing by secondary intention after surgical intervention of a pilonidal cyst. The average age of the patients was 40 years old. Of the seven patients, three had developed a wound healing disturbance, one wound had started to develop a fibrin coating and three were in a good condition. The applied wound care regimens comprised appropriate mechanical or autolytic debridement, rinsing with an antimicrobial solution, haemoglobin application, and primary and secondary dressings. In all seven cases a complete wound closure was achieved within an average of 76 days with six out of seven wounds achieving wound closure within 23-98 days. Aesthetic appearance was deemed excellent in five out of seven cases excellent and acceptable in one. Treatment of one case with a sustained healing disturbance did result in wound closure but with a poor aesthetic outcome and an extensive cicatrisation of the new tissue. Based on these results we recommend that to avoid healing disturbances of wounds healing by secondary intention after surgical pilonidal cyst intervention, an adequate wound care regime comprising appropriate wound debridement, rinsing, topically applied haemoglobin and adequate wound dressing is recommendable as early as possible after surgery. PMID:27064368

  13. Post-surgical wound management of pilonidal cysts with a haemoglobin spray: a case series.

    PubMed

    Mustafi, N; Engels, P

    2016-04-01

    Painful acute cysts in the natal cleft or lower back, known as pilonidal sinus disease, are a severe burden to many younger patients. Although surgical intervention is the preferred first line treatment, postsurgical wound healing disturbances are frequently reported due to infection or other complications. Different treatment options of pilonidal cysts have been discussed in the literature, however, no standardised guideline for the postsurgical wound treatment is available. After surgery, a common recommended treatment to patients is rinsing the wound with clean water and dressing with a sterile compress. We present a case series of seven patients with wounds healing by secondary intention after surgical intervention of a pilonidal cyst. The average age of the patients was 40 years old. Of the seven patients, three had developed a wound healing disturbance, one wound had started to develop a fibrin coating and three were in a good condition. The applied wound care regimens comprised appropriate mechanical or autolytic debridement, rinsing with an antimicrobial solution, haemoglobin application, and primary and secondary dressings. In all seven cases a complete wound closure was achieved within an average of 76 days with six out of seven wounds achieving wound closure within 23-98 days. Aesthetic appearance was deemed excellent in five out of seven cases excellent and acceptable in one. Treatment of one case with a sustained healing disturbance did result in wound closure but with a poor aesthetic outcome and an extensive cicatrisation of the new tissue. Based on these results we recommend that to avoid healing disturbances of wounds healing by secondary intention after surgical pilonidal cyst intervention, an adequate wound care regime comprising appropriate wound debridement, rinsing, topically applied haemoglobin and adequate wound dressing is recommendable as early as possible after surgery.

  14. Surgical management of civilian gunshot wounds to the head.

    PubMed

    Bizhan, Aarabi; Mossop, Corey; Aarabi, Judith Ann

    2015-01-01

    Each year close to 20000 Americans are involved in gunshot wounds to the head (GSWH). Over 90% of the victims of GSWH eventually fail to survive and only a meager 5% of the patients have a chance to continue with a useful life. One of the fundamental jobs of providers is to realize who the best candidate for the best possible management is. Recent evidence indicates that a good Glasgow Coma Scale (GCS) score at the time of admission puts such patients at high priority for management. Lack of abnormal pupillary response to light, trajectory of slug away for central gray, and visibility of basal cisterns upgrade the need for utmost care for such a victim. Surgical management is careful attention to involvement of air sinuses and repair of base dura. Patients with diffuse injury should have intraventricular intracranial pressure (ICP) monitoring and if needed a timely decompressive craniectomy. Since close to 2% of patients with penetrating brain injury may harbor a vascular injury, subjects with injuries close to the Sylvian fissure and those with the fragment crossing two dural compartments should have computed tomography angiography and if needed digital subtraction angiography to rule out traumatic intracranial aneurysms. In case of a positive study, these patients should have endovascular management of their vascular injuries in order to prevent catastrophic intracerebral hematomas and permanent deficit. Although supported by class III data, subjects of GSWH need to be on broad spectrum antibiotics for a period of 3-5 days. If cerebrospinal fluid (CSF) fistulas are observed at any time during the patient's hospital course, they should be taken very seriously and appropriate management is needed to prevent deep intracranial infections.

  15. Nonlinear finite element simulations of injuries with free boundaries: application to surgical wounds.

    PubMed

    Valero, C; Javierre, E; García-Aznar, J M; Gómez-Benito, M J

    2014-06-01

    Wound healing is a process driven by biochemical and mechanical variables in which a new tissue is synthesised to recover original tissue functionality. Wound morphology plays a crucial role in this process, as the skin behaviour is not uniform along different directions. In this work, we simulate the contraction of surgical wounds, which can be characterised as elongated and deep wounds. Because of the regularity of this morphology, we approximate the evolution of the wound through its cross section, adopting a plane strain hypothesis. This simplification reduces the complexity of the computational problem; while allows for a thorough analysis of the role of wound depth in the healing process, an aspect of medical and computational relevance that has not yet been addressed. To reproduce wound contraction, we consider the role of fibroblasts, myofibroblasts, collagen and a generic growth factor. The contraction phenomenon is driven by cell-generated forces. We postulate that these forces are adjusted to the mechanical environment of the tissue where cells are embedded through a mechanosensing and mechanotransduction mechanism. To solve the nonlinear problem, we use the finite element method (FEM) and an updated Lagrangian approach to represent the change in the geometry. To elucidate the role of wound depth and width on the contraction pattern and evolution of the involved species, we analyse different wound geometries with the same wound area. We find that deeper wounds contract less and reach a maximum contraction rate earlier than superficial wounds.

  16. [Problems of organization of surgical care to the wounded in a modern armed conflict: surgical care to the walking wounded in armed conflicts (Report 2)].

    PubMed

    Samokhvalov, I M; Kotenko, P K; Severin, V V

    2013-01-01

    There are two triage groups of the walking wounded in a medical company of a brigade/special-purpose medical team: those returning to fighting role and those who have to be evacuated to level 3 echelon of care. The main purposes of surgical care of the walking wounded in the 3rd echelon of care are the following: diagnosis of injury pattern ruling out severe damages and separation of the independent category of the walking wounded. There is medical evacuation of the walking wounded from the 3rd echelon to the 4th echelon deployed in a combat zone. The walking wounded who needs less than 30 days of staying in hospital are evacuated to the garrison military hospitals and medical treatment facilities subordinated to a district military hospital. The wounded with the prolonged period of hospitalization (more than 30 days) are evacuated toward the district military hospital. Treatment of the walking wounded should be accomplished in the military district where the armed conflict goes on.

  17. Open core control software for surgical robots

    PubMed Central

    Kozuka, Hiroaki; Kim, Hyung Wook; Takesue, Naoyuki; Vladimirov, B.; Sakaguchi, Masamichi; Tokuda, Junichi; Hata, Nobuhiko; Chinzei, Kiyoyuki; Fujimoto, Hideo

    2010-01-01

    Object In these days, patients and doctors in operation room are surrounded by many medical devices as resulting from recent advancement of medical technology. However, these cutting-edge medical devices are working independently and not collaborating with each other, even though the collaborations between these devices such as navigation systems and medical imaging devices are becoming very important for accomplishing complex surgical tasks (such as a tumor removal procedure while checking the tumor location in neurosurgery). On the other hand, several surgical robots have been commercialized, and are becoming common. However, these surgical robots are not open for collaborations with external medical devices in these days. A cutting-edge “intelligent surgical robot” will be possible in collaborating with surgical robots, various kinds of sensors, navigation system and so on. On the other hand, most of the academic software developments for surgical robots are “home-made” in their research institutions and not open to the public. Therefore, open source control software for surgical robots can be beneficial in this field. From these perspectives, we developed Open Core Control software for surgical robots to overcome these challenges. Materials and methods In general, control softwares have hardware dependencies based on actuators, sensors and various kinds of internal devices. Therefore, these control softwares cannot be used on different types of robots without modifications. However, the structure of the Open Core Control software can be reused for various types of robots by abstracting hardware dependent parts. In addition, network connectivity is crucial for collaboration between advanced medical devices. The OpenIGTLink is adopted in Interface class which plays a role to communicate with external medical devices. At the same time, it is essential to maintain the stable operation within the asynchronous data transactions through network. In the Open

  18. Antimicrobial resistance and molecular typing of pseudomonas aeruginosa isolated from surgical wounds in Lagos, Nigeria.

    PubMed

    Smith, Stella; Ganiyu, Olaniyi; John, Rachael; Fowora, Muinah; Akinsinde, Kehinde; Odeigah, Peter

    2012-01-01

    The aim of the study was to determine the resistance patterns of Pseudomonas aeruginosa isolates recovered from patients with surgical wounds in hospitals and also to investigate their epidemiological relatedness using molecular typing techniques. Twenty Pseudomonas sp. isolated from surgical wounds were subjected to antibiotic susceptibility testing by disk diffusion, plasmid profile, SDS-PAGE and PCR using the parC, gyr A gene and RAPD using the 1254 primer. The isolates showed resistance to 12 different antibiotics with six being 100% resistant. Plasmids were detected in 16 (80%) of the isolates. The RAPD-PCR using the primer 1254, SDS-PAGE classified the 20 Pseudomonas spp. into 5 and 6 types respectively. Pseudomona aeruginosa strains isolated from surgical wounds were generally resistant to a broad range of antibiotics and this is rather worrisome. The typing techniques classified the 20 isolates into 5 and 6 groups. PMID:22837123

  19. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System.

    PubMed

    Culver, D H; Horan, T C; Gaynes, R P; Martone, W J; Jarvis, W R; Emori, T G; Banerjee, S N; Edwards, J R; Tolson, J S; Henderson, T S

    1991-09-16

    To perform a valid comparison of rates among surgeons, among hospitals, or across time, surgical wound infection (SWI) rates must account for the variation in patients' underlying severity of illness and other important risk factors. From January 1987 through December 1990, 44 National Nosocomial Infections Surveillance System hospitals reported data collected under the detailed option of the surgical patient surveillance component protocol, which includes definitions of eligible patients, operations, and nosocomial infections. Pooled mean SWI rates (number of infections per 100 operations) within each of the categories of the traditional wound classification system were 2.1, 3.3, 6.4, and 7.1, respectively. A risk index was developed to predict a surgical patient's risk of acquiring an SWI. The risk index score, ranging from 0 to 3, is the number of risk factors present among the following: (1) a patient with an American Society of Anesthesiologists preoperative assessment score of 3, 4, or 5, (2) an operation classified as contaminated or dirty-infected, and (3) an operation lasting over T hours, where T depends upon the operative procedure being performed. The SWI rates for patients with scores of 0, 1, 2, and 3 were 1.5, 2.9, 6.8, and 13.0, respectively. The risk index is a significantly better predictor of SWI risk than the traditional wound classification system and performs well across a broad range of operative procedures.

  20. Wound fluids from human pressure ulcers contain elevated matrix metalloproteinase levels and activity compared to surgical wound fluids.

    PubMed

    Yager, D R; Zhang, L Y; Liang, H X; Diegelmann, R F; Cohen, I K

    1996-11-01

    Fluid from acute surgical wounds and from nonhealing pressure ulcers was examined for the presence of several matrix metalloproteinases. Gelatin zymography demonstrated the presence of two major gelatinases with apparent molecular masses of 72 kDa and 92 kDa and two minor gelatinases with apparent mobilities of 68 kDa and 125 kDa. Antigen-specific sera identified the 72-kDa protein as matrix melloproteinase-2. The same sera also reacted with the 68-kDa protein, which is consistent with it being an activated form of matrix metalloproteinase-2. Antigen-specific sera identified the 92-kDa and 125-kDa proteins as matrix metalloproteinase-9. Levels of matrix metalloproteinase-2 and matrix metalloproteinase-9 were elevated more than 10-fold and 25-fold, respectively, in fluids from pressure ulcers compared with fluids from healing wounds. Examination of total potential and actual collagenolytic activity revealed that fluid from pressure ulcers contained significantly greater levels of both total and active collagenase compared with that of acute surgical wounds. In addition, an enzyme-linked immunosorbent assay demonstrated that fluids from pressure ulcers contained significantly more collagenase complexed with the inhibitor, tissue inhibitor of metalloproteinases. Together, these observations suggest that an imbalance exists between levels of matrix metalloproteinases and their inhibitors in the fluids of pressure ulcers and that this is primarily the result of elevated levels of the matrix metalloproteinases. The presence of excessive levels of activated forms of matrix-degrading enzymes at the wound surface of pressure ulcers may impede the healing of these wounds and may be relevant to the development of new rationales for treatment.

  1. [Emergency open surgical treatment of extravasations of cytostatic agents in the upper extremity].

    PubMed

    Telisselis, P; Heers, G; Plock, B; Baier, C; Neugebauer, R; Füchtmeier, B

    2010-08-01

    Extravasations of cytostatic agents can create necrosis of soft tissues in the hand and forearm. The early emergency subcutaneous "wash-out" with liposuction is the treatment of choice to avoid the development of soft-tissue defects. The objective of this study was to evaluate the open surgical debridement as a possible alternative method since the liposuction device is not commonly available in every hospital. In our study 10 patients were treated for extravasations of cytostatic drugs with a high potential for necrosis by emergency open debridement. All patients were evaluated prospectively by photography and clinical examination. 9 patients out of ten had a primary wound healing, one displayed a wound dehiscence with pre-existing MRSA infection. Another patient developed a seroma postoperatively which was treated by puncture. The mean functional outcome was good. The Eemergency open surgical treatment is a simple, in every hospital suitable therapy to prevent soft-tissue necrosis after extravasation of cytostatic drugs.

  2. Barrier materials. Their influence on surgical wound infections.

    PubMed

    Belkin, N L

    1992-06-01

    Aseptic technique can best be described as an aggregation of reasonable practices performed in the surgical suite as part of the overall methodology in controlling or minimizing the possibility of infection. The key words in this definition are aggregation and reasonable. The real question is whether the surgical nursing community is prepared to reconsider and reassess the importance of a theoretical and reasonable, but not proven, practice that it has been advocating for almost two decades. From the evidence, it appears that a departure from the universal application of the barrier principle would not compromise the quality of care rendered to the surgical patient while at the same time prove to be economically and environmentally advantageous.

  3. A comparison of obsidian and surgical steel scalpel wound healing in rats.

    PubMed

    Disa, J J; Vossoughi, J; Goldberg, N H

    1993-10-01

    There are several anecdotal clinical articles claiming wound healing and scar superiority using obsidian (volcanic glass) scalpels. In order to determine if skin incisions made with obsidian were superior to those made with standard surgical steel, wound tensile strength, scar width, and histology were assessed in 40 adult male Sprague-Dawley rats. Each rat received two parallel 8-cm dorsal skin incisions, one with an obsidian scalpel and the other with a surgical steel scalpel (no. 15 blade). Data were analyzed by ANOVA. Tensile strength of the two wound types was not different at 7, 14, 21, and 42 days. Scar width, however, was significantly less in the obsidian wounds at 7, 10, and 14 days (p < 0.005). At 21 days, scar width was not different in the two groups. At 42 days, all wounds were barely detectable, thus precluding scar width analysis. A blinded histologic review suggested that obsidian wounds contained fewer inflammatory cells and less granulation tissue at 7 days. PMID:8415970

  4. A comparison of obsidian and surgical steel scalpel wound healing in rats.

    PubMed

    Disa, J J; Vossoughi, J; Goldberg, N H

    1993-10-01

    There are several anecdotal clinical articles claiming wound healing and scar superiority using obsidian (volcanic glass) scalpels. In order to determine if skin incisions made with obsidian were superior to those made with standard surgical steel, wound tensile strength, scar width, and histology were assessed in 40 adult male Sprague-Dawley rats. Each rat received two parallel 8-cm dorsal skin incisions, one with an obsidian scalpel and the other with a surgical steel scalpel (no. 15 blade). Data were analyzed by ANOVA. Tensile strength of the two wound types was not different at 7, 14, 21, and 42 days. Scar width, however, was significantly less in the obsidian wounds at 7, 10, and 14 days (p < 0.005). At 21 days, scar width was not different in the two groups. At 42 days, all wounds were barely detectable, thus precluding scar width analysis. A blinded histologic review suggested that obsidian wounds contained fewer inflammatory cells and less granulation tissue at 7 days.

  5. [Early specialized surgical care for gunshot wounds of major vessels in Donbas].

    PubMed

    Rozin, Yu A; Ivanenko, A A

    2016-01-01

    The authors share their experience gained in rendering early specialized surgical care during combat operations in Donbas, having operated on a total of 139 wounded with lesions of large vessels, of these, 21 (15.1%) presenting with concomitant lesions of vessels. Reconstructive operations were carried out in 122 (87.8%) wounded, ligating operations - in 12 (8.6%), and primary amputations - in 5 (3.6%). Two (1.4%) patients died. Blood flow was restored in 117 (84.2%) patients, with six amputations performed after primary operations. The limb was saved in 116 (83.4%) wounded. Peculiarities of a vascular injury in Donbas comprise a large proportion of severe concomitant vascular wounds and lack of intermediate stages of evacuation. The prognosis of life and limb salvage largely depends on correctly chosen method of temporary arrest of bleeding at first stages of medical evacuation and shortening the terms of rendering first specialized surgical care. The variant of operation (reconstruction, ligation or primary amputation) in severe concomitant vascular wounds should be determined proceeding from the degree of ischaemia and severity of the condition of the wounded person, assessed by means of the Military Surgery - Mangled Extremity Severity Score.

  6. Combined treatment with chlorhexidine and 0·9% saline in a newborn infant with an infected surgical wound.

    PubMed

    Tekgündüz, Kadir Şerafettin; Kepenekli, Eda; Demirelli, Yaşar; Caner, İbrahim; Kara, Mustafa

    2016-10-01

    Newborns are more susceptible to infection; this makes proper wound care extremely important in them. Unfortunately, in spite of successful surgery, patients can die as a result of wound area infections. Herein, we report a case in which a combined therapy of chlorhexidine (a disinfectant) and saline (a cleansing agent used in wound care) was used effectively to treat the wound in a newborn infant with an antibiotic-resistant, Gram-negative, bacteria-related surgical site infection.

  7. [Peculiarities of delivery of specific surgical assistance to wounded during counter-terrorist and peacemaking operations on North Caucasia].

    PubMed

    Samokhvalov, I M; Badalov, V I; Goncharov, A V; Alisov, P G; Severin, V G; Panov, V V; Kolos, P G

    2012-07-01

    The organization of surgical care for the wounded in various local wars and armed conflict has its own characteristics, the study of which is necessary to optimize the planning of medical evacuation support of troops. It is based on the concept on an early specialized surgical care. The paper discusses the problematic issues of medical care to the wounded in past peacekeeping operations, and analyze features of specialized surgical care.

  8. [Peculiarities of delivery of specific surgical assistance to wounded during counter-terrorist and peacemaking operations on North Caucasia].

    PubMed

    Samokhvalov, I M; Badalov, V I; Goncharov, A V; Alisov, P G; Severin, V G; Panov, V V; Kolos, P G

    2012-07-01

    The organization of surgical care for the wounded in various local wars and armed conflict has its own characteristics, the study of which is necessary to optimize the planning of medical evacuation support of troops. It is based on the concept on an early specialized surgical care. The paper discusses the problematic issues of medical care to the wounded in past peacekeeping operations, and analyze features of specialized surgical care. PMID:23038953

  9. The utility of the surgical safety checklist for wound patients.

    PubMed

    Myers, Joseph W; Gilmore, Brent A; Powers, Kelly A; Kim, Paul J; Attinger, Christopher E

    2016-10-01

    The purpose of this study was to determine the frequency of changes in patient care resulting from the use of a surgical safety checklist. Data were retrospectively obtained from 233 patients. The number and types of changes made to the patients' intra-operative management, based on the use of the checklist, were recorded. The number of patients whose management was modified as a result of the checklist was 113 (48%) out of 233. The total number of changes made was 132, and 18 patients had more than one modification made to their care plan. Further stratification was identified: among the 132 changes made, antibiotics were held or administered in 73 (55%), changes related to anaemia involving type and screen or transfusion occurred in 27 (20%), modifications made regarding anti-coagulation occurred in 8 (7%), beta-blockers were held in 2 (2%), an allergy was identified in 7 (5%), modifications made to the surgical procedure were 3 (2%) and a category labelled 'other' encompassed 9 (7%) changes. The surgical safety checklist is a standardised form of team communication that leads to modifications of the patient care plan in a large percentage of cases. The ever-increasing complexity of medicine means that patients are at greater risk of oversight and harm without the use of a checklist. PMID:25585543

  10. [Hyperbaric oxygen therapy as adjuvant in stump surgical wound healing].

    PubMed

    Pani, Ugo

    2015-01-01

    Oxygen is an essential gas. Oxygen is also a biological medicine. Hyperbaric oxygen therapy is a treatment which is based on the respiration of pure oxygen in a particular pressurised environment (hyperbaric chamber). The pressure allows the diffusion of oxygen into the blood at a concentration which is ten/fifteen/twenty times the normal level. The increase in oxygen in bodily liquids stimulates the synthesis of a gas, nitric oxide (NO), which has a powerful anti-inflammatory effect and promotes the formation of new blood vessels (also through the employment of stem cells) thus accelerating the healing of wounds. Hyperbaric oxygen therapy reactivates metabolic processes which have stopped and is able to help the recovery and obvious improvement of patients suffering from several serious illnesses. Hyperbaric oxygen therapy is a medicine, and as such requires careful dosage, monitoring of its results, and prevention of possible side effects.

  11. [Rendering surgical care for the wounded presenting with injuries to limb vessels].

    PubMed

    Efimenko, N A; Kokhan, E P; Galik, N I

    2008-01-01

    The proffered paper provides the information about rendering surgical care for the wounded presenting with vascular injuries inflicted and sustained during wars Russia was engaged in, to be followed by a detailed description of the haemorrhage-arresting methods and techniques used in N. I. Pirogov's time, during World War I, the Great Patriotic War, as well as in local military conflicts and combat operations. Also depicted herein is the role surgeons of Russia have played in the development of vascular surgery, and, finally, due coverage is given to the statistical data concerning the methods of rendering care for those having suffered firearm wounds and injuries involving vascular lesions.

  12. Contact Thermography in a study of primary healing of surgical wounds.

    PubMed

    Horzic, M; Bunoza, D; Maric, K

    1996-01-01

    Occurrences in the wound until complete healing are manifested in different ways, one of which is temperature change. The aim of this study was establish if there is regularity in temperature changes in wounds healing by primary intention. Thirty examinees (27 female, 3 male) admitted for gallstone surgery were included. Temperature was measured for eight post-operative days at a fixed time each day and in the same room using the semi-quantitative, contact method of liquid crystal strips. The findings demonstrated that there were few differences among the collective thermal images of individual examines for any given post-operative day. During the first 3 post-operative days, the temperatures rose, with few differences between the temperatures of the wounds and their wider surroundings. From day 4 through 8, the temperatures of the wounds and surroundings fell gradually. Stitches were removed on day 7, and on day 8 only the narrow zones of the incision sites were warmer than the surroundings. The findings suggest that there is regularity in the course of temperature of the surgical wound in primary healing. The clinical implications are that the persistence of a wider zone of increased temperature after day 4 predicts the possibility of wound infection and disturbed healing.

  13. [Rendering surgical care to wounded with neck wounds in an armed conflict].

    PubMed

    Samokhvalov, I M; Zavrazhnov, A A; Fakhrutdinov, A M; Sychev, M I

    2001-10-01

    The results of rendering of the medical care (the first aid, qualified and specialized) obtained in 172 servicemen with neck injuries who stayed in Republic of Chechnya during the period from 09.08.1999 to 28.07.2000 were analyzed. Basing on the results of analysis and experience of casualties' treatment the authors discuss the problems of sequence and volume of surgical care in this group of casualties with reference to available medical evacuation system, surgical tactics at the stage of specialized care. They also consider the peculiarities of operative treatment of the casualties with neck injuries.

  14. Coblation technology for surgical wound debridement: principle, experimental data, and technical data.

    PubMed

    Trial, Chloé; Brancati, Antonio; Marnet, Olivier; Téot, Luc

    2012-12-01

    Debridement is required to prepare the wound bed, essentially in removing undesired tissues observed both in acute wound after burns or trauma and in chronic wounds such as pressure ulcers, leg ulcers, and diabetic foot ulcers. Surgical debridement has been described as one of the most effective methods but can be contraindicated in the elderly, arteriopathic context, or patients under effective anticoagulation. Recently described debridement technologies are based on application of important mechanical severing forces over the wound surface using high-power hydrojets. High water flux acts as a vector for separating necrotic and sloughy tissues from the wound bed and aspirates them out of the wound immediately. Electrical powered techniques and lasers were also scarcely described. The Coblation debridement technology presented here is based on the local induction of a focused plasma field chemically deleting undesired tissues. This technique is a modification of conventional electrosurgical devices, developed in 1928 where tissue excision and coagulation of tissues were observed. Principles of plasma-mediated debridement are based on a bipolar radiofrequency energizing the molecules, thus creating a plasma field. This glow discharge plasma produces chemically active radical species from dissociation of water, breaking molecular bonds, and causing tissue dissolution. The thermal effects are a by-product, which can be modulated by modifying the electrode construction, limiting the local temperature to less than 50°C in order not to induce wound bed renecrosis. The authors describe here the principle, the first technical adaptation for wound debridement, and the potential clinical interest of the Coblation technology.

  15. Coblation technology for surgical wound debridement: principle, experimental data, and technical data.

    PubMed

    Trial, Chloé; Brancati, Antonio; Marnet, Olivier; Téot, Luc

    2012-12-01

    Debridement is required to prepare the wound bed, essentially in removing undesired tissues observed both in acute wound after burns or trauma and in chronic wounds such as pressure ulcers, leg ulcers, and diabetic foot ulcers. Surgical debridement has been described as one of the most effective methods but can be contraindicated in the elderly, arteriopathic context, or patients under effective anticoagulation. Recently described debridement technologies are based on application of important mechanical severing forces over the wound surface using high-power hydrojets. High water flux acts as a vector for separating necrotic and sloughy tissues from the wound bed and aspirates them out of the wound immediately. Electrical powered techniques and lasers were also scarcely described. The Coblation debridement technology presented here is based on the local induction of a focused plasma field chemically deleting undesired tissues. This technique is a modification of conventional electrosurgical devices, developed in 1928 where tissue excision and coagulation of tissues were observed. Principles of plasma-mediated debridement are based on a bipolar radiofrequency energizing the molecules, thus creating a plasma field. This glow discharge plasma produces chemically active radical species from dissociation of water, breaking molecular bonds, and causing tissue dissolution. The thermal effects are a by-product, which can be modulated by modifying the electrode construction, limiting the local temperature to less than 50°C in order not to induce wound bed renecrosis. The authors describe here the principle, the first technical adaptation for wound debridement, and the potential clinical interest of the Coblation technology. PMID:23222161

  16. Perioperative hypothermia and incidence of surgical wound infection: a bibliographic study

    PubMed Central

    da Silva, Aline Batista; Peniche, Aparecida de Cassia Giani

    2014-01-01

    The purpose of this review article was to understand and analyze the scientific production related to the occurrence of perioperative hypothermia and the incidence of infection on the surgical site. For this purpose, a search was conducted in the databases LILACS, MEDLINE, PubMed, CINAHL and Cochrane, using the health science descriptors DECS, from 2004 to 2009. A total of 91 articles were found. After eliminating duplicate items and using selection criteria for inclusion, six manuscripts remained for analysis. The studies were classified as retrospective, prospective, case studies, and clinical trials. After analysis, the majority of studies showed that hypothermia must be prevented during the perioperative period to reduce complications in the healing process of the surgical incision. Therefore, unadverted hypothermia directly influences in surgical site healing, increasing the incidence of infection in the surgical wound. PMID:25628208

  17. Prevalence of biofilms on surgical suture segments in wounds of dogs, cats, and horses.

    PubMed

    König, L; Klopfleisch, R; Kershaw, O; Gruber, A D

    2015-03-01

    The formation of biofilms on surgical implants is thought to play a major role in chronic infection and wound-healing disorders and has been rarely described in veterinary medicine. Due to poor and unreliable results from bacterial culturing, histology may be an economic tool for the detection of biofilms. In this study, the prevalence of biofilms on surgical suture materials and swabs with chronic wound-healing complications in dogs, cats, and horses was assessed by histologic examination using hematoxylin and eosin, Gram, and Giemsa stains, as well as periodic acid-Schiff reaction. Of the 91 tissue samples with intralesional suture material or swab residues associated with inflammation, only 2 contained bacterial colonies arranged in an extracellular polymeric matrix consistent with a biofilm. The results of this study suggest that biofilms on suture material may occur in veterinary medicine.

  18. Suction-irrigation drainage: an underestimated therapeutic option for surgical treatment of deep sternal wound infections†

    PubMed Central

    Deschka, Heinz; Erler, Stefan; El-Ayoubi, Lemir; Vogel, Cordula; Vöhringer, Luise; Wimmer-Greinecker, Gerhard

    2013-01-01

    OBJECTIVES Deep sternal wound infections are significant and severe complications following cardiac surgery and substantially influence perioperative morbidity and mortality. We present the experience of our department using two different surgical treatments over a three-year period. METHODS Between January 2009 and December 2011, a total of 3274 cardiac procedures with complete median sternotomy were performed in our department. In 94 patients (3%), a deep sternal wound infection occurred, including sternal instability with consecutive surgical treatment. The patients either received wound debridement with sternum refixation and suction-irrigation drainage (SID; n = 72) or sternum refixation only (RF; n = 22) if there was sternal instability with limited signs of infection. SID was routinely installed for 7 days: the irrigation solution contained neomycin. In all cases, swabs were taken and analysed. The different methods were evaluated in respect of their clinical outcomes. RESULTS The success rate—defined as single, uncomplicated procedure—of the SID treatment was 74%, compared with 59% of the isolated sternum refixation. Complications included continuous infection, recurrence of sternal instability and wound necrosis. Eighty-eight percent of the swabs in the SID group were positive, compared with 32% in the sternal refixation only group. The dominating pathogenic germs were coagulase-negative staphylococci and staphylococcus aureus. Mortality was 10% for the SID group and 5% for the RF group. CONCLUSIONS Contrary to accepted opinion, the suction-irrigation drainage is an appropriate therapy for deep sternal wound infections. Nevertheless, deep sternal wound infections after cardiac surgery remain severe complications and are related to increased morbidity and mortality. PMID:23529753

  19. Factors associated with the healing of complex surgical wounds in the breast and abdomen: retrospective cohort study

    PubMed Central

    Borges, Eline Lima; Pires, José Ferreira; Abreu, Mery Natali Silva; Lima, Vera Lúcia de Araújo; Silva, Patrícia Aparecida Barbosa; Soares, Sônia Maria

    2016-01-01

    ABSTRACT Objective: to estimate the healing rate of complex surgical wounds and its associated factors. Method: retrospective cohort study from 2003 to 2014 with 160 outpatients of a Brazilian university hospital. Data were obtained through consultation of the medical records. Survival function was estimated using the Kaplan-Meier method and Cox regression model to estimate the likelihood of the occurrence of healing. Results: the complex surgical wound healing rate was 67.8% (95% CI: 60.8-74.9). Factors associated with a higher likelihood of wound healing were segmentectomy/quadrantectomy surgery, consumption of more than 20 grams/day of alcohol, wound extent of less that 17.3 cm2 and the length of existence of the wound prior to outpatient treatment of less than 15 days, while the use of hydrocolloid covering and Marlex mesh were associated with a lower likelihood of healing. Conclusion: the wound healing rate was considered high and was associated with the type of surgical intervention, alcohol consumption, type of covering, extent and length of wound existence. Preventive measures can be implemented during the monitoring of the evolution of the complex surgical wound closure, with possibilities of intervention in the modifiable risk factors. PMID:27737379

  20. Myelomeningocele (open spina bifida) - surgical management.

    PubMed

    Akalan, N

    2011-01-01

    therapy besides neurosurgery. The initial and probably the most crucial step begin with proper repair of the lesion. The aim of surgery, with its simplest definition should be towards maintaining the medical condition of the newborn. In other words, consequences of an open spinal cord segment with associated malformations have to be avoided with appropriate measures. Comparable to the surgical treatment of any congenital malformation, myelomeningocele repair consist of reversing the failed steps of normal neural tube closure. This requires a thorough understanding of the normal and abnormal embryological sequence of events in formation of the spinal cord. Although the purpose of this chapter is to describe the basic concepts and technique of myelomeningocele repair, contemporary information and progress on epidemiology, and etiology and embryology is presented with discussion of controversial issues regarding the selection process, optimal time for surgery and technical modifications.

  1. Stress analysis of filament wound open-ended composite shells

    NASA Astrophysics Data System (ADS)

    Gramoll, K. C.

    1993-04-01

    Membrane stresses and radial displacements for a filament wound, open-ended composite shell with internal pressure loading are developed. The shell is considered to be open at the crown as required by planar filament winding. The shell thickness and material properties vary along the meridian line due to the filament winding process. The membrane stress resultants are compared with finite elements using large deflection nonlinear anisotropic axisymmetric elements for an ellipsoidal shell. Finite elements show large bending stresses near the open edge for an ellipsoid, spheroid and netting shell. The ellipsoid and spheroid shells also show bending stresses throughout the dome structure. Radial deformations are also compared to finite element results for the three dome types.

  2. Use of cyanoacrylate in the coaptation of edges of surgical wounds*

    PubMed Central

    Lins, Ruthinéia Diógenes Alves Uchôa; Gomes, Raquel Christina Barboza; dos Santos, Kátia Simone Alves; da Silva, Paula Vanessa; da Silva, Renata Torres Moreira; Ramos, Ianny Alves

    2012-01-01

    Cyanoacrylate has been used in several fields of different surgical specialties as an adhesive for closure of gingival flaps and in mucous and cutaneous lacerations. One of its advantages is that it has an excellent immunological response. In view of aesthetic needs, cyanoacrylate has been applied with satisfactory results, when compared with sutures. It presents better coaptation of edges of cutaneous and mucosal lesions, smaller residual scars, and biocompatibility. However, it is limited to areas of little tissue tension. This work attempts to provide a literature review with the aim of revealing the advantages of using tissue adhesives, especially cyanoacrylates, in wound coaptation in comparison with conventional methods. PMID:23197206

  3. Surgical wound infection by mannitol-nonfermenting Staphylococcus aureus after lumbar microdiscectomy.

    PubMed

    Savini, Vincenzo; Nigro, Raffaele; Marrollo, Roberta; Polilli, Ennio; Campitelli, Irma; Buonaguidi, Roberto; Fazii, Paolo; Carretto, Edoardo

    2014-01-01

    Purulent infection of a surgical wound developed after discectomy, and a mannitol-nonfermenting Staphylococcus aureus isolate was cultivated as the etiologic agent. Nonfermenting S. aureus strains are exceedingly rare and may be erroneously mistaken and dismissed as contaminants. This report then emphasizes that pure and massive cultures must be carefully evaluated, even if preliminary examination does not suggest a pathogenic organism. Also, although mannitol-negative, the studied strain was correctly detected as S. aureus by both the-FISH test (AdvanDx, USA) and the Liofilchem 'Chromatic Staph aureus', highlighting that additional diagnostic methods may support recognition of uncommon, nonfermenting S. aureus strains in the daily practice.

  4. The effect of basic fibroblast growth factor on regeneration in a surgical wound model of rat submandibular glands

    PubMed Central

    Kobayashi, Fumitaka; Matsuzaka, Kenichi; Inoue, Takashi

    2016-01-01

    This study developed an animal model of surgically wounded submandibular glands (SMGs) and investigated the effects of collagen gel with basic fibroblast growth factor (bFGF) on tissue regeneration of surgically wounded SMGs in vivo. The animal model was produced by creating a surgical wound using a 3-mm diameter biopsy punch in SMGs. The wound was filled with collagen gel with bFGF (bFGF group) or without bFGF (control group). In the animal model of surgically wounded SMGs, salivary glands without scar tissue around the wound area were observed with smaller areas of collagen gel. Small round and spindle-shape cells invaded the collagen gel in both groups after operation day (AOD) 5, and this invasion dramatically increased at AOD 7. Host tissue completely replaced the collagen gel at AOD 21. The invading immune cells in the group treated with collagen gel with bFGF were positive for vimentin, α-smooth muscle actin (αSMA), CD49f, c-kit and AQP5 at AOD 7. Similarly, the mRNA expression of vimentin, αSMA, CD49f, keratin19 and AQP5 was also increased. This study suggests that the use of collagen gels with bFGF improves salivary gland regeneration. PMID:27025261

  5. Wound care challenges in children and adults with spina bifida: an open-cohort study.

    PubMed

    Ottolini, Katherine; Harris, Amy B; Amling, June K; Kennelly, Ann M; Phillips, Leslie A; Tosi, Laura L

    2013-01-01

    Skin breakdown is a frequent concern for individuals with spina bifida. We explored wound incidence in patients with spina bifida and how it varies across a person's life span and functional neurologic level. We examined the settings in which skin breakdown most commonly occurred, looking for evidence of chronic, non-healing wounds. We also sought to develop criteria to improve wound monitoring. We identified reported wound episodes in an open-cohort study over a 13-year period, examining the hospital and outpatient clinical records of spina bifida patients at Children's National Medical Center (CNMC). Current age, age at wound presentation, sex, weight, functional neurologic level, wound location, setting in which the wound was acquired, the development of a chronic wound, and presence of a shunt were recorded. Of the 376 patients in our clinical population, 123 (average age: 18.8 years, range: infancy-56 years) developed a total of 375 wounds; the majority of patients who developed one wound went on to develop one or more additional wounds, and 20 patients developed chronic wounds. Our data suggest that age bracket (adolescents), wheelchair use, and bare feet, as well as possibly obesity and reduced executive functioning, are key risk factors for wound development. These findings have led to a focused effort to increase wound education and prevention. In addition we report on our early experience using a wound care specialist to champion this initiative.

  6. Open and Arthroscopic Surgical Treatment of Femoroacetabular Impingement

    PubMed Central

    Kuhns, Benjamin D.; Frank, Rachel M.; Pulido, Luis

    2015-01-01

    Femoroacetabular impingement (FAI) is a common cause of hip pain, and when indicated, can be successfully managed through open surgery or hip arthroscopy. The goal of this review is to describe the different approaches to the surgical treatment of FAI. We present the indications, surgical technique, rehabilitation, and complications associated with (1) open hip dislocation, (2) reverse periacetabular osteotomy, (3) the direct anterior “mini-open” approach, and (4) arthroscopic surgery for FAI. PMID:26697431

  7. Low dose heparin: bleeding and wound complications in the surgical patient. A prospective randomized study.

    PubMed Central

    Pachter, H L; Riles, T S

    1977-01-01

    A randomized prospective study of low dose heparin was performed in 175 surgical patients to determine the frequency of bleeding and wound complications. The patients were divided into three groups: (1) low dose heparin (5000 units two hours before operation and 5000 units every 12 hours following operation for five days); (2) low dose heparin postoperatively only; and (3) a control group. The frequency of bleeding and wound complications was 27% in group I, 7.5% in group II, and 1.4% in group III. The difference between the control patients and those heparinized pre- and postoperatively is statistically significant (p less than 0.005). None of the patients in any of the three groups had a pulmonary embolus, but the number of patients involved is too small to assess the significance of this finding. However, a bleeding and wound complication rate of 27% is significant. These findings indicate that perhaps the routine use of low dose heparin should be reserved for those patients with preoperative factors indicating an increased risk from thromboembolism. PMID:603271

  8. Transdermal treatment of the surgical and burned wound skin via phytochemical-capped gold nanoparticles.

    PubMed

    Lee, Jaewook; Kim, JiEun; Go, Jun; Lee, Jong Ho; Han, Dong-Wook; Hwang, DaeYoun; Lee, Jaebeom

    2015-11-01

    The biological activities and therapeutic potential of phytochemical-decorated Au nanoparticles (Phyto-AuNPs) were investigated through the treatment of Phyto-AuNPs on the dorsal skin of rats via transdermal drug delivery process in order to regenerate surgical wounded and burned skin. Two different Phyto-AuNPs were applied to the dorsal skin: gallic acid-isoflavone--covered AuNPs (GI-AuNPs) and protocatechuic acid-isoflavone--covered AuNPs (PI-AuNPs). From the biological activity monitoring, it has been resulted that 5-fold thicker epidermis (ER), 50% reduction of metalloproteinase-1 (MMP-1) level, 3-fold higher superoxide dismutase (SOD) activity were obtained in the Phyto-AuNP-treated group, compared with a vehicle group (deionized water (DI-water) treatment). Moreover, the Phyto-AuNPs treatment on the surgical and burn damaged Sprague-Dawley (SD) rats induced higher expression of vascular endothelial growth factor (VEGF) and angiopoietin-2 (Ang-2). It would be plausible that antioxidant property of Phyto-AuNPs assist the acceleration and activation of biomolecules in the healing mechanism, where Phyto-AuNPs can be potential candidates for skin regeneration and wound healing.

  9. Bedside open abdominal surgery. Utility and wound management.

    PubMed

    Mayberry, J C

    2000-01-01

    Abdominal pathology in the critically ill or injured patient frequently leads to the use of open abdominal techniques or the actual performance of abdominal surgery in the ICU. All individuals responsible for the care of patients in the ICU should be familiar with the concepts and techniques of open abdomen wound management. ICU bedside abdominal surgery may be indicated if the patient is too unstable for transport to the operating room and the surgeon believes a limited procedure, such as a decompression of IAH, will be life-saving. Smaller procedures are also feasible, such as intra-abdominal packing changes for which the operating room is unnecessary. Development of a successful Surgery Outside the Operating Room program depends on mature cooperation between the surgeons and other professional ICU staff. Logistic details of such a program should be discussed and a scheduling protocol should be prepared before an emergent need for bedside surgery.

  10. 'This wound has spoilt everything': emotional capital and the experience of surgical site infections.

    PubMed

    Brown, Brian; Tanner, Judith; Padley, Wendy

    2014-11-01

    In this article we explore the experience of suffering from a surgical site infection, a common complication of surgery affecting around 5 per cent of surgical patients, via an interview study of 17 patients in the Midlands in the UK. Despite their prevalence, the experience of surgical site infections has received little attention so far. In spite of the impairment resulting from these iatrogenic problems, participants expressed considerable stoicism and we interpret this via the notion of emotional capital. This idea derives from the work of Pierre Bourdieu, Helga Nowotny and Diane Reay and helps us conceptualise the emotional resources accumulated and expended in managing illness and in gaining the most from healthcare services. Participants were frequently at pains not to blame healthcare personnel or hospitals, often discounting the infection's severity, and attributing it to chance, to 'germs' or to their own failure to buy and apply wound care products. The participants' stoicism was thus partly afforded by their refusal to blame healthcare institutions or personnel. Where anger was described, this was either defused or expressed on behalf of another person. Emotional capital is associated with deflecting the possibility of complaint and sustaining a deferential and grateful position in relation to the healthcare system. PMID:25470322

  11. ‘This wound has spoilt everything’: emotional capital and the experience of surgical site infections

    PubMed Central

    Brown, Brian; Tanner, Judith; Padley, Wendy

    2014-01-01

    In this article we explore the experience of suffering from a surgical site infection, a common complication of surgery affecting around 5 per cent of surgical patients, via an interview study of 17 patients in the Midlands in the UK. Despite their prevalence, the experience of surgical site infections has received little attention so far. In spite of the impairment resulting from these iatrogenic problems, participants expressed considerable stoicism and we interpret this via the notion of emotional capital. This idea derives from the work of Pierre Bourdieu, Helga Nowotny and Diane Reay and helps us conceptualise the emotional resources accumulated and expended in managing illness and in gaining the most from healthcare services. Participants were frequently at pains not to blame healthcare personnel or hospitals, often discounting the infection's severity, and attributing it to chance, to ‘germs’ or to their own failure to buy and apply wound care products. The participants' stoicism was thus partly afforded by their refusal to blame healthcare institutions or personnel. Where anger was described, this was either defused or expressed on behalf of another person. Emotional capital is associated with deflecting the possibility of complaint and sustaining a deferential and grateful position in relation to the healthcare system. PMID:25470322

  12. 'This wound has spoilt everything': emotional capital and the experience of surgical site infections.

    PubMed

    Brown, Brian; Tanner, Judith; Padley, Wendy

    2014-11-01

    In this article we explore the experience of suffering from a surgical site infection, a common complication of surgery affecting around 5 per cent of surgical patients, via an interview study of 17 patients in the Midlands in the UK. Despite their prevalence, the experience of surgical site infections has received little attention so far. In spite of the impairment resulting from these iatrogenic problems, participants expressed considerable stoicism and we interpret this via the notion of emotional capital. This idea derives from the work of Pierre Bourdieu, Helga Nowotny and Diane Reay and helps us conceptualise the emotional resources accumulated and expended in managing illness and in gaining the most from healthcare services. Participants were frequently at pains not to blame healthcare personnel or hospitals, often discounting the infection's severity, and attributing it to chance, to 'germs' or to their own failure to buy and apply wound care products. The participants' stoicism was thus partly afforded by their refusal to blame healthcare institutions or personnel. Where anger was described, this was either defused or expressed on behalf of another person. Emotional capital is associated with deflecting the possibility of complaint and sustaining a deferential and grateful position in relation to the healthcare system.

  13. Efficacy of Postoperative Continuous Wound Infiltration With Local Anesthesia After Open Hepatectomy

    PubMed Central

    Hong, Yu; Yong, Li Zhe

    2014-01-01

    Objectives: Local anesthetic wound infiltration is widely used as an effective adjunct during multimodal postoperative pain management. The aim of this study was to evaluate the effectiveness of continuous wound infusion of ropivacaine in postoperative pain relief, opioid sparing, incidence of nausea and vomiting, and bowel and liver function improvement in patients undergoing open hepatectomy. Methods: Forty patients undergoing open hepatectomy were enrolled in this prospective, randomized, double-blinded, placebo-controlled trial. Patients were divided into 2 groups: the 0.9% saline continuous infusion group (the control group; n=20) and the ropivacaine continuous infusion group (the Ropi group; n=20). Outcomes measured postoperatively were pain score at rest and on movement, sufentanil consumption, incidence of nausea and vomiting, and sedation score across 48 postoperative hours. Time to bowel recovery, liver function change, mean length of hospitalization, patient satisfaction, and other data after 48 postoperative hours were collected until hospital discharge. Results: Pain scores at rest were lower for the ropivacaine group and reached significance after 8 and 16 hours (P<0.01). Sufentanil consumption (41.50±21.80 vs. 89.70±35.22 μg; P<0.01) after 48 hours, time to bowel recovery (1.80±0.70 vs. 3.15±1.04 d; P<0.01), incidence of nausea and vomiting (1.75±0.72 vs. 2.40±0.68; P<0.05), and mean length of hospitalization (5.6±2.44 vs. 7.35±2.85 d; P<0.01) were significantly reduced, and the sedation score and liver function change were also comparable between the 2 groups. There was no difference with respect to pain scores on movement, nor with respect to patient satisfaction. Conclusions: Surgical wound infusion with ropivacaine after hepatectomy can improve pain relief at rest and accelerate recovery and discharge. PMID:24281275

  14. Standard abdominal wound edge protection with surgical dressings vs coverage with a sterile circular polyethylene drape for prevention of surgical site infections (BaFO): study protocol for a randomized controlled trial

    PubMed Central

    2012-01-01

    Background Postoperative surgical site infections cause substantial morbidity, prolonged hospitalization, costs and even mortality and remain one of the most frequent surgical complications. Approximately 14% to 30% of all patients undergoing elective open abdominal surgery are affected and methods to reduce surgical site infection rates warrant further investigation and evaluation in randomized controlled trials. Methods/design To investigate whether the application of a circular plastic wound protector reduces the rate of surgical site infections in general and visceral surgical patients that undergo midline or transverse laparotomy by 50%. BaFO is a randomized, controlled, patient-blinded and observer-blinded multicenter clinical trial with two parallel surgical groups. The primary outcome measure will be the rate of surgical site infections within 45 days postoperative assessed according to the definition of the Center for Disease Control. Statistical analysis of the primary endpoint will be based on the intention-to-treat population. The global level of significance is set at 5% (2 sided) and sample size (n = 258 per group) is determined to assure a power of 80% with a planned interim analysis for the primary endpoint after the inclusion of 340 patients. Discussion The BaFO trial will explore if the rate of surgical site infections can be reduced by a single, simple, inexpensive intervention in patients undergoing open elective abdominal surgery. Its pragmatic design guarantees high external validity and clinical relevance. Trial registration http://www.clinicaltrials.gov NCT01181206. Date of registration: 11 August 2010; date of first patient randomized: 8 September 2010 PMID:22587425

  15. Application of the Single Use Negative Pressure Wound Therapy Device (PICO) on a Heterogeneous Group of Surgical and Traumatic Wounds

    PubMed Central

    Payne, Caroline; Edwards, Daren

    2014-01-01

    Objectives: Traumatic wounds and surgery inherently have their complications. Localized infections, wound dehiscence, and excessive wound leakage can be devastating to the patient with a prolonged recovery, but it is also costly to the hospital with an increased length of stay, extra workload, and dressing changes. The single use PICO (Smith and Nephew Healthcare, Hull, United Kingdom) negative pressure wound therapy (NPWT) dressing has revolutionized our management of various acute, chronic, and high output wounds. It requires fewer dressing changes than conventional practice, is used in the outpatient setting, and is a necessary adjuvant therapy to hasten wound healing. Aims: To observe the efficacy of the PICO vacuum-assisted healing within a cost improvement programme. Settings: Plastic surgery department, Royal London Hospital. Materials and Methods: Twenty-one patients with a diversity of postoperative or posttraumatic wounds were considered suitable for PICO application and treated totally on an outpatient basis once the PICO dressing was applied. All wounds were then subjected to continued PICO dressings until healed. Results: All patients tolerated the PICO well with no dressing failure or failure to comply. The number of dressings per patient ranged from 1 to 7. The cost per patient of treatment ranged from £120 to £1578. Estimated cost of all PICO dressing for 21 patients including plastic surgery dressing clinic appointments = £13,345. Median length of treatment to healing (days) = 16; standard deviation = 9.5. Eight patients would have had an inpatient bed stay with conventional therapy, total 24 bed days saved at Bartshealth @£325 per day. Conclusions: The outpatient application of a disposable NPWT can benefit a wide range of clinical wounds that optimizes patient care, promotes rapid wound healing, and importantly helps manage costs. PMID:24917894

  16. [Organization of surgical care to the wounded in a modern armed conflict: surgical care at the different echelons of care (Report 1)].

    PubMed

    Samokhvalov, I M

    2012-12-01

    The main statements of organization of care to the wounded in modern armed conflicts are presented for the aim of an efficient discussion ahead of publishing a new edition of "Guidelines for War Surgery", Ministry of Defense of the Russian Federation. Lessons learned from the latest armed conflicts, military reform, development of medical units and medical treatment facilities, as well as appearance of new samples of medical equipment and medical kits approved by the Russian Army resulted in the necessity of changes in surgical care to the wounded.

  17. Biobased silver nanocolloid coating on silk fibers for prevention of post-surgical wound infections

    PubMed Central

    Dhas, Sindhu Priya; Anbarasan, Suruthi; Mukherjee, Amitava; Chandrasekaran, Natarajan

    2015-01-01

    Bombyx mori silk fibers are an important biomaterial and are used in surgical sutures due to their remarkable biocompatibility. The major drawback to the application of biomaterials is the risk of bacterial invasion, leading to clinical complications. We have developed an easy and cost-effective method for fabrication of antibacterial silk fibers loaded with silver nanoparticles (AgNPs) by an in situ and ex situ process using an aqueous extract of Rhizophora apiculata leaf. Scanning electron microscopy revealed that well dispersed nanoparticles impregnated the silk fibers both in situ and ex situ. The crystalline nature of the AgNPs in the silk fibers was demonstrated by X-ray diffraction. The thermal and mechanical properties of the silk fibers were enhanced after they were impregnated with AgNPs. The silver-coated silk fibers fabricated by the in situ and ex situ method exhibited more than 90% inhibition against Pseudomonas aeruginosa and Staphylococcus aureus. Silk fibers doped with AgNPs were found to be biocompatible with 3T3 fibroblasts. The results obtained represent an important advance towards the clinical application of biocompatible AgNP-loaded silk fibers for prevention of surgical wound infections. PMID:26491317

  18. [Peculiarities of surgical care in case of open injuries of limbs in emergency situations in peacetime].

    PubMed

    Dubrov, V É; Mitish, V A; Kobritsov, G P; Shabanov, V É; Baĭramov, Sh A; Khanin, M Iu

    2014-01-01

    It was done the comparative analysis of treatment results of casualties with open injuries of limbs in emergency situations in peacetime. It was determined that traditional approach of field surgery is unacceptable for this group of casualties. It is connected with limitations of evacuation and high frequency of complications. The developed modified surgical protocol permits not only to provide specialized care to casualties with soft tissue trauma and open fracture of limbs but also to reduce frequency of deep suppuration in 1.9 times. Also it allows to decrease number of dressings for one patient and period of the wound defect preparation to reconstructive plastic surgeries in 2.6 and 1.5 times respectively. PMID:24874226

  19. p70S6 kinase mediates breast cancer cell survival in response to surgical wound fluid stimulation.

    PubMed

    Segatto, Ilenia; Berton, Stefania; Sonego, Maura; Massarut, Samuele; Fabris, Linda; Armenia, Joshua; Mileto, Mario; Colombatti, Alfonso; Vecchione, Andrea; Baldassarre, Gustavo; Belletti, Barbara

    2014-05-01

    In early breast cancer, local relapses represent a determinant and not simply an indicator of risk for distant relapse and death. Notably, 90% of local recurrences occur at or close to the same quadrant of the primary cancer. Relevance of PI3K/mTOR/p70S6K signaling in breast tumorigenesis is very well documented. However, the pathway/s involved in the process of breast cancer local relapse are not well understood. The ribosomal protein p70S6K has been implicated in breast cancer cell response to post-surgical inflammation, supporting the hypothesis that it may be crucial also for breast cancer recurrence. Here, we show that p70S6K activity is required for the survival of breast cancer cells challenged in "hostile" microenvironments. We found that impairment of p70S6K activity in breast cancer cells strongly decreased their tumor take rate in nude mice. In line with this observation, if cells were challenged to grow in anchorage independence or in clonogenic assay, growth of colonies was strongly dependent on an intact p70S6K signaling. This in vitro finding was particularly evident when breast cancer cells were grown in the presence of wound fluids harvested following surgery from breast cancer patients, suggesting that the stimuli present in the post-surgical setting at least partially relied on activity of p70S6K to stimulate breast cancer relapse. From a mechanistic point of view, our results indicated that p70S6K signaling was able to activate Gli1 and up-regulate the anti-apoptotic protein Bcl2, thereby activating a survival response in breast cancer cells challenged in hostile settings. Our work highlights a previously poorly recognized function of p70S6K in preserving breast cancer cell survival, which could eventually be responsible for local relapse and opens the way to the design of new and more specific therapies aiming to restrain the deleterious effects of wound response.

  20. Management of open wounds: lessons from orthopedic oncology.

    PubMed

    Siegel, Herrick J

    2014-01-01

    The management of complex wounds remains a challenge, and although there have been many promising advances, patients often undergo a morbid and lengthy process to obtain sufficient, satisfactory healing. Sarcoma patients are especially vulnerable to soft tissue wound-healing complications. These patients are often treated with neoadjuvant radiation and/or chemotherapy and have compromised local vascularity to healing tissue. The advent and refinement of wound vacuum-assisted closure technology have been shown to have a tremendous impact. This article reviews the benefits of some novel technologies currently undergoing investigation in orthopedic oncology that will likely have applications in wound management from other causes.

  1. Sutureless prepuceplasty with wound healing by second intention: An alternative surgical approach in children's phimosis treatment

    PubMed Central

    Christianakis, Efstratios

    2008-01-01

    Background A new technique for the treatment of children's phimosis is presented that minimizes the repairing time, the postoperative complications and maintains the physical foreskin appearance intact. Methods Eightyseven children with phimosis were treated with this new developed technique, between 2003 and 2005. Sutureless prepuceplasty creates a permanent surgical extension of the close prepuce. Stretching and retraction of phimotic foreskin reveals a tight prepuce ring that is cutting in its dorsal surface longitudinally. Rarely triple symmetric incisions in the preputial outlet are necessary. The foreskin is loose and moves absolutely free in bilateral courses. The wounds are healing by second intention. Antisepsis, steroids and Elicina cream, (which contains allantoin, collagen, elastin, glycolic acid and vitamins A, D, and E) should apply daily, for twenty to thirty days. Results The foreskin is moving in centripetal or efferent courses absolutely loosely, painlessly and bloodlessly. The mean time of follow-up was 27 months (one to four years). No complications were observed. Conclusion Sutureless prepuceplasty may present an acceptable alternative in children's phimosis reconstruction. PMID:18318903

  2. Negative pressure wound therapy in the management of late deep infections after open reconstruction of achilles tendon rupture.

    PubMed

    Mosser, Philipp; Kelm, Jens; Anagnostakos, Konstantinos

    2015-01-01

    Infection is a major complication after open reconstruction of Achilles tendon ruptures. We report on the use of vacuum-assisted closure (VAC) therapy in the treatment of late deep infections after open Achilles tendon reconstruction. Six patients (5 males [83.33%], 1 female [16.67%]; mean age, 52.8 [range 37 to 66] years) were been treated using an identical protocol. Surgical management consisted of debridement, lavage, and necrectomy of infected tendon parts. The VAC therapy was used for local wound preconditioning and infection management. A continuous negative pressure of 125 mm Hg was applied on each wound. For final wound closure, a split-thickness skin graft was performed. The skin graft healing process was also supported by VAC therapy during the first 5 days. The VAC dressings were changed a mean average of 3 (range 1 to 4) times until split-thickness skin grafting could be performed. The mean total duration of the VAC therapy was 13.6 ± 5.9 days. The mean hospital stay was 31.2 ± 15.9 days. No complications with regard to bleeding, seroma, or hematoma formation beneath the skin graft were observed. At a mean follow-up duration of 29.9 (range 4 to 65) months, no re-infection or infection persistence was observed. The VAC device seems to be a valuable tool in the treatment of infected tendons. The generalization of these conclusions should await the results of future studies with larger patient series.

  3. Impact of wound edge protection devices on surgical site infection after laparotomy: multicentre randomised controlled trial (ROSSINI Trial)

    PubMed Central

    Calvert, Melanie; Bartlett, David C; Gheorghe, Adrian; Redman, Val; Dowswell, George; Hawkins, William; Mak, Tony; Youssef, Haney; Richardson, Caroline; Hornby, Steven; Magill, Laura; Haslop, Richard; Wilson, Sue; Morton, Dion

    2013-01-01

    Objective To determine the clinical effectiveness of wound edge protection devices in reducing surgical site infection after abdominal surgery. Design Multicentre observer blinded randomised controlled trial. Participants Patients undergoing laparotomy at 21 UK hospitals. Interventions Standard care or the use of a wound edge protection device during surgery. Main outcome measures Surgical site infection within 30 days of surgery, assessed by blinded clinicians at seven and 30 days and by patient’s self report for the intervening period. Secondary outcomes included quality of life, duration of stay in hospital, and the effect of characteristics of the patient and operation on the efficacy of the device. Results 760 patients were enrolled with 382 patients assigned to the device group and 378 to the control group. Six patients in the device group and five in the control group did not undergo laparotomy. Fourteen patients, seven in each group, were lost to follow-up. A total of 184 patients experienced surgical site infection within 30 days of surgery, 91/369 (24.7%) in the device group and 93/366 (25.4%) in the control group (odds ratio 0.97, 95% confidence interval 0.69 to 1.36; P=0.85). This lack of benefit was consistent across wound assessments performed by clinicians and those reported by patients and across all secondary outcomes. In the secondary analyses no subgroup could be identified in which there was evidence of clinical benefit associated with use of the device. Conclusions Wound edge protection devices do not reduce the rate of surgical site infection in patients undergoing laparotomy, and therefore their routine use for this role cannot be recommended. Trial registration Current Controlled Trials ISRCTN 40402832 PMID:23903454

  4. Open and arthroscopic surgical anatomy of the ankle.

    PubMed

    Frank, Rachel M; Hsu, Andrew R; Gross, Christopher E; Walton, David M; Lee, Simon

    2013-01-01

    Ankle-related complaints are among the most commonly encountered problems for musculoskeletal clinicians. Ankle pathology is widely variable, including, but not limited to, fractures, deformity, infection, oncologic diseases, neuromuscular conditions, and arthritis. While nonoperative management with activity modification, bracing and/or shoe modifications, and medications is usually indicated as first line of treatment, surgical intervention may become necessary. A thorough understanding of the complex anatomy and biomechanics of the ankle, and in particular, the potential neurovascular structures that may be encountered, is important to reduce complications and obtain good surgical outcomes. The purpose of this review is to discuss the most common open and arthroscopic exposures to the ankle with a focus on surgically relevant anatomy for each approach. PMID:24288614

  5. Open and Arthroscopic Surgical Anatomy of the Ankle

    PubMed Central

    Frank, Rachel M.; Hsu, Andrew R.; Gross, Christopher E.; Walton, David M.

    2013-01-01

    Ankle-related complaints are among the most commonly encountered problems for musculoskeletal clinicians. Ankle pathology is widely variable, including, but not limited to, fractures, deformity, infection, oncologic diseases, neuromuscular conditions, and arthritis. While nonoperative management with activity modification, bracing and/or shoe modifications, and medications is usually indicated as first line of treatment, surgical intervention may become necessary. A thorough understanding of the complex anatomy and biomechanics of the ankle, and in particular, the potential neurovascular structures that may be encountered, is important to reduce complications and obtain good surgical outcomes. The purpose of this review is to discuss the most common open and arthroscopic exposures to the ankle with a focus on surgically relevant anatomy for each approach. PMID:24288614

  6. Application of hyaluronic acid in the healing of non-experimental open wounds: A pilot study on 12 wounds in 10 client-owned dogs

    PubMed Central

    Ferrari, Roberta; Boracchi, Patrizia; Romussi, Stefano; Ravasio, Giuliano; Stefanello, Damiano

    2015-01-01

    Aim: Veterinarians have frequently to deal with wounds to the skin, subcutis, and underlying muscle. The aim was to explore the application of hyaluronic acid (HA)-containing dressing on open skin wounds in dogs. The progress of healing was assessed by wound area reduction and two scoring scales applied in human medicine. Materials and Methods: Ten client-owned dogs with 12 cutaneous open wounds healed by the second intention were included. All wounds were treated using available in commerce HA-containing wound dressing from admission to complete re-epithelialization. At every clinical examination, wound area and scale scoring assessments were performed. Results: After debridement, an increased wound size was obtained while an improvement was determined by both grading systems. The median numbers of return to the clinic for bandage change were 5 times. The median time to complete wound healing was 34.5 days. The mean wound area at day 7, 14, 21, and 28 were, respectively, 90.4%, 47.7%, 22.4%, and 14.8% of the original size (for linear measurement) and 95.5%, 54.4%, 23.10%, and 14.8% of the original size (for software measurement). Regarding wound healing assessment tools, the agreement between two operators was considered high for both scales. Conclusions: HA-containing dressing may be a possible wound treatment for cutaneous open wounds in dogs. The assessment of wound quality using scale scoring system could be useful especially in the 1st week and to direct clinical decision-making process. PMID:27047026

  7. Combination of negative pressure wound therapy with open bone grafting for bone and soft tissue defects.

    PubMed

    Deng, Kai; Yu, Ai-Xi; Xia, Cheng-Yan; Li, Zong-Huan; Wang, Wei-Yang

    2013-08-01

    The aim of this study was to investigate the efficiency of negative pressure wound therapy (NPWT) combined with open bone graft (OBG; NPWT-OBG) for the treatment of bone and soft tissue defects with polluted wounds in an animal model. All rabbits with bone and soft tissue defects and polluted wounds were randomly divided into two groups, the experimental group (NPWT with bone graft) and the control group (OBG). The efficacy of the treatment was assessed by the wound conditions and healing time. Bacterial bioburdens and bony calluses were evaluated by bacteria counting and X-rays, respectively. Furthermore, granulation tissue samples from the wounds on days 0, 3, 7 and 14 of healing were evaluated for blood vessels and vascular endothelial growth factor (VEGF) levels. Wounds in the experimental group tended to have a shorter healing time, healthier wound conditions, lower bacterial bioburden, improvement of the bony calluses and an increased blood supply compared with those in the control group. With NPWT, wound infection was effectively controlled. For wounds with osseous and soft tissue defects, NPWT combined with bone grafting was demonstrated to be more effective than an OBG.

  8. Open, laparoscopic and robotic radical prostatectomy: optimizing the surgical approach.

    PubMed

    Bivalacqua, Trinity J; Pierorazio, Phillip M; Su, Li-Ming

    2009-09-01

    As advances in the understanding of prostatic anatomy led to improvements in functional and oncologic outcomes after prostatectomy of the past few decades, advances in technology and surgical technique have made minimally-invasive prostate surgery a reality. Today patients diagnosed with clinically localized prostate cancer have more surgical treatment options than in the past including open, laparoscopic and robot-assisted laparoscopic radical prostatectomy. Advantages and disadvantages exist for each modality and lead to subtle differences in the technical execution of the procedure. Evidence from centers of excellence and from experienced surgeons demonstrates that both laparoscopic and robotic-assisted laparoscopic radical prostatectomy appear to be comparable to outcomes achieved with open radical retropubic prostatectomy series. Individual surgeon skill, experience and clinical judgment are likely the stronger predictors of outcome rather than the technique chosen. However, learning curves, oncologic outcomes and cost-efficacy remain important considerations in the dissemination of minimally-invasive prostate surgery. A greater appreciation of the periprostatic anatomy and further modification of surgical technique will result in continued improvement in functional outcomes and oncological control for patients undergoing radical prostatectomy, whether by open or minimally-invasive surgery. PMID:19286370

  9. Functional T lymphocytes infiltrate implanted polyvinyl alcohol foams during surgical wound closure therapy.

    PubMed

    Gouttefangeas, C; Eberle, M; Ruck, P; Stark, M; Müller, J E; Becker, H D; Rammensee, H G; Pinocy, J

    2001-06-01

    Vacuum-assisted closure involving the implantation of polyvinyl alcohol foam is a technique recently developed for the treatment of patients suffering from either wound infection or chronic wounds. This method has been shown to improve and accelerate wound healing. However, little is known about the cell populations that infiltrate the foam, and their potential role in resolving the infection and promoting granulation tissue formation. Our study demonstrates that wound-implanted foams are mainly infiltrated with granulocytes, but that mononuclear cells, including macrophages and minor populations of T, B and natural killer lymphocytes, are also present. We show that foam-infiltrating T cells, especially CD4(+) T cells, constitute a phenotypically and functionally heterogeneous population influenced by wound-infecting bacteria. Thus, T lymphocytes could play a role in wound cleansing. In addition, our data indicate that implanted polyvinyl alcohol foams might be suitable microenvironments for manipulating T cell-mediated immune responses in patients.

  10. Inhibition of tumor-cell attachment to extracellular matrix as a method for preventing tumor recurrence in a surgical wound.

    PubMed Central

    Whalen, G F; Ingber, D E

    1989-01-01

    Studies with four different transplantable murine tumors demonstrated that surgical instruments contaminated by contact with a tumor mass could produce tumors in a surgical wound. Eighty-seven per cent of mice with wounds made by invisibly contaminated scissors developed tumors. Irrigation with water did not prevent tumor growth. Before spilled tumor cells can invade and grow into a recurrence in the wound site, they must first attach to underlying extracellular matrix. We have devised a simple in vitro assay to identify inhibitors of tumor-cell attachment to develop therapeutic compounds that can prevent tumor-cell reimplantation. Various test compounds, including proteases (trypsin and Dispase), known modulators of matrix metabolism (proline analogues, cycloheximide, heparin, cortisone, cortexolone, and heparin-steroid combinations), large molecular weight polymers (agarose, dextran, polyethylene oxide), and synthetic fibronectin peptides were tested for their ability to inhibit mouse melanoma (B16-F10) cell attachment to gelatinized dishes. Most of these compounds had little or no effect on tumor-cell adhesion when cells were plated in serum-containing medium. However we identified three compounds that inhibited tumor-cell attachment in a reversible fashion: (1) a specific inhibitor of collagen deposition (L-azetidine-2-carboxylic acid); (2) a bacterial neutral protease (Dispase); and (3) synthetic fibronectin peptides that contained the arginine-glycine-asparate (RGD) sequence that is responsible for cell binding. Dispase and the RGD-containing peptides also inhibited cell implantation and prevented tumor formation in a surgical wound. We propose that inhibitors of attachment might be used either alone or with other biologic modifiers to prohibit implantation of free tumor cells at the time of surgery and thus, to prevent local tumor recurrence. PMID:2686568

  11. Use of external fixation and primary wound closure in an open comminuted first metatarsal fracture: a case report.

    PubMed

    Miller, Jason C; Shever, Sepideh

    2008-01-01

    Management of open, comminuted fractures presents a challenge for the foot and ankle surgeon. Reconstructive surgery for such injuries has a high potential for the development of serious complications, and factors such as the extent of soft tissue injury, neurovascular status to the foot, and fracture stability must be taken into consideration before determining a surgical plan. This article describes the case of a patient who presented with an open, comminuted first metatarsal fracture as a result of a chainsaw injury. The patient was treated with a uniplanar mini-external fixator, demineralized bone matrix, primary wound closure, and external bone growth stimulation. At 1-year follow-up, the interview and examination revealed the patient to be pain free with a functional first ray. ACFAS Level of Clinical Evidence: 4.

  12. HOSPITALIZATION TIME AFTER OPEN APPENDECTOMY BY THREE DIFFERENT SURGICAL TECHNIQUES

    PubMed Central

    XIMENES, Agláia Moreira Garcia; MELLO, Fernando Salvo Torres; de LIMA-JÚNIOR, Zailton Bezerra; FERREIRA, Cícero Faustino; CAVALCANTI, Amanda Dantas Ferreira; DIAS-FILHO, Adalberto Vieira

    2014-01-01

    Background The choice of surgical technique to approach the appendicular stump depends mostly on skill and personal preference of the surgeon or on the protocol used in the service, and the influence of this choice in hospitalization time is not evaluated. Aim To evaluate the relation between surgical technique and postoperative hospitalization time in patients presenting with acute appendicitis. Methods Retrospective analysis of 180 patients who underwent open appendectomy. These where divided into three groups according to surgical technique: conventional appendectomy (simple ligation of the stump), tobacco pouch suture and Parker-Kerr suture. Data where crossed with hospitalization time (until three days, from four to six days and over seven days). Results A hundred and eighty patients with age from 15 to 85 years where included. From these, 95 underwent conventional technique, had an average hospitalization time of 3,9 days and seven had complications (surgical site infection, seroma, suture dehiscence and evisceration). In 67 patients, tobacco pouch suture was chosen and had average hospitalization time of 3,7 days and two complications (infection and seroma). In 18 Parker-Kerr suture was made, with average hospitalization time of 2,6 days, with no complication. Contingency coefficient between the variables hospitalization time and technique was 0,255 and Cramér's V was 0,186. Conclusion There was tendency to larger hospitalization time and larger number of complications in conventional appendectomy, whereas in patients where Parker-Kerr suture was performed, hospitalization time was significantly smaller. PMID:25184769

  13. Surgical Skills Beyond Scientific Management

    PubMed Central

    Whitfield, Nicholas

    2015-01-01

    During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel’s attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel–Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice. PMID:26090737

  14. Surgical Skills Beyond Scientific Management.

    PubMed

    Whitfield, Nicholas

    2015-07-01

    During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel's attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel-Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice.

  15. Surgical Skills Beyond Scientific Management.

    PubMed

    Whitfield, Nicholas

    2015-07-01

    During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel's attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel-Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice. PMID:26090737

  16. Surgical amputation of a digit and vacuum-assisted-closure (V.A.C.) management in a case of osteomyelitis and wound care in an eastern black rhinoceros (Diceros bicornis michaeli).

    PubMed

    Harrison, Tara M; Stanley, Bryden J; Sikarskie, James G; Bohart, George; Ames, N Kent; Tomlian, Janice; Marquardt, Mark; Marcum, Annabel; Kiupel, Matti; Sledge, Dodd; Agnew, Dalen

    2011-06-01

    A 14-yr-old female eastern black rhinoceros (Diceros bicornis michaeli) presented with progressive suppurative osteomyelitis in her left hind lateral toe. beta-Hemolytic Streptococcus sp. was isolated. The animal was treated with multiple systemic antibiotics, and topical wound cleansing. Repeated debridements and nail trimmings were performed for 5 mo prior to electing amputation. The toe was surgically amputated under general anesthesia between the first and second phalanges. Analgesia was diffused into the wound topically via a catheter and elastomeric pump. The open amputation site was covered with adherent drapes and a negative-pressure wound therapy device provided vacuum-assisted closure (V.A.C.) for 72 hr. Three months later this animal developed a deep dermal ulcer on the lateral aspect of the right hind limb, at the level of the stifle. Methicillin-resistant Staphylococcus aureus was isolated. The wound was managed by initial daily lavage, followed by 1 mo of V.A.C. therapy, with 72 hr between dressing changes. Clinically, this therapy expedited the formation of healthy granulation tissue and overall healing was accelerated. The animal tolerated the machine and bandage changes well via operant conditioning. The use of negative-pressure wound therapy appeared to shorten time to resolution of slow-healing wounds in black rhinoceros. PMID:22946413

  17. Alterations in respiratory mechanics after laparoscopic and open surgical procedures

    PubMed Central

    Kimberley, Nicholas A.; Kirkpatrick, Susan M.; Watters, James M.

    1996-01-01

    Objective To compare the effects of laparoscopic and open surgical procedures on postoperative strength and respiratory mechanics. Design Prospective cohort study. Setting Adult university hospital. Participants Fifty-one women aged 21 to 62 years scheduled to undergo elective cholecystectomy or hysterectomy (or related procedures), otherwise in good health. Intervention Open or laparoscopic cholecystectomy or hysterectomy (or related procedures). Main Outcome Measures Maximum voluntary handgrip strength (HGS), forced vital capacity (VC), forced expiratory volume in 1 second (FEV1), and maximal inspiratory pressure (MIP) were each measured preoperatively and on the first postoperative morning. A visual analogue pain scale score was evaluated in relation to performance of the postoperative strength and respiratory measurements. Results VC, FEV1 and MIP, but not HGS, were decreased after surgery. Postoperative VC, FEV1 and MIP were lower after open procedures than after laparoscopic procedures and after cholecystectomy than after hysterectomy (all p < 0.001). Pain scores were lower after laparoscopic than after open procedures (p < 0.005) and could account in part for differences in postoperative respiratory mechanics. Conclusions Cholecystectomy and hysterectomy do not result in generalized muscle weakness, unlike more major abdominal procedures. Postoperative alterations in respiratory mechanics are related to the site of the surgery, the use of an open versus a laparoscopic approach and postoperative pain. PMID:8697322

  18. Scientific basis for selecting surgical needles and needle holders for wound closure.

    PubMed

    Edlich, R F; Towler, M A; Rodeheaver, G T; Becker, D G; Lombardi, S A; Thacker, J G

    1990-07-01

    Standardized reproducible tests have been devised to determine surgical needle sharpness, resistance to bending, and ductility. Three comparable groups of reverse cutting edge needles were selected from different manufacturers for measurement of these needle performance parameters. This testing demonstrated that needle diameter, manufacturing process, needle material composition, cross-sectional design, and the manufacturer were all important determinants of surgical needle performance. In addition, the biomechanics of curved surgical needle bending has been related to the clamping moment of surgical needle holders. This relationship identifies the surgical needle holder that can be used with surgical needles without deformation. The results of these studies provide a scientific basis for the selection of surgical needles and needle holders for use in surgery.

  19. Effectiveness and safety of continuous wound infiltration for postoperative pain management after open gastrectomy

    PubMed Central

    Zheng, Xing; Feng, Xu; Cai, Xiu-Jun

    2016-01-01

    AIM: To prospectively evaluate the effectiveness and safety of continuous wound infiltration (CWI) for pain management after open gastrectomy. METHODS: Seventy-five adult patients with American Society of Anesthesiologists (ASA) Physical Status Classification System (ASA) grade 1-3 undergoing open gastrectomy were randomized to three groups. Group 1 patients received CWI with 0.3% ropivacaine (group CWI). Group 2 patients received 0.5 mg/mL morphine intravenously by a patient-controlled analgesia pump (PCIA) (group PCIA). Group 3 patients received epidural analgesia (EA) with 0.12% ropivacaine and 20 µg/mL morphine with an infusion at 6-8 mL/h for 48 h (group EA). A standard general anesthetic technique was used for all three groups. Rescue analgesia (2 mg bolus of morphine, intravenous) was given when the visual analogue scale (VAS) score was ≥ 4. The outcomes measured over 48 h after the operation were VAS scores both at rest and during mobilization, total morphine consumption, relative side effects, and basic vital signs. Further results including time to extubation, recovery of bowel function, surgical wound healing, mean length of hospitalization after surgery, and the patient’s satisfaction were also recorded. RESULTS: All three groups had similar VAS scores during the first 48 h after surgery. Group CWI and group EA, compared with group PCIA, had lower morphine consumption (P < 0.001), less postoperative nausea and vomiting (1.20 ± 0.41 vs 1.96 ± 0.67, 1.32 ± 0.56 vs 1.96 ± 0.67, respectively, P < 0.001), earlier extubation (16.56 ± 5.24 min vs 19.76 ± 5.75 min, P < 0.05, 15.48 ± 4.59 min vs 19.76 ± 5.75 min, P < 0.01), and earlier recovery of bowel function (2.96 ± 1.17 d vs 3.60 ± 1.04 d, 2.80 ± 1.38 d vs 3.60 ± 1.04 d, respectively, P < 0.05). The mean length of hospitalization after surgery was reduced in groups CWI (8.20 ± 2.58 d vs 10.08 ± 3.15 d, P < 0.05) and EA (7.96 ± 2.30 d vs 10.08 ± 3.15 d, P < 0.01) compared with group PCIA

  20. Perforated second trimester appendicitis with abdominal compartment syndrome managed with negative pressure wound therapy and open abdomen

    PubMed Central

    Turnock, Adam R.; Fleischer, Brian P.; Carney, Martin J.; Vanderlan, Wesley B.

    2016-01-01

    Abdominal compartment syndrome (ACS) is a known complication of laparotomy; however, the literature is lacking in regards to treatment of this entity in pregnant patients. We present a case of acute perforated appendicitis in a second trimester primagravida, complicated by gangrenous necrosis of the contiguous bowel with subsequent development of ACS and intra-abdominal sepsis. This was treated with a novel approach, using non-commercial negative pressure wound therapy and open abdomen technique. Gestational integrity was preserved and the patient went on to experience a normal spontaneous vaginal delivery. At 5 years post-delivery the patient has had no surgical complications and her baby has met all developmental milestones. PMID:27302498

  1. Bluebelle study (phase A): a mixed-methods feasibility study to inform an RCT of surgical wound dressing strategies

    PubMed Central

    2016-01-01

    Objectives Dressing primary surgical wounds is common, but the implications for surgical site infection (SSI) remain unknown. The Bluebelle study aimed to determine the feasibility of a randomised controlled trial (RCT) comparing ‘simple’, ‘complex’ or ‘no’ dressings on abdominal wounds, as prespecified in a funder's research brief. Bluebelle includes exploratory work (phase A) to inform a pilot version of the proposed RCT (phase B). Phase A aimed to investigate current dressing practices and perspectives on the proposed RCT, with a view to refining the forthcoming pilot. Design Mixed methods, including semi-structured interviews and document analysis. Setting 6 UK hospitals. Participants 51 patients and 92 clinical professionals from abdominal surgical specialities. Results Professionals had variable interpretations of what constitutes a ‘dressing’, particularly with respect to ‘glue’—a product listed under ‘wound-closure products’ in the British National Formulary, which some surgeons reportedly applied as a ‘wound covering’. Areas of ambiguity arising from interviews informed development of pragmatic definitions, including specification of conditions under which glue constituted a ‘dressing’. Professionals reported that ‘simple’ dressings were routinely used in practice, whereas ‘complex’ dressings were not. This raised questions about the relevance of comparison groups, prompting the design of a survey to determine the types/frequency of dressing use in abdominal surgery (reported elsewhere). This confirmed that complex dressings were rarely used, while ‘glue as a dressing’ was used relatively frequently. ‘Complex dressings’ were therefore substituted for ‘glue as a dressing’ (following an updated Cochrane review, which found insufficient evidence to determine the effectiveness of ‘glue as a dressing’). Patients and professionals acknowledged uncertainty around dressing use and SSI prevention, but felt

  2. Protocol for a randomised controlled trial of standard wound management versus negative pressure wound therapy in the treatment of adult patients with an open fracture of the lower limb: UK Wound management of Open Lower Limb Fractures (UK WOLFF)

    PubMed Central

    Achten, Juul; Parsons, Nick R; Bruce, Julie; Petrou, Stavros; Tutton, Elizabeth; Willett, Keith; Lamb, Sarah E; Costa, Matthew L

    2015-01-01

    Introduction Patients who sustain open lower limb fractures have reported infection risks as high as 27%. The type of dressing applied after initial debridement could potentially affect this risk. In this trial, standard dressings will be compared with a new emerging treatment, negative pressure wound therapy, for patients with open lower limb fractures. Methods and analysis All adult patients presenting with an open lower limb fracture, with a Gustilo and Anderson (G&A) grade 2/3, will be considered for inclusion. 460 consented patients will provide 90% power to detect a difference of eight points in the Disability Rating Index (DRI) score at 12 months, at the 5% level. A randomisation sequence, stratified by trial centre and G&A grade, will be produced and administered by a secure web-based service. A qualitative substudy will assess patients’ experience of giving consent for the trial, and acceptability of trial procedures to patients and staff. Patients will have clinical follow-up in a fracture clinic up to a minimum of 12 months as per standard National Health Service (NHS) practice. Functional and quality of life outcome data will be collected using the DRI, SF12 and EQ-5D questionnaires at 3, 6, 9 and 12 months postoperatively. In addition, information will be requested with regards to resource use and any late complications or surgical interventions related to their injury. The main analysis will investigate differences in the DRI score at 1 year after injury, between the two treatment groups on an intention-to-treat basis. Tests will be two sided and considered to provide evidence for a significant difference if p values are less than 0.05. Ethics and dissemination Ethical approval was given by NRES Committee West Midlands—Coventry & Warwickshire on 6/2/2012 (ref: 12/WM/0001). The results of the trial will be disseminated via peer-reviewed publications and presentations at relevant conferences. Trial registration number ISRCTN33756652. PMID

  3. Magnetoledtherapy in the treatment of wounds after surgical procedures of the knee joint

    PubMed Central

    Pasek, Jarosław; Pasek, Tomasz; Sieroń, Aleksander

    2014-01-01

    The intense development of methods of physical medicine has been noted recently. The new methods are treatment methods, which in many cases allow a reduction of treatment time and positively influence the quality of life of patients undergoing treatment. This applies to illnesses and injuries of the locomotor system and diseases affecting soft tissues, as well as chronic wounds. This article discusses the positive results of the treatment of a 63-year-old woman with a persisting chronic wound of her right lower extremity after knee joint endoprosthesis surgery. The physical medicine method applied, in the form of magnetoledtherapy, contributed to complete wound healing and alleviation of pain suffered, as well as improvement of the quality of life of the treated patient. PMID:25214792

  4. Raven-II: an open platform for surgical robotics research.

    PubMed

    Hannaford, Blake; Rosen, Jacob; Friedman, Diana W; King, Hawkeye; Roan, Phillip; Cheng, Lei; Glozman, Daniel; Ma, Ji; Kosari, Sina Nia; White, Lee

    2013-04-01

    The Raven-II is a platform for collaborative research on advances in surgical robotics. Seven universities have begun research using this platform. The Raven-II system has two 3-DOF spherical positioning mechanisms capable of attaching interchangeable four DOF instruments. The Raven-II software is based on open standards such as Linux and ROS to maximally facilitate software development. The mechanism is robust enough for repeated experiments and animal surgery experiments, but is not engineered to sufficient safety standards for human use. Mechanisms in place for interaction among the user community and dissemination of results include an electronic forum, an online software SVN repository, and meetings and workshops at major robotics conferences.

  5. [Cardiac wounds. Experience from 10 years of war. Apropos of 32 cases treated surgically].

    PubMed

    Jebara, V A; Ghossain, M A; Saadé, B

    1989-01-01

    Thirty-two patients with cardiac wounds from high velocity firearms (bullets or shrapnel) were operated. Seven of these patients who had no cardiac activity on arrival underwent emergency thoracotomy with a mortality of 85%. The other twenty-five patients underwent planned sternotomy with a mortality of 12%. The authors analyse these case with emphasis on the diagnostic and therapeutic management.

  6. Molecular Wiring in Smart Dressings: Opening a New Route to Monitoring Wound pH

    PubMed Central

    McLister, Anna; Davis, James

    2015-01-01

    It has been proposed that fluctuations in wound pH can give valuable insights into the healing processes in chronic wounds, but acquiring such data can be a technological challenge especially where there is little sample available. Developments in voltammetric pH sensing have opened up new avenues for the design of probes that can function in ultra-small volumes and can be inherently disposable but, as yet few can meet the demands of wound monitoring. A preliminary investigation of the pH response of a new redox wire prepared from a peptide homopolymer of tryptophan is presented and its potential applicability as a sensing material for use in smart dressings is critically discussed. PMID:27417774

  7. Negative pressure wound therapy for Gustilo Anderson grade IIIb open tibial fractures

    PubMed Central

    Park, Chul Hyun; Shon, Oog Jin; Kim, Gi Beom

    2016-01-01

    Background: Traditionally, Gustilo Anderson grade IIIb open tibial fractures have been treated by initial wide wound debridement, stabilization of fracture with external fixation, and delayed wound closure. The purpose of this study is to evaluate the clinical and radiological results of staged treatment using negative pressure wound therapy (NPWT) for Gustilo Anderson grade IIIb open tibial fractures. Materials and Methods: 15 patients with Gustilo Anderson grade IIIb open tibial fractures, treated using staged protocol by a single surgeon between January 2007 and December 2011 were reviewed in this retrospective study. The clinical results were assessed using a Puno scoring system for severe open fractures of the tibia at the last followup. The range of motion (ROM) of the knee and ankle joints and postoperative complication were evaluated at the last followup. The radiographic results were assessed using time to bone union, coronal and sagittal angulations and a shortening at the last followup. Results: The mean score of Puno scoring system was 87.4 (range 67–94). The mean ROM of the knee and ankle joints was 121.3° (range 90°–130°) and 37.7° (range 15°–50°), respectively. Bone union developed in all patients and the mean time to union was 25.3 weeks (range 16–42 weeks). The mean coronal angulation was 2.1° (range 0–4°) and sagittal was 2.7° (range 1–4°). The mean shortening was 4.1 mm (range 0–8 mm). Three patients had partial flap necrosis and 1 patient had total flap necrosis. There was no superficial and deep wound infection. Conclusion: Staged treatment using NPWT decreased the risks of infection and requirement of flap surgeries in Gustilo Anderson grade IIIb open tibial fractures. Therefore, staged treatment using NPWT could be a useful treatment option for Gustilo Anderson grade IIIb open tibial fractures. PMID:27746498

  8. [Surgical care for the wounded in an armed conflict: the organization and support of first aid, prehospital and initial medical care (1)].

    PubMed

    Efimenko, N A; Gumanenko, E K; Samokhvalov, I M; Trusov, A A

    1999-06-01

    The article is devoted to surgical care organization to the battle casualties in Northern Caucasus, analysis of size and structure of "sanitary losses" (wounded in actions), questions of rendering first aid, battalion medical specialist aid and initial physician care. Gunshot wounds prevailed (64.1%) in the structure of battle surgical casualties. The blunt traumas and non-gunshot injuries have made of 33.2%, burns--4.1%, frost-bites--1.3%. The efficiency of medical care in this armed conflict is investigated on the own experience and retrospective analysis of graduated care to the 1030 casualties. Significance of duly rendering of the first aid to battle casualties is shown: the morality in this group had made 1.3%. Among wounded, which the first aid did not appear, the morality was of 7.0%.

  9. Comparison of standard surgical debridement versus the VERSAJET Plus™ Hydrosurgery system in the treatment of open tibia fractures: a prospective open label randomized controlled trial.

    PubMed

    Oosthuizen, Beyers; Mole, Trevor; Martin, Robin; Myburgh, Johannes G

    2014-01-01

    The aim of this study was to assess the efficacy of an alternative debridement technology in the treatment of Gustilo & Anderson grade III A and III B open tibia fractures. The objective was to explore whether improvements to the debridement using tangential hydrosurgery (VERSAJET™ Plus Smith & Nephew) could reduce the number of debridement episodes and the days before closure. A pilot scale randomized controlled trial was conducted against conventional surgery. A total of 40 patients were recruited. Sixteen patients received hydrosurgery and 24 patients were treated with standard surgical debridement. Baseline characteristics were well balanced. There was significant evidence (p < 0.001) that VERSAJET patients required fewer debridement procedures than standard surgical debridement prior to wound closure (ratio standard: VERSAJET = 1.747). The median time to wound closure was 3 days (95% CI 3 days, 5 days) for VERSAJET and 5 days (95% CI 4 days, 8 days) for standard debridement, although the difference was not statistically significant (p = 0.275). There were no instances of post-operative infection. PMID:25356370

  10. Comparison of standard surgical debridement versus the VERSAJET Plus™ Hydrosurgery system in the treatment of open tibia fractures: a prospective open label randomized controlled trial.

    PubMed

    Oosthuizen, Beyers; Mole, Trevor; Martin, Robin; Myburgh, Johannes G

    2014-01-01

    The aim of this study was to assess the efficacy of an alternative debridement technology in the treatment of Gustilo & Anderson grade III A and III B open tibia fractures. The objective was to explore whether improvements to the debridement using tangential hydrosurgery (VERSAJET™ Plus Smith & Nephew) could reduce the number of debridement episodes and the days before closure. A pilot scale randomized controlled trial was conducted against conventional surgery. A total of 40 patients were recruited. Sixteen patients received hydrosurgery and 24 patients were treated with standard surgical debridement. Baseline characteristics were well balanced. There was significant evidence (p < 0.001) that VERSAJET patients required fewer debridement procedures than standard surgical debridement prior to wound closure (ratio standard: VERSAJET = 1.747). The median time to wound closure was 3 days (95% CI 3 days, 5 days) for VERSAJET and 5 days (95% CI 4 days, 8 days) for standard debridement, although the difference was not statistically significant (p = 0.275). There were no instances of post-operative infection.

  11. Operative videothoracoscopy in the surgical treatment of penetrating firearms wounds of the chest.

    PubMed

    Brusov, P G; Kuritsyn, A N; Urazovsky, N Y; Tariverdiev, M L

    1998-09-01

    We prospectively analyzed our experience with operative videothoracoscopy (OVT) performed in a field military hospital in cases of penetrating firearms wounds of the thorax (PFAWT) sustained in Chechnya. From February to April 1996, we treated 206 wounded patients, of whom 37 (18.0%) had sustained chest injuries. PFAWT were present in 23 soldiers, accounting for 62.2% of all chest injuries. Twelve injuries were confined to the thorax, eight patients had associated injuries, and three soldiers had thoracoabdominal injuries. Nineteen patients had pleural drainage performed during medical evacuation. The thoracic injuries were right-sided (17), involved bullets or shell splinters (23); were through and through (16), represented solitary wounds (19), and were associated with internal organ injuries (21). Fifteen patients had indications for OVT when they were delivered from the battle-field 1.5 to 22 hours after injury. All patients manifested signs of hemorrhagic shock and hemodynamic instability. Indications for OVT were ongoing intrapleural bleeding (6), clotted hemothorax (6), or marked air leakage (3) preventing lung inflation with the OP-02 apparatus (field modification). OVT revealed 12 lung wounds, nine of which were multiple wounds, pleural bleeding in 6 patients, clotted hemothorax in 11 patients, and foreign bodies in 5 patients. Two patients underwent thoracotomy, one for suspicion of heart injury and the second because we could not adequately visualize and control bleeding revealed at OVT to be from the intercostal artery in the left costovertebral angle. Eight of 23 patients had no indication for operative videothoracoscopy and were managed with continued pleural aspiration and drug therapy. Wedge resection of the lung using an Endo-GIA-30 stapler was necessary in two patients because of parenchymal destruction and bleeding. Evacuation of clotted blood by fragmentation and aspiration was satisfactory in all cases. Satisfactory manual suturing of selected

  12. Clippers or the knife? The reform of surgical practice and the difficulty of early wound closure.

    PubMed

    Stephens-Borg, Keith

    2009-09-01

    Salt, vinegar and wine sounds more like a recipe from the Saturday kitchen, but in 1667 it was all a surgeon could use to close wounds, along with silk and linen strips. In providing this service, barbers and surgeons found themselves confused and intertwined, struggling for professional recognition that was about to experience reform. Allegations of neglect in the aftermath of a major seafaring battle on the very shores of our capital city required the court of King Charles II to search for a solution of supreme magnitude to accommodate the hundreds of maimed sailors who were littering the streets of London. A campaign to conceal the horrors of warfare began which lead to the implementation of the Greenwich charter and the construction of a hospital which the architect Christopher Wren helped to design.

  13. Non-surgical treatment of deep wounds triggered by harmful physical and chemical agents: a successful combined use of collagenase and hyaluronic acid.

    PubMed

    Onesti, Maria G; Fino, Pasquale; Ponzo, Ida; Ruggieri, Martina; Scuderi, Nicolò

    2016-02-01

    Some chronic ulcers often occur with slough, not progressing through the normal stages of wound healing. Treatment is long and other therapies need to be performed in addition to surgery. Patients not eligible for surgery because of ASA class (American Society of Anesthesiologists class) appear to benefit from chemical therapy with collagenase or hydrocolloids in order to prepare the wound bed, promoting the healing process. We describe four cases of traumatic, upper limb deep wounds caused by different physical and chemical agents, emphasising the effectiveness of treatment based on topical application of collagenase and hyaluronic acid (HA) before standardised surgical procedures. We performed careful disinfection of lesions combined with application of topical cream containing hyaluronic acid, bacterial fermented sodium hyaluronate (0·2%w/w) salt, and bacterial collagenase obtained from non-pathogenic Vibrio alginolyticus (>2·0 nkat1/g). In one patient a dermo-epidermal graft was used to cover the wide loss of substance. In two patients application of a HA-based dermal substitute was done. We obtained successful results in terms of wound healing, with satisfactory aesthetic result and optimal recovery of the affected limb functionality. Topical application of collagenase and HA, alone or before standardised surgical procedures allows faster wound healing. PMID:24698215

  14. Clostridium difficile ribotype 078 cultured from post-surgical non-healing wound in a patient carrying ribotype 014 in the intestinal tract.

    PubMed

    Nyc, Otakar; Krutova, Marcela; Kriz, Jiri; Matejkova, Jana; Bebrova, Eliska; Hysperska, Veronika; Kuijper, Ed J

    2015-11-01

    Extra-intestinal infections caused by Clostridium difficile are rare. The risk of extra-intestinal infections associated with C. difficile may be particularly relevant in environments contaminated with C. difficile spores. This paper describes the case of a non-diarrheic patient colonized with C. difficile ribotype 014 in the intestinal tract who developed a post-surgical wound infection by C. difficile ribotype 078. The infection responded to metronidazole administered first intravenously and then orally. This case indicates that C. difficile may not only be related to diarrheic diseases, but also to infections of non-healing wounds, especially in situations when C. difficile is the only isolated pathogen.

  15. Investigating the antimicrobial activity of natural honey and its effects on the pathogenic bacterial infections of surgical wounds and conjunctiva.

    PubMed

    Al-Waili, Noori S

    2004-01-01

    Antimicrobial activities of 10-100% (wt/vol) concentrations of new honey, stored honey, heated honey, ultraviolet-exposed honey, and heated stored honey were tested against common human pathogens, including Escherichia coli, Entrobacter cloacae, Pseudomonas aeruginosa, Shigella dysenteriae, Klebsiella sp., Haemophilus influenzae, Proteus sp., Staphylococcus aureus, Streptococcus hemolyticus group B, and Candida albicans. Antimicrobial activity of honey was tested in acidic, neutral, or alkaline media. These were compared with similar concentrations of glucose in nutrient broth. Surgical wounds were made on the dorsum of mice and infected with S. aureus or Klebsiella sp. The wounds were treated with local application of honey four times a day or appropriate antibiotics and compared with control values. Bacterial conjunctivitis due to E. coli, Proteus sp., S. aureus, Klebsiella sp., and P. aeruginosa was induced in rats. Conjunctival application of honey four times a day or appropriate antibiotics was used for treatment and compared with control values. Growth of all the isolates was completely inhibited by 30-100% honey concentrations. The most sensitive microbes were E. coli, P. aeruginosa, and H. influenzae. Glucose showed less antimicrobial activity than honey, and many microbes showed positive culture even in 100% glucose. Heating to 80 degrees C for 1 hour decreased antimicrobial activity of both new and stored honey. Storage of honey for 5 years decreased its antimicrobial activity, while ultraviolet light exposure increased its activity against some of the microorganisms. Antimicrobial activity of honey was stronger in acidic media than in neutral or alkaline media. Single doses of honey used to prepare the 60% concentration in nutrient broth were bacteriocidal for P. aeruginosa and bacteriostatic for S. aureus and Klebsiella sp. during certain periods. Local application of raw honey on infected wounds reduced redness, swelling, time for complete resolution

  16. Analysis of abdominal wounds made by surgical trocars using functional luminal imaging probe (FLIP) technology.

    PubMed

    McMahon, Barry P; O'Donovan, Deidre; Liao, Donghua; Zhao, Jingbo; Schiretz, Rich; Heninrich, Russell; Gregersen, Hans

    2008-09-01

    The aim was to use a novel functional luminal imaging probe for evaluation of wound defects and tissue damage resulting from the use of trocars. Following general anesthesia of 4 adult pigs, 6 different trocars were randomly inserted at preselected locations in the porcine abdominal wall. The functional luminal imaging probe was used to profile the trocar holes during bag distension from 8 axial cross-sectional area measurements. The cross-sectional areas and pressure in the bag were recorded and exported to Matlab for analysis and data display. Geometric profiles were generated, and the minimum cross-sectional area and hole length (abdominal wall thickness) were used as endpoints. Successful distensions were made in all cases. The slope of the contours increased away from the narrowest point of the hole. The slope increased more rapidly toward the inner abdominal wall than toward the outer wall. The slope of the linear trend lines for the cross-sectional area-pressure relation represents the compliance at the narrowest point in the wall. The hole length (abdominal wall thickness) could be obtained at different cross-sectional area cutoff points. A cutoff point of 300 mm(2) gave good results when compared to the length of the hole measured after the tissue was excised. This technique represents a new and straightforward way to evaluate the effects of trocars on the abdominal wall. It may also prove useful in comparing techniques and technology from different manufacturers. PMID:18757380

  17. Efficacy of silver coated surgical sutures on bacterial contamination, cellular response and wound healing.

    PubMed

    Gallo, Anna Lucia; Paladini, Federica; Romano, Alessandro; Verri, Tiziano; Quattrini, Angelo; Sannino, Alessandro; Pollini, Mauro

    2016-12-01

    The resistance demonstrated by many microorganisms towards conventional antibiotics has stimulated the interest in alternative antimicrobial agents and in novel approaches for prevention of infections. Silver, a natural braod-spectrum antimicrobial agent known since antiquity, has been widely employed in biomedical field due to its recognized antibacterial, antifungal and antiviral properties. In this work, antibacterial silver coatings were deposited on absorbable surgical sutures through the in situ photo-chemical deposition of silver clusters. Scanning electron microscopy (SEM), Energy dispersive X-ray spectroscopy (EDX) and thermo-gravimetric analysis (TGA) were performed in order to investigate the presence and distribution of the silver clusters on the substrate. The amounts of silver deposited and released by the silver treated sutures were calculated through Inductively Coupled Plasma-Mass Spectroscopy (ICP-MS), and the results were related to the biodegradation of the material. The microbiological properties and the potential cytotoxicity of the silver-treated sutures were investigated in relation with hydrolysis experiments, in order to determine the effect of the degradation on antibacterial properties and biocompatibility. PMID:27612783

  18. Abortion - surgical

    MedlinePlus

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  19. Matching biological mesh and negative pressure wound therapy in reconstructing an open abdomen defect.

    PubMed

    Caviggioli, Fabio; Klinger, Francesco Maria; Lisa, Andrea; Maione, Luca; Forcellini, Davide; Vinci, Valeriano; Codolini, Luca; Klinger, Marco

    2014-01-01

    Reconstruction of open abdominal defects is a clinical problem which general and plastic surgeons have to address in cooperation. We report the case of a 66-year-old man who presented an abdominal dehiscence after multiple laparotomies for a sigmoid-rectal adenocarcinoma that infiltrated into the abdominal wall, subsequently complicated by peritonitis and enteric fistula. A cutaneous dehiscence and an incontinent abdominal wall resulted after the last surgery. The abdominal wall was reconstructed using a biological porcine cross-linked mesh Permacol (Covidien Inc., Norwalk, CT). Negative Pressure Wound Therapy (NPWT), instead, was used on the mesh in order to reduce wound dimensions, promote granulation tissue formation, and obtain secondary closure of cutaneous dehiscence which was finally achieved with a split-thickness skin graft. Biological mesh behaved like a scaffold for the granulation tissue that was stimulated by the negative pressure. The biological mesh was rapidly integrated in the abdominal wall restoring abdominal wall continence, while the small dehiscence, still present in the central area, was subsequently covered with a split-thickness skin graft. The combination of these different procedures led us to solve this complicated case obtaining complete wound closure after less than 2 months.

  20. Comparison of CDE data in phacoemulsification between an open hospital-based ambulatory surgical center and a free-standing ambulatory surgical center.

    PubMed

    Chen, Ming; Chen, Mindy

    2010-01-01

    Mean CDE (cumulative dissipated energy) values were compared for an open hospital- based surgical center and a free-standing surgical center. The same model of phacoemulsifier (Alcon Infiniti Ozil) was used. Mean CDE values showed that surgeons (individual private practice) at the free-standing surgical center were more efficient than surgeons (individual private practice) at the open hospital-based surgical center (mean CDE at the hospital-based surgical center 18.96 seconds [SD = 12.51]; mean CDE at the free-standing surgical center 13.2 seconds [SD = 9.5]). CDE can be used to monitor the efficiency of a cataract surgeon and surgical center in phacoemulsification. The CDE value may be used by institutions as one of the indicators for quality control and audit in phacoemulsification.

  1. Evaluation of the effects of topical tripeptide-copper complex and zinc oxide on open-wound healing in rabbits.

    PubMed

    Cangul, I Taci; Gul, Nihal Y; Topal, Ayse; Yilmaz, Rahsan

    2006-12-01

    In this study the clinical and histopathological effects of topically applied tripeptide-copper complex (TCC) and zinc oxide on open-wound healing in rabbits was evaluated. Eighteen New Zealand rabbits were divided into three groups: TCC, zinc oxide and no treatment. One full thickness wound was created on each side of the dorsal midline in each rabbit. Wound margins were traced on days 0, 7, 14, and 21 and topical TCC and zinc oxide were applied daily for 21 days to each rabbit in the respective treatment groups. The mean unhealed wound area was significantly smaller in the TCC than in the zinc oxide group on day 7, but it was significantly smaller in the TCC group than in to the control group on days 7, 14 and 21. The mean percentage of wound contraction on day 7 was significantly higher in the TCC than in the zinc oxide group; however, it was significantly higher in the TCC group than in the control group on days 7, 14 and 21. Median time for the coverage of the wound bed with granulation tissue was significantly shorter in the TCC group than in the other groups. Filling of the open wound with granulation tissue to skin level was significantly slower in the control group than in the other two groups. Neutrophil counts decreased regardless of the group in parallel with healing, while neovascularization was best observed in the TCC group. The results suggest that TCC is a better choice in the treatment protocols of open wounds in rabbits than zinc oxide. PMID:17083573

  2. Evaluation of surgical treatment of Dupuytren's disease by modified open palm technique☆☆☆

    PubMed Central

    Guilhen, Thiago Almeida; Vieira, Ana Beatriz Macedo; de Castro, Marcelo Claudiano; Hirata, Helton Hiroshi; Machado, Itibagi Rocha

    2014-01-01

    Objective to assess the surgical technique using the modified palm open technique for the treatment of severe contractions of Dupuytren's disease. Methods over a period of four years, 16 patients underwent surgical treatment, and in its entirety belonged to stages III and IV of the classification proposed by Tubiana et al. We performed measurements of the extension deficit of the metacarpophalangeal joints, proximal and distal interphalangeal in preoperative, postoperative (3 months) and late postoperative period (5–8 years). Angles greater than 30° metacarpophalangeal joints and 15° proximal interphalangeal the results were considered surgical recurrence. Results there was obtained an average of 6.3° at the metacarpophalangeal joint, 13.8° in the proximal interphalangeal and distal interphalangeal at 1.9°. Conclusion the modified open palm technique is an effective method in the surgical treatment of severe contractures in Dupuytren's disease. PMID:26229769

  3. Comparison of Laparoscopic, Hand-Assisted, and Open Surgical Nephroureterectomy

    PubMed Central

    Maeda, Toshihiro; Tanaka, Toshiaki; Fukuta, Fumimasa; Kobayashi, Ko; Nishiyama, Naotaka; Takahashi, Satoshi; Masumori, Naoya

    2014-01-01

    Background and Objectives: The aim of this study was to compare oncologic outcomes after laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy for upper urinary tract urothelial cancer. Methods: Between April 1995 and August 2010, 189 patients underwent laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, or open nephroureterectomy for upper urinary tract urothelial cancer. Of these patients, 110 with no previous or concurrent bladder cancer or any metastatic disease were included in this study. Cancer-specific survival, recurrence-free survival, and intravesical recurrence-free survival rates were analyzed by the Kaplan-Meier method and compared with the log-rank test. The median follow-up period for the cohort was 70 months (range, 6–192 months). Results: The 3 groups were well matched for tumor stage, grade, and the presence of lymphovascular invasion and concomitant carcinoma in situ. The estimated 5-year cancer-specific survival rates were 81.1%, 65.6%, and 65.2% for laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy, respectively (P = .4179). The estimated 5-year recurrence-free survival rates were 33.8%, 10.0%, and 41.2% for laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy, respectively (P = .0245). The estimated 5-year intravesical recurrence-free survival rates were 64.8%, 10.0%, and 76.2% for laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy, respectively (P < .0001). Conclusion: Although there was no significant difference in cancer-specific survival rate among the laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy groups, hand-assisted laparoscopic nephroureterectomy may be inferior to laparoscopic nephroureterectomy or open nephroureterectomy

  4. Surgical wound care - closed

    MedlinePlus

    ... outlined below will help you remember. Getting prepared: Clean your hands before touching the dressing. Wash your hands with soap and warm water. Also clean under your nails. Rinse, then dry your hands ...

  5. Influence of naproxen on the healing of open excision wound in rats.

    PubMed

    Margaret, I; Jamil, K

    1997-01-01

    Excision wounds were made on the paravertebral area on the dorsal side of rat under light ether anaesthesia. The wound was a full thickness wound with removal of the skin upto the fascia. Animals were fed the drug naproxen in a gum acacia suspension with low, median and high doses based on the LD50 value of the drug. The animals were dosed upto the time eschar separated and no raw wound was left. Healing was assessed by planimetric measurement of the wound, periodically, thereby following wound closure by contraction. Granulation tissue formation and wound strength was assessed by using the granuloma model. Epithelialization was also determined. The cellular activity was assessed histologically and the biochemical indices on day of wounding and after the complete healing of the wound. Granulation tissue was used in assessing tensile strength and contraction. Histological sections of the wound on different days were assessed for connective tissue formation by the Mallory-Heidenhan stain. The closure of wounds were represented as percent contraction of original wound size and epithelialization as complete formation of epithelial layer with no rawness of the wound. The scar shape was noted and measured. The results of this study will be discussed.

  6. Treatment of postoperative lower extremity wounds using human fibroblast-derived dermis: a retrospective analysis.

    PubMed

    Carlson, Russell M; Smith, Nicholas C; Dux, Katherine; Stuck, Rodney M

    2014-04-01

    Human fibroblast-derived dermis skin substitute is a well-studied treatment for diabetic foot ulcers; however, no case series currently exist for its use in healing postoperative wounds of the lower extremity. A retrospective analysis was conducted on 32 lower extremity postoperative wounds treated weekly with human fibroblast-derived dermis skin substitute. Postoperative wounds were defined as a wound resulting from an open partial foot amputation, surgical wound dehiscence, or nonhealing surgical wound of the lower extremity. Wound surface area was calculated at 4 and 12 weeks or until wound closure if prior to 12 weeks. Postoperative wounds treated with weekly applications showed mean improvement in surface area reduction of 63.6% at 4 weeks and 96.1% at 12 weeks. More than 56% of all wounds healed prior to the 12-week endpoint. Additionally, only one adverse event was noted in this group. This retrospective review supports the use of human fibroblast-derived dermis skin substitute in the treatment of postoperative lower extremity wounds. This advanced wound care therapy aids in decreased total healing time and increased rate of healing for not only diabetic foot wounds but also postoperative wounds of the lower extremity, as demonstrated by this retrospective review.

  7. [Specialized surgical care for children (victims of the earthquake) with open injuries].

    PubMed

    Roshal', L M; Mitish, V A; Medinskiĭ, P V

    2014-01-01

    The article presents the authors' experience of providing specialized surgical care for 197 children who had been affected by the earthquake in Pakistan (2005), Indonesia (2006 and 2009) and Haiti (2010). All victims had open injuries of soft tissues and bones. The article recites the strategy and principles of work organization of the mobile team of specialists from the Research Institute of Clinical and Research Institute of Urgent Pediatric Surgery and Traumatology in disaster areas. It includes the creation of a center for specialized surgical care for children, consultative work in all regional hospitals to where victims are initially evacuated, transportation and concentration of children with the most severe injuries in a specialized center. The basic principles of interaction with the central and local public health authorities and medical staff of hospitals were developed. The main characteristics of such injuries and their complications were defined as well. Mistakes made by the local and international surgical teams at the stages of primary and specialized surgical care were described. The effectiveness of the applied strategy of active surgical treatment of open injuries of soft tissue and bones complicated by surgical infection has been analyzed.

  8. [Specialized surgical care for children (victims of the earthquake) with open injuries].

    PubMed

    Roshal', L M; Mitish, V A; Medinskiĭ, P V

    2014-01-01

    The article presents the authors' experience of providing specialized surgical care for 197 children who had been affected by the earthquake in Pakistan (2005), Indonesia (2006 and 2009) and Haiti (2010). All victims had open injuries of soft tissues and bones. The article recites the strategy and principles of work organization of the mobile team of specialists from the Research Institute of Clinical and Research Institute of Urgent Pediatric Surgery and Traumatology in disaster areas. It includes the creation of a center for specialized surgical care for children, consultative work in all regional hospitals to where victims are initially evacuated, transportation and concentration of children with the most severe injuries in a specialized center. The basic principles of interaction with the central and local public health authorities and medical staff of hospitals were developed. The main characteristics of such injuries and their complications were defined as well. Mistakes made by the local and international surgical teams at the stages of primary and specialized surgical care were described. The effectiveness of the applied strategy of active surgical treatment of open injuries of soft tissue and bones complicated by surgical infection has been analyzed. PMID:24429717

  9. Evaluation of the antioxidant activity and the healing action of the ethanol extract of Calotropis procera bark against surgical wounds

    PubMed Central

    Tsala, David Emery; Nga, Nnanga; Thiery, Bella Ndzana Martin; Bienvenue, Mballa Therese; Theophile, Dimo

    2015-01-01

    The objective of the present study was to evaluate the antioxidant potential and the wound healing effect of the ethanolic extract of the bark of Calotropis procera. The antioxidant study was evaluated in vitro, using 2,2-diphenylpicrylhydrazyl (DPPH) and deoxyribose degradation assays. Wound healing was studied using excision and incision wound on normal and dexamethasone-suppressed wound healing rodent models. Alkaloids, flavonoids, proteins and phenols were screened in the extract used whereas saponins and true tannins were absent. The extract contains only 12.5 gallic acid equivalent and 399.54 rutin equivalent. It was found to inhibit DPPH and deoxyribose oxidation (IC50 = 24.24 and 5.40 respectively). In vivo study demonstrated a significant reduction in the epithelialization time (P < 0.001) to 17-18 days in normal and dexamethasone treated rats following the ethanolic extract of the bark of C. procera application. The same extract also significantly increased the breaking strength in dexamethasone treated rats. Histological examination of incision wounds of treated group showed matured extracellular matrix, numerous fibroblasts. This study illustrated an excellent potential of the bark of C. procera therapy on dermal wound healing, with a tentative mechanism of action related to improved collagen deposition and reduced inflammatory reaction. PMID:26401387

  10. Surgical Anatomy of the Knee A Review of Common Open Approaches.

    PubMed

    Manning, Blaine T; Frank, Rachel M; Wetters, Nathan G; Bach, Bernard R; Rosenberg, Aaron G; Levine, Brett R

    2016-09-01

    Knee-related complaints are among the most commonly encountered conditions by orthopaedic surgeons. Knee pathology varies widely and includes arthritis, deformities, fractures, infections, neuromuscular disorders, oncologic diseases, and soft-tissue injury. While nonoperative treatment modalities (activity modification, medications, injections, and physical therapy) are typically used as primary interventions, surgical treatment may ultimately become necessary. The purpose of this review is to discuss the most common open approaches to the knee, with an emphasis on surgically relevant anatomy for each approach. Understanding of the anatomy of the knee joint and associated neurovascular structures is necessary in order to avoid intraoperative complications and optimize postoperative recovery. PMID:27620546

  11. Triclosan-coated sutures reduce surgical site infection after open vein harvesting in coronary artery bypass grafting patients: a randomized controlled trial†

    PubMed Central

    Thimour-Bergström, Linda; Roman-Emanuel, Christine; Scherstén, Henrik; Friberg, Örjan; Gudbjartsson, Tomas; Jeppsson, Anders

    2013-01-01

    OBJECTIVES The incidence of surgical site infection (SSI) after open vein harvesting in coronary artery bypass grafting (CABG) patients ranges in different studies between 2 and 20%. Triclosan is an antibacterial substance that reduces the growth of bacteria by inhibiting fatty acid synthesis. We hypothesized that wound closure with triclosan-coated sutures would reduce SSI after open vein harvesting. METHODS An investigator-initiated prospective randomized double-blind single-centre study was performed with 374 patients, randomized to subcutaneous and intracutaneous leg-wound closure with either triclosan-coated sutures (Vicryl Plus® and Monocryl Plus®, Ethicon, Somerville, NJ, USA) (n = 184) or identical sutures without triclosan (n = 190) from the same manufacturer. All patients were followed up after 30 days (clinical visit) and 60 days (telephone interview). Primary endpoint was SSI within 60 days after surgery according to the definition of Center for Disease Control. Predefined secondary endpoints included culture-proven and antibiotic-treated SSI. RESULTS The primary endpoint occurred in 23 patients (12.5%) with triclosan-coated sutures and in 38 patients (20.0%) in the group without triclosan (P = 0.0497, risk ratio 0.63, (95% confidence interval 0.39–1.00). Corresponding figures for culture-proven infections were 7.6 vs 12.1%, (P = 0.15), and for antibiotic-treated infections, 10.9 vs 18.4%, (P = 0.039). Staphylococcus aureus and coagulase-negative staphylococci were the most common pathogens in both groups. Insulin-treated diabetes and vein-harvesting time were associated with SSI after vein harvesting. CONCLUSIONS Leg-wound closure with triclosan-coated sutures in CABG patients reduces SSIs after open vein harvesting. (ClinicalTrials.gov number NCT01212315). PMID:23435526

  12. Open fractures and the incidence of infection in the surgical debridement 6 hours after trauma

    PubMed Central

    Fernandes, Miguel de Castro; Peres, Luciano Rodrigo; de Queiroz, Aristóteles Correia; Lima, José Queiroz; Turíbio, Flávio Moral; Matsumoto, Marcelo Hide

    2015-01-01

    Objectives: To determine whether a time delay greater than 6h from injury to surgical debridement influences the infection rate in open fractures. Methods: During a period of 18 months, from October 2010 to March 2012, 151 open fractures were available for study in 142 patients in our hospital. The data were collected prospectively and the patients were followed up for 6 weeks. The patients were divided into two groups regarding the time delay from injury to surgical debridement (more or less than 6 hours). Results: Surgical debridement was carried out in less than 6h from injury in 90 (59.6%) fractures and after 6 hours from injury in 61 (40.4%) fractures. Infection rates were 12.22% and 13.24%, respectively. The global infection rate was 13.24%. Conclusion: A significantly increased infection rate was not observed in patients whose surgical debridement occurred more than 6h after injury. However, in the fractures of high-energy trauma, a statistically significant increase of the rate of infection was observed in those operated 6 hours after trauma. Level of Evidence II, Study Type Comparative and Prospective. PMID:26327794

  13. Alcoholic Chlorhexidine or Alcoholic Iodine Skin Antisepsis (ACAISA): protocol for cluster randomised controlled trial of surgical skin preparation for the prevention of superficial wound complications in prosthetic hip and knee replacement surgery

    PubMed Central

    Peel, T N; Cheng, A C; Buising, K L; Dowsey, M M; Choong, P F M

    2014-01-01

    Introduction Wound complications following arthroplasty are associated with significant impact on the patient and healthcare system. Skin cleansing prior to surgical incision is a simple and effective method to prevent wound complications however, the question of which agent is superior for surgical skin antisepsis is unresolved. Methods and analysis This cluster randomised controlled trial aims to compare the incidence of superficial wound complications in patients undergoing elective prosthetic hip or knee replacement surgery receiving surgical skin antisepsis with either: 0.5% chlorhexidine gluconate (CHG) in 70% alcohol or 10% povidone in 70% alcohol. The trial will be conducted at an Australian tertiary, university affiliated hospital over a 3-year period involving 750 participants. Participants will be drawn from the surgical waiting list. Consent for this study will be ‘opt-out’ consent. On a given day, all eligible participants will have skin preparation either with 0.5% chlorhexidine in 70% alcohol or 10% povidone iodine in 70% alcohol. The primary outcome is superficial wound complications (comprised of superficial incisional surgical site infections (SSI) and/or prolonged wound ooze) in the first 30 days following prosthetic joint replacement surgery. Secondary outcomes will include the incidence of wound complications according to the joint replaced, assessment of the causative agents of SSI and cost-effectiveness analysis. The primary analysis is an intention-to-treat analysis including all participants who undergo randomisation and will be performed at the individual level taking into account the clustering effect. Ethics and dissemination The study design and protocol was reviewed and approved by the St Vincent's Hospital Human Research Ethics Committee (HREC-A 016/14 10/3/2014). Study findings will be disseminated in the printed media, and learned forums. A written lay summary will be available to study participants on request. Trial

  14. Incisional Negative Pressure Wound Therapy for Prevention of Postoperative Infections Following Caesarean Section

    ClinicalTrials.gov

    2016-10-17

    Surgical Wound Infection; Infection; Cesarean Section; Cesarean Section; Dehiscence; Complications; Cesarean Section; Complications; Cesarean Section, Wound, Dehiscence; Wound; Rupture, Surgery, Cesarean Section

  15. Role of Recipient-site Preparation Techniques and Post-operative Wound Dressing in the Surgical Management of Vitiligo

    PubMed Central

    Al-Hadidi, Nour; Griffith, James L; Al-Jamal, Mohammed S; Hamzavi, Iltefat

    2015-01-01

    Vitiligo is an acquired skin disorder characterized by the destruction of melanocytes resulting in achromic macules and patches involving the affected skin. Multiple methods of treatments have emerged to manage vitiligo, including medical and surgical techniques. Among the surgical techniques described in the management of vitiligo are minipunch grafting, split-thickness skin grafting, hair follicle transplantation, suction blister grafting, and cultured and non-cultured autologous melanocyte transplantation. However, prior to grafting optimal recipient-site preparation is needed for graft survival and successful repigmentation outcomes. Similarly, post-operative care of the recipient site is vital to yielding a viable graft irrespective of the transplantation technique employed. This article reviews the multiple methods employed to prepare the recipient site in vitiligo surgeries and the post-surgical conditions which optimize graft viability. A pubmed search was conducted utilizing the key words listed below. PMID:26157306

  16. Development of the Biopen: a handheld device for surgical printing of adipose stem cells at a chondral wound site.

    PubMed

    O'Connell, Cathal D; Di Bella, Claudia; Thompson, Fletcher; Augustine, Cheryl; Beirne, Stephen; Cornock, Rhys; Richards, Christopher J; Chung, Johnson; Gambhir, Sanjeev; Yue, Zhilian; Bourke, Justin; Zhang, Binbin; Taylor, Adam; Quigley, Anita; Kapsa, Robert; Choong, Peter; Wallace, Gordon G

    2016-03-01

    We present a new approach which aims to translate freeform biofabrication into the surgical field, while staying true to the practical constraints of the operating theatre. Herein we describe the development of a handheld biofabrication tool, dubbed the 'biopen', which enables the deposition of living cells and biomaterials in a manual, direct-write fashion. A gelatin-methacrylamide/hyaluronic acid-methacrylate (GelMa/HAMa) hydrogel was printed and UV crosslinked during the deposition process to generate surgically sculpted 3D structures. Custom titanium nozzles were fabricated to allow printing of multiple ink formulations in a collinear (side-by-side) geometry. Independently applied extrusion pressure for both chambers allows for geometric control of the printed structure and for the creation of compositional gradients. In vitro experiments demonstrated that human adipose stem cells maintain high viability (>97%) one week after biopen printing in GelMa/HAMa hydrogels. The biopen described in this study paves the way for the use of 3D bioprinting during the surgical process. The ability to directly control the deposition of regenerative scaffolds with or without the presence of live cells during the surgical process presents an exciting advance not only in the fields of cartilage and bone regeneration but also in other fields where tissue regeneration and replacement are critical. PMID:27004561

  17. Development of the Biopen: a handheld device for surgical printing of adipose stem cells at a chondral wound site.

    PubMed

    O'Connell, Cathal D; Di Bella, Claudia; Thompson, Fletcher; Augustine, Cheryl; Beirne, Stephen; Cornock, Rhys; Richards, Christopher J; Chung, Johnson; Gambhir, Sanjeev; Yue, Zhilian; Bourke, Justin; Zhang, Binbin; Taylor, Adam; Quigley, Anita; Kapsa, Robert; Choong, Peter; Wallace, Gordon G

    2016-03-01

    We present a new approach which aims to translate freeform biofabrication into the surgical field, while staying true to the practical constraints of the operating theatre. Herein we describe the development of a handheld biofabrication tool, dubbed the 'biopen', which enables the deposition of living cells and biomaterials in a manual, direct-write fashion. A gelatin-methacrylamide/hyaluronic acid-methacrylate (GelMa/HAMa) hydrogel was printed and UV crosslinked during the deposition process to generate surgically sculpted 3D structures. Custom titanium nozzles were fabricated to allow printing of multiple ink formulations in a collinear (side-by-side) geometry. Independently applied extrusion pressure for both chambers allows for geometric control of the printed structure and for the creation of compositional gradients. In vitro experiments demonstrated that human adipose stem cells maintain high viability (>97%) one week after biopen printing in GelMa/HAMa hydrogels. The biopen described in this study paves the way for the use of 3D bioprinting during the surgical process. The ability to directly control the deposition of regenerative scaffolds with or without the presence of live cells during the surgical process presents an exciting advance not only in the fields of cartilage and bone regeneration but also in other fields where tissue regeneration and replacement are critical.

  18. Unique Technique for Open Surgical Repair after Failed Endovascular Aneurysm Repair with Proximal Anastomoses.

    PubMed

    Takebayashi, Satoshi; Hirota, Jun; Mori, Kazuki; Shuto, Takashi; Okamoto, Keitaro; Sato, Aiko; Wada, Tomoyuki; Anai, Hirofumi; Miyamoto, Shinji

    2016-01-01

    Endovascular aortic aneurysm repair (EVAR) has revolutionized the management of abdominal aortic aneurysms (AAAs), with lower perioperative morbidity and mortality compared to conventional surgical repair. However, late secondary re-interventions after EVAR are still needed before aneurysm rupture in many cases. A patient with impending rupture of an AAA associated with a type I endoleak 7 years after EVAR who was successfully treated with a unique technique of fixation of the proximal aortic neck taking into account the structure of the stent graft is reported. This technique offers a safe solution to late open conversion after failed EVAR. PMID:27375808

  19. Unique Technique for Open Surgical Repair after Failed Endovascular Aneurysm Repair with Proximal Anastomoses

    PubMed Central

    Hirota, Jun; Mori, Kazuki; Shuto, Takashi; Okamoto, Keitaro; Sato, Aiko; Wada, Tomoyuki; Anai, Hirofumi; Miyamoto, Shinji

    2016-01-01

    Endovascular aortic aneurysm repair (EVAR) has revolutionized the management of abdominal aortic aneurysms (AAAs), with lower perioperative morbidity and mortality compared to conventional surgical repair. However, late secondary re-interventions after EVAR are still needed before aneurysm rupture in many cases. A patient with impending rupture of an AAA associated with a type I endoleak 7 years after EVAR who was successfully treated with a unique technique of fixation of the proximal aortic neck taking into account the structure of the stent graft is reported. This technique offers a safe solution to late open conversion after failed EVAR. PMID:27375808

  20. Surgical treatment of type I Chiari malformation: the role of Magendie's foramen opening e tonsils manipulation.

    PubMed

    Vidal, Claudio Henrique Fernandes

    2015-02-01

    The treatment for type 1 Chiari malformation (CM 1) is one of the most controversial topics in the neurosurgical field. The present study evaluated two of the most applied surgical techniques to treat CM 1. Method 32 patients were evaluated and divided in two groups: group 1 had 16 patients that were submitted to decompression of occipital bone and dura mater of the craniovertebral junction (CVJ); group 2 also had 16 patients and in addition to the previous procedure, they were submitted to Magendie's foramen opening e tonsils manipulation. The comparison between the groups included neurological exam and cerebrospinal fluid flow imaging during pre and postoperative periods. Results Both techniques were equivalents in terms of neurological improvement of the patients (p > 0.05), but the group 2 had more surgical complications, with relative risk of 2.45 (CI 1.55-3.86) for adverse events. Whatever the cerebrospinal fluid flow at CVJ, the patients of the group 1 achieved greater amount of flow than the group 2 (p < 0.05) during the postoperative period. Conclusion The cranial and dural decompression of the CVJ without arachnoidal violation was the best surgical intervention for treatment of CM 1, between these two compared techniques.

  1. Surgical approach to right colon cancer: From open technique to robot. State of art

    PubMed Central

    Fabozzi, Massimiliano; Cirillo, Pia; Corcione, Francesco

    2016-01-01

    This work is a topic highlight on the surgical treatment of the right colon pathologies, focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures. Different laparoscopic procedures have been described for the treatment of right colon tumors: Totally laparoscopic right colectomy, laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy, single incision laparoscopic surgery colectomy, robotic right colectomy. Two main characteristics of these techniques are the different type of anastomosis: Intracorporeal (for totally laparoscopic right colectomy, single incision laparoscopic surgery colectomy, laparoscopic assisted right colectomy and robotic technique) or extracorporeal (for laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy and open right colectomy) and the different incision (suprapubic, median or transverse on the right side of abdomen). The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon. The totally laparoscopic right colectomy with intracorporeal anastomosis and even more the single incision laparoscopic surgery colectomy, remain a technical challenge due to the complexity of procedures (especially for the single incision laparoscopic surgery colectomy) and the particular right colon vascular anatomy but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures. Data reported in literature while confirming the advantages of laparoscopic approach, do not allow to solve controversies about which is the best laparoscopic technique (Intracorporeal vs Extracorporeal Anastomosis) to treat the right colon cancer. However, the laparoscopic techniques with intracorporeal anastomosis for the right colon seem to show some theoretical advantages (functional, technical

  2. Surgical approach to right colon cancer: From open technique to robot. State of art

    PubMed Central

    Fabozzi, Massimiliano; Cirillo, Pia; Corcione, Francesco

    2016-01-01

    This work is a topic highlight on the surgical treatment of the right colon pathologies, focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures. Different laparoscopic procedures have been described for the treatment of right colon tumors: Totally laparoscopic right colectomy, laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy, single incision laparoscopic surgery colectomy, robotic right colectomy. Two main characteristics of these techniques are the different type of anastomosis: Intracorporeal (for totally laparoscopic right colectomy, single incision laparoscopic surgery colectomy, laparoscopic assisted right colectomy and robotic technique) or extracorporeal (for laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy and open right colectomy) and the different incision (suprapubic, median or transverse on the right side of abdomen). The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon. The totally laparoscopic right colectomy with intracorporeal anastomosis and even more the single incision laparoscopic surgery colectomy, remain a technical challenge due to the complexity of procedures (especially for the single incision laparoscopic surgery colectomy) and the particular right colon vascular anatomy but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures. Data reported in literature while confirming the advantages of laparoscopic approach, do not allow to solve controversies about which is the best laparoscopic technique (Intracorporeal vs Extracorporeal Anastomosis) to treat the right colon cancer. However, the laparoscopic techniques with intracorporeal anastomosis for the right colon seem to show some theoretical advantages (functional, technical

  3. Surgical approach to right colon cancer: From open technique to robot. State of art.

    PubMed

    Fabozzi, Massimiliano; Cirillo, Pia; Corcione, Francesco

    2016-08-27

    This work is a topic highlight on the surgical treatment of the right colon pathologies, focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures. Different laparoscopic procedures have been described for the treatment of right colon tumors: Totally laparoscopic right colectomy, laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy, single incision laparoscopic surgery colectomy, robotic right colectomy. Two main characteristics of these techniques are the different type of anastomosis: Intracorporeal (for totally laparoscopic right colectomy, single incision laparoscopic surgery colectomy, laparoscopic assisted right colectomy and robotic technique) or extracorporeal (for laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy and open right colectomy) and the different incision (suprapubic, median or transverse on the right side of abdomen). The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon. The totally laparoscopic right colectomy with intracorporeal anastomosis and even more the single incision laparoscopic surgery colectomy, remain a technical challenge due to the complexity of procedures (especially for the single incision laparoscopic surgery colectomy) and the particular right colon vascular anatomy but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures. Data reported in literature while confirming the advantages of laparoscopic approach, do not allow to solve controversies about which is the best laparoscopic technique (Intracorporeal vs Extracorporeal Anastomosis) to treat the right colon cancer. However, the laparoscopic techniques with intracorporeal anastomosis for the right colon seem to show some theoretical advantages (functional, technical

  4. Surgical approach to right colon cancer: From open technique to robot. State of art.

    PubMed

    Fabozzi, Massimiliano; Cirillo, Pia; Corcione, Francesco

    2016-08-27

    This work is a topic highlight on the surgical treatment of the right colon pathologies, focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures. Different laparoscopic procedures have been described for the treatment of right colon tumors: Totally laparoscopic right colectomy, laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy, single incision laparoscopic surgery colectomy, robotic right colectomy. Two main characteristics of these techniques are the different type of anastomosis: Intracorporeal (for totally laparoscopic right colectomy, single incision laparoscopic surgery colectomy, laparoscopic assisted right colectomy and robotic technique) or extracorporeal (for laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy and open right colectomy) and the different incision (suprapubic, median or transverse on the right side of abdomen). The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon. The totally laparoscopic right colectomy with intracorporeal anastomosis and even more the single incision laparoscopic surgery colectomy, remain a technical challenge due to the complexity of procedures (especially for the single incision laparoscopic surgery colectomy) and the particular right colon vascular anatomy but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures. Data reported in literature while confirming the advantages of laparoscopic approach, do not allow to solve controversies about which is the best laparoscopic technique (Intracorporeal vs Extracorporeal Anastomosis) to treat the right colon cancer. However, the laparoscopic techniques with intracorporeal anastomosis for the right colon seem to show some theoretical advantages (functional, technical

  5. The Cost-Effectiveness of Wound-Edge Protection Devices Compared to Standard Care in Reducing Surgical Site Infection after Laparotomy: An Economic Evaluation alongside the ROSSINI Trial

    PubMed Central

    Gheorghe, Adrian; Roberts, Tracy E.; Pinkney, Thomas D.; Bartlett, David C.; Morton, Dion; Calvert, Melanie

    2014-01-01

    Background Wound-edge protection devices (WEPDs) have been used in surgery for more than 40 years to reduce surgical site infection (SSI). No economic evaluation of WEPDs against any comparator has ever been conducted. The aim of the paper was to assess whether WEPDs are cost-effective in reducing SSI compared to standard care alone in the United Kingdom. Methods and Findings An economic evaluation was conducted alongside the ROSSINI trial. The study perspective was that of the UK National Health Service and the time horizon was 30 days post-operatively. The study was conducted in 21 UK hospitals. 760 patients undergoing laparotomy were randomised to either WEPD or standard care and 735 were included in the primary analysis. The main economic outcome was cost-effectiveness based on incremental cost (£) per quality adjusted life year (QALY) gained. Patients in the WEPD arm accessed health care worth £5,420 on average and gained 0.02131 QALYs, compared to £5,130 and 0.02133 QALYs gained in the standard care arm. The WEPD strategy was more costly and equally effective compared to standard care, but there was significant uncertainty around incremental costs and QALYs. The findings were robust to a range of sensitivity analyses. Conclusions There is no evidence to suggest that WEPDs can be considered a cost effective device to reduce SSI. Their continued use is a waste of limited health care resources. PMID:24748154

  6. Surgical drain after open or laparoscopic splenectomy: is it needed or contraindicated?

    PubMed Central

    VECCHIO, R.; INTAGLIATA, E.; MARCHESE, S.; BATTAGLIA, S.; CACCIOLA, R.R.; CACCIOLA, E.

    2015-01-01

    Objective The Authors report their experience with the routine use of surgical drainage in a large series of splenectomies. Summary of background data Benefits and risks related to surgical drains have been always discussed, with some surgeons in favor of them and skeptic others considering not physiological their use. After splenectomy, their use is also largely debated, especially because of susceptibility of operated patients to infections. Patients and methods Two thousand nine cases have been reviewed. Indications for splenectomy, performed either by open or laparoscopic approach, included idiopathic thrombocytopenic purpura in 137 patients (65,4%), splenic lymphoma in 36 (17,2%), hereditary spherocytosis in 15 (7,4%), β-thalassemia in 8 (3,7%), other diseases in 13 (6,1%). Results “Active” or “passive” drains were placed in 80% and 20% of cases, respectively. Drains were removed 2–3 days after surgery in 90,2%, within 10 days in 4,3%, within 2 months in 0,4% of cases. In 2 cases a post-operative bleeding, detected through the drainage, required re-operation. One patient developed a subphrenic abscess, successfully treated by a percutaneous drainage. One case of pancreatic fistula was observed. Conclusions In Authors’ experience, the use of drains after splenectomy does not affect the risk of subsequent infectious complications, independently on the type of the drainage system used. Early removal of drains in this series might have played an important role in the very low incidence of abdominal infections reported. The use of surgical drains after splenectomy might play an important role to early detect post-operative bleeding, as it happened in 2 cases of this series. PMID:26188753

  7. The Midterm Surgical Outcome of Modified Expansive Open-Door Laminoplasty

    PubMed Central

    Yeh, Kuang-Ting; Lee, Ru-Ping; Chen, Ing-Ho; Yu, Tzai-Chiu; Peng, Cheng-Huan; Liu, Kuan-Lin; Wang, Jen-Hung

    2016-01-01

    Laminoplasty is a standard technique for treating patients with multilevel cervical spondylotic myelopathy. Modified expansive open-door laminoplasty (MEOLP) preserves the unilateral paraspinal musculature and nuchal ligament and prevents facet joint violation. The purpose of this study was to elucidate the midterm surgical outcomes of this less invasive technique. We retrospectively recruited 65 consecutive patients who underwent MEOLP at our institution in 2011 with at least 4 years of follow-up. Clinical conditions were evaluated by examining neck disability index, Japanese Orthopaedic Association (JOA), Nurick scale, and axial neck pain visual analog scale scores. Sagittal alignment of the cervical spine was assessed using serial lateral static and dynamic radiographs. Clinical and radiographic outcomes revealed significant recovery at the first postoperative year and still exhibited gradual improvement 1–4 years after surgery. The mean JOA recovery rate was 82.3% and 85% range of motion was observed at the final follow-up. None of the patients experienced aggravated or severe neck pain 1 year after surgery or showed complications of temporary C5 nerve palsy and lamina reclosure by the final follow-up. As a less invasive method for reducing surgical dissection by using various modifications, MEOLP yielded satisfactory midterm outcomes. PMID:27563676

  8. The Midterm Surgical Outcome of Modified Expansive Open-Door Laminoplasty.

    PubMed

    Yeh, Kuang-Ting; Lee, Ru-Ping; Chen, Ing-Ho; Yu, Tzai-Chiu; Peng, Cheng-Huan; Liu, Kuan-Lin; Wang, Jen-Hung; Wu, Wen-Tien

    2016-01-01

    Laminoplasty is a standard technique for treating patients with multilevel cervical spondylotic myelopathy. Modified expansive open-door laminoplasty (MEOLP) preserves the unilateral paraspinal musculature and nuchal ligament and prevents facet joint violation. The purpose of this study was to elucidate the midterm surgical outcomes of this less invasive technique. We retrospectively recruited 65 consecutive patients who underwent MEOLP at our institution in 2011 with at least 4 years of follow-up. Clinical conditions were evaluated by examining neck disability index, Japanese Orthopaedic Association (JOA), Nurick scale, and axial neck pain visual analog scale scores. Sagittal alignment of the cervical spine was assessed using serial lateral static and dynamic radiographs. Clinical and radiographic outcomes revealed significant recovery at the first postoperative year and still exhibited gradual improvement 1-4 years after surgery. The mean JOA recovery rate was 82.3% and 85% range of motion was observed at the final follow-up. None of the patients experienced aggravated or severe neck pain 1 year after surgery or showed complications of temporary C5 nerve palsy and lamina reclosure by the final follow-up. As a less invasive method for reducing surgical dissection by using various modifications, MEOLP yielded satisfactory midterm outcomes. PMID:27563676

  9. Complications of laparoscopic versus open bariatric surgical interventions in obesity management.

    PubMed

    Yin, Jian; Hou, Xuhui

    2014-11-01

    With the epidemic of obesity fast spreading its grasp throughout the world, the medical professionals of diverse facilities need to be called on for better management to prevent its further progression. In particular, the gastroenterologists have a major role to play in all aspects of obese patient care. They should be able to recognize and treat obesity and associated disorders through the understanding and assessment of the various benefits and risks linked with a particular type of obesity treatment option. While treating these problems, a better understanding of the physiologic and anatomic alterations that might be associated with the treatment procedure and the weight loss-linked problems in association with the method of surgical intervention need to be weighed. Morbid obesity has been efficaciously treated by bariatric surgery promoting weight loss considerably and reducing the obesity-associated risks such as certain cancers, diabetes, cardiovascular disease, and all-cause mortality. Bariatric surgery has been performed traditionally through open method or, the more recent and popular form, laparoscopically that involves only a small incision in the abdomen. The laparoscopic bariatric surgery has become the surgical method of choice since its introduction in 1993 and has immediately crossed open surgery in terms of popularity. Drastic numbers came out when the two methods were compared for their applicability during a 3-year period in the United States. Only 6,000 reported open gastric bypass surgeries were recorded, but the number soared to nearly 16,000 for laparoscopic gastric bypass surgeries. The laparoscopic method has been found to be associated with much reduced complications and hospital stay along with lower cases of mortality as suggested by small randomized controlled trials and observational studies. However, these facts need to be reassessed through large-sized controlled trials and population-based studies. In addition, the previously

  10. A prospective randomised open label study to evaluate the potential of a new silver alginate/carboxymethylcellulose antimicrobial wound dressing to promote wound healing.

    PubMed

    Beele, Hilde; Meuleneire, Frans; Nahuys, Marc; Percival, Steven L

    2010-08-01

    The aim of this study was to observe both the clinical signs and symptoms of wounds at risk of infection, that is critically colonised (biofilm infected) and antimicrobial-performance of an ionic silver alginate/carboxymethylcellulose (SACMC) dressing, in comparison with a non silver calcium alginate fibre (AF) dressing, on chronic venous leg and pressure ulcers. Thirty-six patients with venous or pressure ulcers, considered clinically to be critically colonised (biofilm infected), were randomly chosen to receive either an SACMC dressing or a non silver calcium AF dressing. The efficacy of each wound dressing was evaluated over a 4-week period. The primary study endpoints were prevention of infection and progression to wound healing. The SACMC group showed a statistically significant (P = 0.017) improvement to healing as indicated by a reduction in the surface area of the wound, over the 4-week study period, compared with AF controls. In conclusion, the SACMC dressing showed a greater ability to prevent wounds progressing to infection when compared with the AF control dressing. In addition, the results of this study also showed an improvement in wound healing for SACMC when compared with a non silver dressing.

  11. Vascular Complications and Bleeding After Transfemoral Transcatheter Aortic Valve Implantation Performed Through Open Surgical Access.

    PubMed

    Leclercq, Florence; Akodad, Mariama; Macia, Jean-Christophe; Gandet, Thomas; Lattuca, Benoit; Schmutz, Laurent; Gervasoni, Richard; Nogue, Erika; Nagot, Nicolas; Levy, Gilles; Maupas, Eric; Robert, Gabriel; Targosz, Frederic; Vernhet, Hélène; Cayla, Guillaume; Albat, Bernard

    2015-11-01

    Major vascular complications (VC) remain frequent after transcatheter aortic valve implantation (TAVI) and may be associated with unfavorable clinical outcomes. The objective of this study was to evaluate the rate of VC after transfemoral TAVI performed using an exclusive open surgical access strategy. From 2010 to 2014, we included in a monocentric registry all consecutive patients who underwent transfemoral TAVI. The procedures were performed with 16Fr to 20Fr sheath systems. VC were evaluated within 30 days and classified as major or minor according to the Valve Academic Research Consortium 2 definition. The study included 396 patients, 218 were women (55%), median age was 85 years (81 to 88), and the median logistic Euroscore was 15.2% (11 to 23). The balloon-expandable SAPIEN XT and the self-expandable Medtronic Core Valve prosthesis were used in 288 (72.7%) and 108 patients (27.3%), respectively. The total length of the procedure was 68 ± 15 minutes including 13 ± 5 minutes for the open surgical access. Major and minor VC were observed in 9 (2.3%) and 16 patients (4%), respectively, whereas life-threatening and major bleeding concerned 18 patients (4.6%). The median duration of hospitalization was 5 days (interquartile range 2 to 7), significantly higher in patients with VC (7 days [5 to 15], p <0.001). Mortality at 1-month and 1-year follow-up (n = 26, 6.6%; and n = 67, 17.2%, respectively) was not related to major or minor VC (p = 0.6). In multivariable analysis, only diabetes (odds ratio 2.5, 95% confidence interval 1.1 to 6.1, p = 0.034) and chronic kidney failure (odds ratio 3.0, 95% confidence interval 1.0 to 9.0, p = 0.046) were predictive of VC, whereas body mass index, gender, Euroscore, and lower limb arteriopathy were not. In conclusion, minimal rate of VC and bleeding can be obtained after transfemoral TAVI performed using an exclusive surgical strategy, with a particular advantage observed in high-risk bleeding patients.

  12. Vascular Complications and Bleeding After Transfemoral Transcatheter Aortic Valve Implantation Performed Through Open Surgical Access.

    PubMed

    Leclercq, Florence; Akodad, Mariama; Macia, Jean-Christophe; Gandet, Thomas; Lattuca, Benoit; Schmutz, Laurent; Gervasoni, Richard; Nogue, Erika; Nagot, Nicolas; Levy, Gilles; Maupas, Eric; Robert, Gabriel; Targosz, Frederic; Vernhet, Hélène; Cayla, Guillaume; Albat, Bernard

    2015-11-01

    Major vascular complications (VC) remain frequent after transcatheter aortic valve implantation (TAVI) and may be associated with unfavorable clinical outcomes. The objective of this study was to evaluate the rate of VC after transfemoral TAVI performed using an exclusive open surgical access strategy. From 2010 to 2014, we included in a monocentric registry all consecutive patients who underwent transfemoral TAVI. The procedures were performed with 16Fr to 20Fr sheath systems. VC were evaluated within 30 days and classified as major or minor according to the Valve Academic Research Consortium 2 definition. The study included 396 patients, 218 were women (55%), median age was 85 years (81 to 88), and the median logistic Euroscore was 15.2% (11 to 23). The balloon-expandable SAPIEN XT and the self-expandable Medtronic Core Valve prosthesis were used in 288 (72.7%) and 108 patients (27.3%), respectively. The total length of the procedure was 68 ± 15 minutes including 13 ± 5 minutes for the open surgical access. Major and minor VC were observed in 9 (2.3%) and 16 patients (4%), respectively, whereas life-threatening and major bleeding concerned 18 patients (4.6%). The median duration of hospitalization was 5 days (interquartile range 2 to 7), significantly higher in patients with VC (7 days [5 to 15], p <0.001). Mortality at 1-month and 1-year follow-up (n = 26, 6.6%; and n = 67, 17.2%, respectively) was not related to major or minor VC (p = 0.6). In multivariable analysis, only diabetes (odds ratio 2.5, 95% confidence interval 1.1 to 6.1, p = 0.034) and chronic kidney failure (odds ratio 3.0, 95% confidence interval 1.0 to 9.0, p = 0.046) were predictive of VC, whereas body mass index, gender, Euroscore, and lower limb arteriopathy were not. In conclusion, minimal rate of VC and bleeding can be obtained after transfemoral TAVI performed using an exclusive surgical strategy, with a particular advantage observed in high-risk bleeding patients. PMID

  13. Wound Care.

    PubMed

    Balsa, Ingrid M; Culp, William T N

    2015-09-01

    Wound care requires an understanding of normal wound healing, causes of delays of wound healing, and the management of wounds. Every wound must be treated as an individual with regard to cause, chronicity, location, and level of microbial contamination, as well as patient factors that affect wound healing. Knowledge of wound care products available and when negative pressure wound therapy and drain placement is appropriate can improve outcomes with wound healing. Inappropriate product use can cause delays in healing. As a wound healing progresses, management of a wound and the bandage material used must evolve.

  14. Comparison of the Width of Peritumoral Surgical Margin in Open and Robotic Partial Nephrectomy: A Propensity Score Matched Analysis

    PubMed Central

    Oh, Jong Jin; Lee, Jung Keun; Kim, Kwangmo; Byun, Seok-Soo; Lee, Sang Eun

    2016-01-01

    Background To compare the surgical margin status after open partial nephrectomy (OPN) and robotic partial nephrectomy (RPN) performed in patients with T1a renal cell carcinoma (RCC). Methods This was a propensity score-matched study including 702 patients with cT1a RCC treated with partial nephrectomy (PN) between May 2003 and July 2015. Perioperative parameters, including surgical margin width after PN, were compared between two surgical methods. After determining propensity score for tumor size and location, the width of peritumoral surgical margin was investigated. Multivariate logistic analysis to predict peritumoral surgical margin less than 1mm was analyzed. Results The mean width of peritumoral surgical margin was 2.61 ± 2.15 mm in OPN group (n = 385), significantly wider than the 2.29 ± 2.00 mm of RPN group (n = 317) (p = 0.042). The multivariate analysis showed surgical methods was significant factors to narrow surgical margin less than 1mm (p = 0.031). After propensity score matching, the surgical margin width was significantly longer in OPN (2.67 ± 2.14 mm) group than RPN (2.25 ± 2.03 mm) group (p = 0.016). A positive resection margin occurred in 7 (1.8%) patients in the OPN group and 4 (1.3%) in the RPN group. During the median follow-up of 48.3 months, two patients who underwent OPN had tumor bed recurrence. Conclusions RPN may result in a narrower peritumoral surgical margin than OPN. Further investigation on the potential impact of such a phenomenon should be performed in a larger-scale study. PMID:27336438

  15. The renal tumor morphological characteristics that affect surgical planning for laparoscopic or open partial nephrectomy.

    PubMed

    Funahashi, Yasuhito; Murotani, Kenta; Yoshino, Yasushi; Sassa, Naoto; Ishida, Shohei; Gotoh, Momokazu

    2015-02-01

    The purpose of this study is to investigate the morphological characteristics of renal tumors which affect the surgeons' decision-making for the selection of open or laparoscopic partial nephrectomy. We included 147 patients who underwent partial nephrectomy for renal masses with elective indications in this study. Laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) were performed in 72 and 75 patients, respectively. Preoperative trans-sectional images were used to assess tumor characteristics such as tumor size, endophyticity, distance from the sinus, distance from the kidney equator, hilar designation, inside designation, and R.E.N.A.L. nephrometry score. Univariate logistic regression analyses demonstrated that tumor size, endophyticity, distance from the sinus, hilar designation, inside designation, and R.E.N.A.L. nephrometry score were associated with decision of laparoscopic partial nephrectomy. Among these factors, multiple regression analyses showed that endophyticity (odds ratio = 0.92, p = 0.007) and distance from the sinus (odds ratio = 1.201, p < 0.001) had statistically significant associations with the type of operation performed. ROC analyses demonstrated cut-off values of 16 mm for endophyticity (sensitivity 69%, specificity 77%) and of 4 mm for distance from the sinus (sensitivity 79%, specificity 65%) for predicting the selection of laparoscopic surgery. In conclusion, this study revealed that endophyticity and distance from the sinus were important for the surgical planning of partial nephrectomy.

  16. [THE PRINCIPLES OF ORGANIZATION AND TREATMENT FOR SORTING OF WOUNDED PERSONS WITH A COMBAT SURGICAL TRAUMA OF EXTREMITIES ON THE IV LEVEL OF THE MEDICAL CARE PROVISION].

    PubMed

    Korohl, S O; Zherdev, I I; Domanskiy, A M

    2015-12-01

    Experience of medical sorting of 434 injured persons with a gun-shot woundings of extremities in 2014-2015 yrs is adduced. The principles of organization and treatment for medical sorting of wounded persons were elaborated. Prognostic intrahospital, diagnostic and evacuation--transport sorting was introduced in wounded persons in the IV level hospital, concerning severity of traumatic shock and prognosis of their survival.

  17. [THE PRINCIPLES OF ORGANIZATION AND TREATMENT FOR SORTING OF WOUNDED PERSONS WITH A COMBAT SURGICAL TRAUMA OF EXTREMITIES ON THE IV LEVEL OF THE MEDICAL CARE PROVISION].

    PubMed

    Korohl, S O; Zherdev, I I; Domanskiy, A M

    2015-12-01

    Experience of medical sorting of 434 injured persons with a gun-shot woundings of extremities in 2014-2015 yrs is adduced. The principles of organization and treatment for medical sorting of wounded persons were elaborated. Prognostic intrahospital, diagnostic and evacuation--transport sorting was introduced in wounded persons in the IV level hospital, concerning severity of traumatic shock and prognosis of their survival. PMID:27025033

  18. Wet wound healing.

    PubMed

    Vranckx, Jan J; Slama, Jaromir; Preuss, Stefan; Perez, Norvin; Svensjö, Tor; Visovatti, Scott; Breuing, Karl; Bartlett, Richard; Pribaz, Julian; Weiss, Denton; Eriksson, Elof

    2002-12-01

    Wound treatment in a flexible transparent chamber attached to the perimeter of the wound and containing a liquid has been extensively tested in preclinical experiments in pigs and found to offer several advantages. It protects the wound; the liquid medium or saline in the chamber provides in vivo tissue culture-like conditions; and antibiotics, analgesics, and various molecules can be delivered to the wound through the chamber. The wound chamber causes no injury to the wound itself or to the surrounding intact skin. Topical delivery of, for instance, antibiotics can provide very high concentrations at the wound site and with a favorable direction of the concentration gradient. A series of 28 wounds in 20 patients were treated with a wound chamber containing saline and antibiotics. Most patients had significant comorbidity and had not responded to conservative or surgical management with débridement and delayed primary closure or skin grafts. Six wounds had foreign bodies present; four of these were joint prostheses. Seven patients were on corticosteroids for rheumatoid arthritis, lupus, or chronic obstructive pulmonary disease, and four patients had diabetes. Most patients were treated with the wound chamber in preparation for a delayed skin graft or flap procedure, but one was treated with a wound chamber until the wound healed. Twenty-five of the wounds (89 percent) healed, and five wounds (18 percent) required additional conservative management after the initial chamber treatment and grafting procedure. Of the three wounds that did not heal, one healed after additional chamber treatment, one had a skin graft that did not take, and one required reamputation at a higher level. Antibiotic delivery was less than one intravenous dose daily, which avoided the potential for systemic absorption to toxic levels. Antibiotics such as vancomycin and gentamicin could be used in concentrations of up to 10,000 times the minimal inhibitory concentration. Forty-eight hours

  19. Wound healing for the clinician.

    PubMed

    Zitelli, J

    1987-01-01

    Wound healing is a complex sequence of events, beginning with tissue injury, mediated by inflammation, and ending long after reepithelialization is complete. Research and controlled clinical experience have provided a better understanding so that clinicians can influence the events of healing to decrease pain, control bleeding, infection, and cosmetic result as well as speed the time for complete healing. The following is a summary of guidelines for the management of wound healing: (1) wound creation; wounds should be created with minimal necrosis of tissue in order to prevent delays in healing. Electrosurgical, cryosurgical, and laser surgical wounds heal more slowly than wounds created by scalpel excision or curettage. Electro-coagulation should be used sparingly in sutured wounds. Large lesions are best treated in a single stage rather than in divided treatments since the rate of wound healing is not proportional to the area but instead to the logarithm of the area. Thus, the total healing time is much shorter if done in a single treatment session. (2) use of drugs; corticosteroids given before or within three days of wounding in dose of prednisone 40 mg or greater will inhibit wound healing. Vitamin A topically or systemically may reverse this inhibition. Aspirin and other nonsteroidal anti-inflammatory agents are more important for their effects on platelet function and bleeding than on wound healing. (3) wound dressings; the use of occlusive dressings to promote moist wound healing is the most significant advance in wound management. Occlusive dressings shorten the time for healing, decrease pain, reduce wound contamination, and improve the cosmetic result. (4) control of wound contraction and scar formation; at the time of wound formation, guiding sutures may be helpful in wound healing by secondary intention in order to control the direction of wound contraction and prevent distortion. Intralesional steroids may be useful for hypertrophic scars and keloids

  20. Wound healing for the clinician.

    PubMed

    Zitelli, J

    1987-01-01

    Wound healing is a complex sequence of events, beginning with tissue injury, mediated by inflammation, and ending long after reepithelialization is complete. Research and controlled clinical experience have provided a better understanding so that clinicians can influence the events of healing to decrease pain, control bleeding, infection, and cosmetic result as well as speed the time for complete healing. The following is a summary of guidelines for the management of wound healing: (1) wound creation; wounds should be created with minimal necrosis of tissue in order to prevent delays in healing. Electrosurgical, cryosurgical, and laser surgical wounds heal more slowly than wounds created by scalpel excision or curettage. Electro-coagulation should be used sparingly in sutured wounds. Large lesions are best treated in a single stage rather than in divided treatments since the rate of wound healing is not proportional to the area but instead to the logarithm of the area. Thus, the total healing time is much shorter if done in a single treatment session. (2) use of drugs; corticosteroids given before or within three days of wounding in dose of prednisone 40 mg or greater will inhibit wound healing. Vitamin A topically or systemically may reverse this inhibition. Aspirin and other nonsteroidal anti-inflammatory agents are more important for their effects on platelet function and bleeding than on wound healing. (3) wound dressings; the use of occlusive dressings to promote moist wound healing is the most significant advance in wound management. Occlusive dressings shorten the time for healing, decrease pain, reduce wound contamination, and improve the cosmetic result. (4) control of wound contraction and scar formation; at the time of wound formation, guiding sutures may be helpful in wound healing by secondary intention in order to control the direction of wound contraction and prevent distortion. Intralesional steroids may be useful for hypertrophic scars and keloids

  1. Does osteoporosis increase complication risk in surgical fracture treatment? A protocol combining new endpoints for two prospective multicentre open cohort studies

    PubMed Central

    2010-01-01

    Background With an ever-increasing elderly population, orthopaedic surgeons are faced with treating a high number of fragility fractures. Biomechanical tests have demonstrated the potential role of osteoporosis in the increased risk of fracture fixation complications, yet this has not been sufficiently proven in clinical practice. Based on this knowledge, two clinical studies were designed to investigate the influence of local bone quality on the occurrence of complications in elderly patients with distal radius and proximal humerus fractures treated by open reduction and internal fixation. Methods/Design The studies were planned using a prospective multicentre open cohort design and included patients between 50 and 90 years of age. Distal radius and proximal humerus fractures were treated with locking compression 2.4 mm and proximal humerus internal locking plates, respectively. Follow-up examinations were planned for 6 weeks, 3 and 12 months as well as a telephone interview at 6 months. The primary outcome focuses on the occurrence of at least one local bone quality related complication. Local bone quality is determined by measuring bone mineral density and bone mineral content at the contralateral radius. Primary complications are categorised according to predefined factors directly related to the bone/fracture or the implant/surgical technique. Secondary outcomes include the documentation of soft tissue/wound or general/systemic complications, clinical assessment of range of motion, and patient-rated evaluations of upper limb function and quality of life using both objective and subjective measures. Discussion The prospective multicentre open cohort studies will determine the value of local bone quality as measured by bone mineral density and content, and compare the quality of local bone of patients who experience a complication (cases) following surgery with that of patients who do not (controls). These measurements are novel and objective alternatives to

  2. [Comparative description and retrospective analisis of modern methods of surgical wounds closure for intraoperative prophylaxis of development of pathologic cutaneous cicatrices].

    PubMed

    Stavyts'kyĭ, S O; Avetikov, D S; Lokes, K P; Rozkolupa, O O; Boĭko, I V

    2014-05-01

    The experience of application of various methods of closure was presented for the head and neck cutaneous wound surfaces after elective operative interventions. The variant of the postoperative results estimation and optimization of the wounds healing by primary closure was proposed.

  3. Hand safety for specialty crop production workers: a pilot study investigating frequencies of minor open-wound hand injuries and presence of pathogenic bacteria.

    PubMed

    Pate, M L; Nummer, B

    2013-10-01

    The purpose of this study was to quantify the presence of minor open-wound hand injuries in addition to Salmonella, Staphylococcus aureus, coliforms, and Escherichia coli on the hands of farm workers who hand-harvest fruit crops in Utah. Data collection was conducted on four farms without USDA Good Agricultural Practices (GAP) certification and on two farms with GAP certification. This study identified essential safety issues that need to be addressed for improving the effectiveness of safety training for migrant farm workers. Farms that have a food safety audit program in place are less likely to have farm workers exposed to pathogenic bacteria and open-wound injuries to their hands. High frequency of S. aureus may indicate a potentially higher risk for wound infection within this worker population. This could lead to infections that are resistant to the antibiotics commonly used to treat ordinary staph infections, resulting in greater work loss time and medical expenses for these workers. Higher frequencies of bacterial presence on workers' hands on non-certified farms indicate a need to identify essential practices to improve worker hygiene habits and on-farm management practices to promote healthy hygiene. Open-wound injuries to migrant farm workers during hand-harvesting could create additional health problems with the possibility of infection and the spread of diseases. Continued research is needed to understand workers' acceptance of these injuries and barriers to personal protection. PMID:24673033

  4. Telemedicine for wound management.

    PubMed

    Chittoria, Ravi K

    2012-05-01

    The escalating physiological, psychological, social and financial burdens of wounds and wound care on patients, families and society demand the immediate attention of the health care sector. Many forces are affecting the changes in health care provision for patients with chronic wounds, including managed care, the limited number of wound care therapists, an increasingly ageing and disabled population, regulatory and malpractice issues, and compromised care. The physician is also faced with a number of difficult issues when caring for chronic wound patients because their conditions are time consuming and high risk, represent an unprofitable part of care practice and raise issues of liability. Telemedicine enhances communication with the surgical wound care specialist. Digital image for skin lesions is a safe, accurate and cost-effective referral pathway. The two basic modes of telemedicine applications, store and forward (asynchronous transfer) and real-time transmission (synchronous transfer, e.g. video conference), are utilized in the wound care setting. Telemedicine technology in the hands of an experienced physician can streamline management of a problem wound. Although there is always an element of anxiety related to technical change, the evolution of wound care telemedicine technology has demonstrated a predictable maturation process.

  5. Comparison of Costs of Endovascular Repair versus Open Surgical Repair for Abdominal Aortic Aneurysm in Korea

    PubMed Central

    Min, Sang Il; Min, Seung-Kee; Ahn, Sanghyun; Kim, Suh Min; Park, Daedo; Park, Taejin; Chung, Jin Wook; Park, Jae Hyung; Ha, Jongwon; Kim, Sang Joon

    2012-01-01

    This study was designed to compare the hospital-related costs of elective abdominal aortic aneurysm (AAA) treatment and cost structure between endovascular aneurysm repair (EVAR) and open surgical repair (OSR) in Korean health care system. One hundred five primary elective AAA repairs (79 OSRs and 26 EVARs) performed in the Seoul National University Hospital from 2005 to 2009 were included. Patient characteristics were similar between two groups except for older age (P = 0.004) and more frequent history of malignancy (P = 0.031) in EVAR group. Thirty-day mortality rate was similar between two groups and there was no AAA-related mortality in both groups for 5 yr after repair. The total in-hospital costs for the index admission were significantly higher in EVAR patients (mean, KRW19,857,119) than OSR patients (mean KRW12,395,507) (P < 0.001). The reimbursement was also significantly higher in EVAR patients than OSR patients (mean, KRW14,071,081 vs KRW6,238,895, P < 0.001) while patients payments was comparable between two groups. EVAR patients showed higher follow-up cost up to 2 yr due to more frequent imaging studies and reinterventions for type II endoleaks (15.4%). In the perspective of cost-effectiveness, this study suggests that the determination of which method to be used in AAA treatment be more finely trimmed and be individualized. PMID:22468106

  6. Deltoid detachment consequent to open surgical repair of massive rotator cuff tears.

    PubMed

    Gumina, S; Di Giorgio, G; Perugia, D; Postacchini, F

    2008-02-01

    Deltoid detachment is one of the complications in open rotator cuff repair. Although it is often described, the actual prevalence, time at which it occurs and the predisposing causes are still unknown. We prospectively studied 112 patients with massive rotator cuff tears with a mean age of 67. The surgical approach was performed with a lateral para-acromial incision. Clinical assessment was performed with Constant's method. Of the 112 patients, 9 (8%) had deltoid detachment. It occurred about 3 months after surgery. Of the nine patients, two underwent revision surgery for the deltoid trans-bone reattachment. At the follow-up, the patients with deltoid detachment had a mean increase of only 5.5 points in the Constant score compared to that of 16.9 obtained by the control group. Deltoid reattachment, performed on the two patients, provided a mean increase of 7 points only with respect to the post-operative control at the 4th month. Considering the unsatisfactory functional result consequent to deltoid detachment and the slight improvement obtained with the reattachment, we recommend the following: use suture thread thicker than #2, do not use a simple stitch and avoid extending acromioplasty to the lateral margin of the acromion. PMID:17410365

  7. Deltoid detachment consequent to open surgical repair of massive rotator cuff tears

    PubMed Central

    Di Giorgio, G.; Perugia, D.; Postacchini, F.

    2007-01-01

    Deltoid detachment is one of the complications in open rotator cuff repair. Although it is often described, the actual prevalence, time at which it occurs and the predisposing causes are still unknown. We prospectively studied 112 patients with massive rotator cuff tears with a mean age of 67. The surgical approach was performed with a lateral para-acromial incision. Clinical assessment was performed with Constant’s method. Of the 112 patients, 9 (8%) had deltoid detachment. It occurred about 3 months after surgery. Of the nine patients, two underwent revision surgery for the deltoid trans-bone reattachment. At the follow-up, the patients with deltoid detachment had a mean increase of only 5.5 points in the Constant score compared to that of 16.9 obtained by the control group. Deltoid reattachment, performed on the two patients, provided a mean increase of 7 points only with respect to the post-operative control at the 4th month. Considering the unsatisfactory functional result consequent to deltoid detachment and the slight improvement obtained with the reattachment, we recommend the following: use suture thread thicker than #2, do not use a simple stitch and avoid extending acromioplasty to the lateral margin of the acromion. PMID:17410365

  8. Photographic wound documentation of open fractures: an update for the digital generation

    PubMed Central

    Morgan, B W; Read, J R; Solan, M C

    2007-01-01

    Objective To examine the availability of working cameras in UK emergency departments and to discuss the merits of digital imaging over Polaroid. Design This study was conducted by means of a telephone questionnaire to 50 UK emergency departments. Results It was found that 80% were able to produce either a working Polaroid or digital camera, and that 63% of emergency departments had a digital camera available. Conclusions We report a pronounced increase in the ability of emergency departments to photograph open fractures, due in part to the availability of digital cameras. We recommend the appropriate use of these tools in the management of open fractures. PMID:18029517

  9. A systematic review and meta-analysis including GRADE qualification of the risk of surgical site infections after prophylactic negative pressure wound therapy compared with conventional dressings in clean and contaminated surgery

    PubMed Central

    De Vries, Fleur E.E.; Wallert, Elon D.; Solomkin, Joseph S.; Allegranzi, Benedetta; Egger, Matthias; Dellinger, E. Patchen; Boermeester, Marja A.

    2016-01-01

    Abstract Objective: Systematically review and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) studies on prophylactic negative pressure wound therapy (pNPWT) to prevent surgical site infections (SSIs). Introduction: pNPWT has been suggested as a new method to prevent wound complications, specifically SSIs, by its application on closed incisional wounds. Methods: This review was conducted as part of the development of the Global Guidelines for prevention of SSIs commissioned by World Health Organization in Geneva. PubMed, Embase, CENTRAL, CINAHL, and the World Health Organization database between January 1, 1990 and October 7, 2015 were searched. Inclusion criteria were randomized controlled trials and observational studies comparing pNPWT with conventional wound dressings and reporting on the incidence of SSI. Meta-analyses were performed with a random effect model. GRADE Pro software was used to qualify the evidence. Results: Nineteen articles describing 21 studies (6 randomized controlled trials and 15 observational) were included in the review. Summary estimate showed a significant benefit of pNPWT over conventional wound dressings in reducing SSIs in both randomized controlled trials and observational studies, odds ratio of 0.56 (95% confidence interval, 0.32–0.96; P = 0.04) and odds ratio of 0.30 (95% confidence interval, 0.22–0.42; P < 0.00001), respectively. This translates into lowering the SSI rate from 140 to 83 (49–135) per 1000 patients and from 106 to 34 (25–47) per 1000 patients, respectively. In stratified analyses, these results were consistent in both clean and clean-contaminated procedures and in different types of surgery, however results were no longer significant for orthopaedic/trauma surgery. The level of evidence as qualified with GRADE was however low. Conclusions: Low-quality evidence indicates that prophylactic NPWT significantly reduces the risk of SSIs. PMID:27603360

  10. Open reduction and internal fixation of two- and three-part displaced surgical neck fractures of the proximal humerus.

    PubMed

    Cuomo, F; Flatow, E L; Maday, M G; Miller, S R; McIlveen, S J; Bigliani, L U

    1992-11-01

    Twenty-two patients aged 20 to 82 years (average 56 years) were followed for 1.1 to 8.9 years (average 3.3 years) after open reduction and internal fixation of two- and three-part displaced surgical neck fractures of the proximal humerus. There were 14 two-part displaced surgical neck fractures, seven three-part displaced greater tuberosity and surgical neck fractures, and one three-part displaced lesser tuberosity and surgical neck fracture. Fixation was achieved with heavy nonabsorbable sutures or wire that incorporated the rotator cuff tendons, tuberosities, and shaft. In cases with significant surgical neck comminution, humeral Enders nails were incorporated in a tension-band construct to provide longitudinal stability. Eighteen (82%) of the 22 patients had good or excellent results. Three (14%) of the 22 had satisfactory results, and one (5%) had an unsatisfactory result. The use of a technique of limited internal fixation for these displaced fractures without the use of plates and screws achieved fracture stability and a high percentage of acceptable results.

  11. Wound care dressings and choices for care of wounds in the home.

    PubMed

    Adkins, Carrie L

    2013-05-01

    Statistics from various resources report that many patients in home healthcare settings have wounds. These vary from surgical, pressure, neuropathic, trauma, stasis, and venous wounds. These require the assessment, knowledge, and expertise of a clinician to assist them with wound care management. The purpose of this article is to identify and categorize types of wound care products appropriate for the various types of wounds that clinicians care for and manage in the home.

  12. Infection in conflict wounded

    PubMed Central

    Eardley, W. G. P.; Brown, K. V.; Bonner, T. J.; Green, A. D.; Clasper, J. C.

    2011-01-01

    Although mechanisms of modern military wounding may be distinct from those of ancient conflicts, the infectious sequelae of ballistic trauma and the evolving microbial flora of war wounds remain a considerable burden on both the injured combatant and their deployed medical systems. Battlefield surgeons of ancient times favoured suppuration in war wounding and as such Galenic encouragement of pus formation would hinder progress in wound care for centuries. Napoleonic surgeons eventually abandoned this mantra, embracing radical surgical intervention, primarily by amputation, to prevent infection. Later, microscopy enabled identification of microorganisms and characterization of wound flora. Concurrent advances in sanitation and evacuation enabled improved outcomes and establishment of modern military medical systems. Advances in medical doctrine and technology afford those injured in current conflicts with increasing survivability through rapid evacuation, sophisticated resuscitation and timely surgical intervention. Infectious complications in those that do survive, however, are a major concern. Addressing antibiotic use, nosocomial transmission and infectious sequelae are a current clinical management and research priority and will remain so in an era characterized by a massive burden of combat extremity injury. This paper provides a review of infection in combat wounding from a historical setting through to the modern evidence base. PMID:21149356

  13. Cell therapy for wound healing.

    PubMed

    You, Hi-Jin; Han, Seung-Kyu

    2014-03-01

    In covering wounds, efforts should include utilization of the safest and least invasive methods with goals of achieving optimal functional and cosmetic outcome. The recent development of advanced wound healing technology has triggered the use of cells to improve wound healing conditions. The purpose of this review is to provide information on clinically available cell-based treatment options for healing of acute and chronic wounds. Compared with a variety of conventional methods, such as skin grafts and local flaps, the cell therapy technique is simple, less time-consuming, and reduces the surgical burden for patients in the repair of acute wounds. Cell therapy has also been developed for chronic wound healing. By transplanting cells with an excellent wound healing capacity profile to chronic wounds, in which wound healing cannot be achieved successfully, attempts are made to convert the wound bed into the environment where maximum wound healing can be achieved. Fibroblasts, keratinocytes, adipose-derived stromal vascular fraction cells, bone marrow stem cells, and platelets have been used for wound healing in clinical practice. Some formulations are commercially available. To establish the cell therapy as a standard treatment, however, further research is needed.

  14. Wound Management: The Occlusive Dressing

    PubMed Central

    Rheinecker, Scot B.

    1995-01-01

    Superficial wounds resulting from athletic injury are common in sports medicine. Although such wounds can be quite painful, they are usually merely inconvenient to the athlete. If improperly managed, however, superficial wounds may heal slowly and cause unnecessary scar tissue proliferation at the wound site. Scar formation causes the wound to break open frequently and puts the athlete at risk of cross-contamination by pathogenic organisms. New advances in the science of wound management strongly favor the use of occlusive dressings to increase patient comfort, increase patient compliance, decrease the risk of infection, and decrease overall healing time. Occlusion has clearly been proven to aid in the healing of superficial wounds and should be considered as a treatment alternative for wounds in the sports medicine setting. In this paper, I discuss three of the most widely used types of occlusive dressings: 1) films, 2) hydrogels, and 3) hydrocolloids. PMID:16558325

  15. Wound modulation after filtration surgery.

    PubMed

    Seibold, Leonard K; Sherwood, Mark B; Kahook, Malik Y

    2012-11-01

    Filtration surgery is the standard invasive procedure for the management of intraocular pressure in advanced glaucoma. The key to a successful outcome is to modulate the normal wound healing cascade that leads to closure of the newly created aqueous outflow pathway. Antifibrotic agents such as mitomycin C and 5-fluorouracil have been increasingly used to modulate the wound healing process and increase surgical success. Although these agents have proven efficacy, they also increase the risk of complications. Efforts have centered on the identification of novel agents and techniques that can influence wound modulation without these complications. We detail new agents and methods under investigation to control wound healing after filtration surgery. PMID:23068975

  16. Postoperative washing of sutured wounds.

    PubMed

    Harrison, Conrad; Wade, Cian; Gore, Sinclair

    2016-11-01

    A best evidence topic was written according to the structured protocol. The three part question addressed was: [In patients undergoing closure of surgical wounds with sutures] does [keeping the wound dry for the first 48 h after closure] [reduce the incidence of surgical site infections (SSIs)]? 4 relevant papers were culled from the literature and appraised. The authors, date, country, population, study type, main outcomes, key results and study weaknesses were tabulated. Current NICE guidelines recommend cleaning surgical wounds with sterile saline only for the first 48 h following skin closure. We found no evidence that washing wounds with tap water during this period increases the incidence of SSIs compared to keeping them dry. Further randomised controlled trials will enable the construction of conclusive systematic reviews and meta-analyses. PMID:27668079

  17. Wound Healing and the Dressing*

    PubMed Central

    Scales, John T.

    1963-01-01

    The evolution of surgical dressings is traced from 1600 b.c. to a.d. 1944. The availability of an increasing variety of man-made fibres and films from 1944 onwards has stimulated work on wound dressings, and some of the more important contributions, both clinical and experimental, are discussed. The functions of a wound dressing and the properties which the ideal wound dressing should possess are given. The necessity for both histological and clinical evaluation of wound dressings in animals and in man is stressed. Wound dressings are the most commonly used therapeutic agents, but there is no means whereby their performance can be assessed. An attempt should be made either nationally or internationally to establish a standard method of assessing the performance of wound dressings. For this it is necessary to have an internationally agreed standard dressing which could be used as a reference or control dressing in all animal and human work. The only animal with skin morphologically similar to that of man is the domestic pig. Three types of wounds could be used: (1) partial-thickness wounds; (2) full-thickness excisions; and (3) third-degree burns. The development of standard techniques for the assessment of the efficiency of wound dressings would be of considerable benefit to the research worker, the medical profession, the patient, and the surgical dressings industry. PMID:13976490

  18. Open Surgical Treatment for Femoroacetabular Impingement in Patients over Thirty Years: Two Years Follow-up Results

    PubMed Central

    2015-01-01

    Purpose We report short term results of open surgical treatment for symptomatic femoroacetabular impingement (FAI) in patients over the age of 30 years. Materials and Methods Between May 2011 and June 2012, thirteen FAI hips (11 patients) with hip pain persisting longer than 6 months were treated by either surgical hip dislocation (SHD) or anterior mini-open. They were followed up for longer than 2 years. The 11 patients included 7 females and 4 males with a mean age of 45 (range, 33-60) years. They were clinically evaluated for modified Harris hip score (MHHS) and University of California at Los Angeles (UCLA) activity level. Their lateral center-edge angle, acetabular index, and alpha angle were measured and compared. Results Acetabuloplasties were performed for seven cases. Femoral osteochondroplasty was performed for all thirteen cases. At minimum follow-up of two year (range, 24-29 months), all patients had substantial relief in preoperative pain with improvement in range of motion. The median MHHS was significantly (P<0.05) improved from 61 points preoperatively to 87 points at the last follow-up. The median UCLA activity level was 7 (range, 5-8) at last follow-up. Radiological indices improved. Two cases showed mild residual pain attributable to adhesion between capsule and reshaped femoral head-neck area. Conclusion Open surgical treatment of FAI was a reliable and effective treatment method in symptomatic FAIs for patients over the age of 30 years without advanced arthritic change of hip joint at short term follow-up. PMID:27536632

  19. Surgical stabilization for open tibial fractures in children: External fixation or elastic stable intramedullary nail - which method is optimal?

    PubMed Central

    Ramasubbu, Rohan A; Ramasubbu, Benjamin M

    2016-01-01

    Background: Management of open tibial fractures is well documented in adults, with existing protocols outlining detailed treatment strategies. No clear guidelines exist for children. Surgical stabilization of tibial fractures in the pediatric population requires implants that do not disrupt the open epiphyses (growth plate). Both elastic stable intramedullary nails and external fixation can be used. The objective of this study was to identify the optimal method of surgical stabilization in the treatment of open tibial fractures in children. Materials and Methods: MEDLINE and Embase were searched from their inception to March 2014 using the following advanced search terms (Key words): “open tibia fracture,” “fracture fixation,” “external fixation,” “intramedullary,” and “bone nail.” Only studies in English and pertaining to children with open fractures treated with elastic stable intramedullary nails or external fixation between 1994 and 2014 were included. Twelve clinical studies were critically appraised. Results: Due to a paucity in the literature coupled with a nonsystematic presentation of results, it proved to be very difficult in extracting relevant results from the studies. This was further added by a variation in outcome measures. Consequently, the results we obtained were difficult to draw conclusions from. Conclusion: There is no conclusive evidence or best practice guidelines for their management. Thus, as is highlighted in this study, more research is needed to determine the optimum treatment strategy for this common pediatric injury. The existing literature is of poor quality; consisting mainly of retrospective reviews of patients’ medical records, charts, and radiographs. Carefully designed, high-quality prospective cohort studies utilizing a nationalized multi-hospital approach are needed to improve understanding before protocols and guidelines can be developed and implemented. PMID:27746486

  20. A Real World, Observational Registry of Chronic Wounds and Ulcers

    ClinicalTrials.gov

    2016-05-18

    Diabetic Foot; Varicose Ulcer; Pressure Ulcer; Surgical Wound Dehiscence; Vasculitis; Skin Ulcer; Leg Ulcer; Wounds and Injuries; Pyoderma; Peripheral Arterial Disease; Diabetic Neuropathies; Lymphedema; Venous Insufficiency; Diabetes Complications; Amputation Stump

  1. Results of open and robot-assisted pancreatectomies with autologous islet transplantations: treating chronic pancreatitis and preventing surgically induced diabetes.

    PubMed

    Gruessner, R W G; Cercone, R; Galvani, C; Rana, A; Porubsky, M; Gruessner, A C; Rilo, H

    2014-01-01

    For patients with chronic pancreatitis (CP), standard surgical procedures (eg, partial or total resections, drainage procedures) are inadequate treatment options, because they do not confer pain relief and they leave patients prone to brittle diabetes and hypoglycemia. The combination of total pancreatectomy and islet autotransplantation (TP-IAT), however, can create insulin-independent and pain-free states. At our center, from August 2009 through August 2013, 61 patients with CP underwent either open or robot-assisted TP-IAT. The 30-day mortality rate was 0%. The transplanted islet equivalents per body weight ranged from 10,000 to 17,770. In all, 19% of the patients became insulin independent (after a range of 1-24 months); 27% of patients required <10 units of insulin. Moreover, at 12 months after surgery, 71% of the patients were pain free and no longer required analgesics. Our metabolic outcomes could have been even better if most patients had been referred at an earlier disease stage; instead, ∼80% had already undergone surgical procedures, and 91% had abnormal results on preoperative continuous glucose monitoring tests. Only if patients with CP are referred early for a TP-IAT-rather than being subjected to additional inadequate endoscopic and surgical procedures-can insulin-independent and pain-free states be accomplished in most. PMID:25131087

  2. Predictors of positive surgical margins at open and robot-assisted laparoscopic radical prostatectomy: a single surgeon series.

    PubMed

    Weerakoon, Mahesha; Sengupta, Shomik; Sethi, Kapil; Ischia, Joseph; Webb, David R

    2012-12-01

    Robot-assisted laparoscopic radical prostatectomy (RALRP), increasingly used to treat localized prostate cancer, has advantages over open radical prostatectomy (ORP) in terms of reduced bleeding and quicker convalescence. However, debate continues over whether RALRP provides superior or at least equivalent surgical outcomes. This study compares positive surgical margins (+SM), as a surrogate for long-term cancer control, at RALRP and ORP performed by a single experienced surgeon during the process of taking up RALRP. 400 consecutive patients undergoing surgery for prostate cancer under a single surgeon (DW) between November 1999 and July 2009 were studied. Prior to July 2005, all patients underwent ORP; after this date, most patients were treated by RALRP. Data were collected by retrospective chart review and analysed independently of the treating surgeon. +SM were defined as the presence of cancer at an inked surface. Overall, 23 (11.5%) of 200 patients undergoing RALRP had +SM, compared to 40 (20.0%) of 200 patients undergoing ORP (P < 0.05). On univariate logistic regression analysis, in addition to surgical approach (odds ratio [OR] = 1.92), patient age (OR = 1.05), pathologic stage (OR = 3.93) and specimen Gleason (GS) score (OR = 1.86) were significant predictors of +SM. On multivariate analysis, surgical approach, p-stage and specimen GS remained significant predictors of +SM. RALRP is associated with lower rates of +SM compared to ORP, even after adjusting for other known risk factors. Of note, the RALRP in this study were part of the surgeon's learning curve. PMID:27628470

  3. Wound healing and all-cause mortality in 958 wound patients treated in home care.

    PubMed

    Zarchi, Kian; Martinussen, Torben; Jemec, Gregor B E

    2015-09-01

    Skin wounds are associated with significant morbidity and mortality. Data are, however, not readily available for benchmarking, to allow prognostic evaluation, and to suggest when involvement of wound-healing experts is indicated. We, therefore, conducted an observational cohort study to investigate wound healing and all-cause mortality associated with different types of skin wounds. Consecutive skin wound patients who received wound care by home-care nurses from January 2010 to December 2011 in a district in Eastern Denmark were included in this study. Patients were followed until wound healing, death, or the end of follow-up on December 2012. In total, 958 consecutive patients received wound care by home-care nurses, corresponding to a 1-year prevalence of 1.2% of the total population in the district. During the study, wound healing was achieved in 511 (53.3%), whereas 90 (9.4%) died. During the first 3 weeks of therapy, healing was most likely to occur in surgical wounds (surgical vs. other wounds: adjusted hazard ratio [AHR] 2.21, 95% confidence interval 1.50-3.23), while from 3 weeks to 3 months of therapy, cancer wounds, and pressure ulcers were least likely to heal (cancer vs. other wounds: AHR 0.12, 0.03-0.50; pressure vs. other wounds: AHR 0.44, 0.27-0.74). Cancer wounds and pressure ulcers were further associated with a three times increased probability of mortality compared with other wounds (cancer vs. other wounds: AHR 3.19, 1.35-7.50; pressure vs. other wounds: AHR 2.91, 1.56-5.42). In summary, the wound type was found to be a significant predictor of healing and mortality with cancer wounds and pressure ulcers being associated with poor prognosis.

  4. Gunshot wounds: epidemiology, wound ballistics, and soft-tissue treatment.

    PubMed

    Dougherty, Paul J; Najibi, Soheil; Silverton, Craig; Vaidya, Rahul

    2009-01-01

    The extremities are the most common anatomic location for gunshot wounds. Because of the prevalence of gunshot injuries, it is important that orthopaedic surgeons are knowledgeable about caring for them. The most common injuries seen with gunshot wounds are those of the soft tissues. Nonsurgical management of patients who have gunshot wounds with minimal soft-tissue disruption has been successfully accomplished in emergency departments for several years; this includes extremity wounds without nerve, intra-articular, or vascular injury. Stable, nonarticular fractures of an extremity have also been successfully treated with either minimal surgical or nonsurgical methods in the emergency department. Indications for surgical treatment include unstable fractures, intra-articular injuries, a significant soft-tissue injury (especially with skin loss), vascular injury, and/or a large or expanding hematoma.

  5. Gunshot wounds: epidemiology, wound ballistics, and soft-tissue treatment.

    PubMed

    Dougherty, Paul J; Najibi, Soheil; Silverton, Craig; Vaidya, Rahul

    2009-01-01

    The extremities are the most common anatomic location for gunshot wounds. Because of the prevalence of gunshot injuries, it is important that orthopaedic surgeons are knowledgeable about caring for them. The most common injuries seen with gunshot wounds are those of the soft tissues. Nonsurgical management of patients who have gunshot wounds with minimal soft-tissue disruption has been successfully accomplished in emergency departments for several years; this includes extremity wounds without nerve, intra-articular, or vascular injury. Stable, nonarticular fractures of an extremity have also been successfully treated with either minimal surgical or nonsurgical methods in the emergency department. Indications for surgical treatment include unstable fractures, intra-articular injuries, a significant soft-tissue injury (especially with skin loss), vascular injury, and/or a large or expanding hematoma. PMID:19385526

  6. Deep sternal wound infection after cardiac surgery: Evidences and controversies.

    PubMed

    Cotogni, Paolo; Barbero, Cristina; Rinaldi, Mauro

    2015-11-01

    Despite many advances in prevention and perioperative care, deep sternal wound infection (DSWI) remains a pressing concern in cardiac surgery, with a still relevant incidence and with a considerable impact on in-hospital mortality and also on mid- and long-term survival. The permanent high impact of this complication is partially related to the increasing proportion of patients at high-risk for infection, as well as to the many patient and surgical risk factors involved in the pathogenesis of DSWI. The prophylactic antibiotic therapy is one of the most important tools in the prevention of DSWI. However, the choice of antibiotic, the dose, the duration, the adequate levels in serum and tissue, and the timing of antimicrobial prophylaxis are still controversial. The treatment of DSWI ranges from surgical revision with primary closure to surgical revision with open dressings or closed irrigation, from reconstruction with soft tissue flaps to negative pressure wound therapy (NPWT). However, to date, there have been no accepted recommendations regarding the best management of DSWI. Emerging evidence in the literature has validated the efficacy and safety of NPWT either as a single-line therapy, or as a "bridge" prior to final surgical closure. In conclusion, the careful control of patient and surgical risk factors - when possible, the proper antimicrobial prophylaxis, and the choice of validated techniques of treatment could contribute to keep DSWIs at a minimal rate. PMID:26557476

  7. Deep sternal wound infection after cardiac surgery: Evidences and controversies

    PubMed Central

    Cotogni, Paolo; Barbero, Cristina; Rinaldi, Mauro

    2015-01-01

    Despite many advances in prevention and perioperative care, deep sternal wound infection (DSWI) remains a pressing concern in cardiac surgery, with a still relevant incidence and with a considerable impact on in-hospital mortality and also on mid- and long-term survival. The permanent high impact of this complication is partially related to the increasing proportion of patients at high-risk for infection, as well as to the many patient and surgical risk factors involved in the pathogenesis of DSWI. The prophylactic antibiotic therapy is one of the most important tools in the prevention of DSWI. However, the choice of antibiotic, the dose, the duration, the adequate levels in serum and tissue, and the timing of antimicrobial prophylaxis are still controversial. The treatment of DSWI ranges from surgical revision with primary closure to surgical revision with open dressings or closed irrigation, from reconstruction with soft tissue flaps to negative pressure wound therapy (NPWT). However, to date, there have been no accepted recommendations regarding the best management of DSWI. Emerging evidence in the literature has validated the efficacy and safety of NPWT either as a single-line therapy, or as a “bridge” prior to final surgical closure. In conclusion, the careful control of patient and surgical risk factors - when possible, the proper antimicrobial prophylaxis, and the choice of validated techniques of treatment could contribute to keep DSWIs at a minimal rate. PMID:26557476

  8. Management of a Dehisced Hand Wound Using Hydrogen Peroxide, Electrical Stimulation, Silver-containing Dressings, and Compression: A Case Study.

    PubMed

    Zhou, Kehua; Krug, Kenneth; Brogan, Michael S

    2015-07-01

    Wound dehiscence is the separation of a wound along surgical sutures. A 57-year-old, otherwise healthy mechanic presented with a large open wound of >1 month duration on his left hand. His wound had dehisced after treatment that involved cleansing, surgical sutures, and oral antibiotics. He presented with a 5.0 cmx0.7 cmx0.3 cm lesion through the palmar creases of the hand with edema around the fourth and fifth digits and a callous formation around the distal portion of the wound. The wound had scant serosanguinous drainage and some induration at the periwound area, as well as a moderate foul odor. Tendons were not affected, but function was limited, the hand was painful, and the patient had been unable to work. Treatment was initiated with twice-a-week immersion of the hand in hydrogen peroxide diluted with water subjected to high-voltage pulsed current electric stimulation (HVPC). The wound was dressed with silver-containing dressings secured with stretch gauze and a compression garment. The wound was completely closed after 9 visits (35 days). No functional limitations of the hand or fingers, no cosmetic defect, and no wound recurrence were noted 9 months after healing. Although uncommon, dehisced wounds, especially in certain anatomical locations such as the hand, can be difficult to heal and may cause long-term problems with functioning. The treatment combination facilitated expedient healing of this dehisced hand wound. Research is needed to help elucidate the observations from this case study. PMID:26185974

  9. [Saliva and wound healing].

    PubMed

    Veerman, E C I; Oudhoff, M J; Brand, H S

    2011-05-01

    The oral mucosa is frequently exposed to mechanical forces, which may result in tissue damage. Saliva contributes to the repair of the oral mucosa in several ways. In the first place, it creates a humid environment to improve the function of inflammatory cells. During the last few years, it has been shown that saliva also contains a large number of proteins with a role in wound healing. Saliva contains growth factors, especially Epidermal Growth FACTOR, which promotes the proliferation of epithelial cells. Trefoil factor 3 and histatin promote the process of wound closure. The importance of Secretory Leucocyte Protease Inhibitor is demonstrated by the fact that in the absence of this salivary protein, oral wound healing is considerably delayed. Understanding these salivary proteins opens the way for the development of new wound healing medications.

  10. Use of an acellular flowable dermal replacement scaffold on lower extremity sinus tract wounds: a retrospective series.

    PubMed

    Brigido, Stephen A; Schwartz, Edward; McCarroll, Raymond; Hardin-Young, Janet

    2009-04-01

    A novel injectable human dermal matrix has been developed for the treatment of complex diabetic sinus tract wounds. Bioengineered grafts are commercially available that have been somewhat effective in treating chronic wounds such as diabetic foot ulcers; however, these bioengineered grafts are only available in sheet form. These therapies are less effective in treating complex or irregularly shaped wounds that demonstrate tunnels or extensions into deep soft tissue. One acellular graft (GRAFTJACKET, Matrix, Wright Medical Technology, Arlington, Tennessee) that has been shown to effectively treat open wounds is also available in a micronized form (GRAFTJACKET Xpress Scaffold, Wright Medical Technology). This human dermal graft forms a flowable soft tissue scaffold that can be delivered via syringe into tunneling wounds. In this retrospective series, 12 patients with deep tunneling wounds were treated with GRAFTJACKET Xpress Scaffold and followed for 12 weeks. Complete wound healing was achieved in 10 of 12 patients within the 12-week evaluation. The average time to complete healing was 8.5 weeks, whereas the average time to depth healing was 7.8 weeks. The data from the study suggest that this injectable human dermal matrix has unique properties that allow it to facilitate healing of complex tunneling diabetic foot ulcers. The material is easy to prepare and inject into the wound, thereby preventing the necessity of extensive surgical exposure. The matrix supports neo-subcutaneous tissue formation and allows the body to rapidly repair these wounds.

  11. Nine-month evaluation of dogs after open-heart surgical removal of heartworms.

    PubMed

    Shiang, H; Jurado, R; Liu, S K; Chen, V; Calem, J; Litwak, R S

    1987-06-01

    Adult heartworms were surgically removed from 4 infected dogs by use of intracardiac techniques during cardiopulmonary bypass. The number of worms removed ranged from 12 to 14 per dog. Observation for 9 months after surgery gave no clinical evidence of active adult heartworm infection, in spite of the consistent finding of circulating microfilariae during the follow-up period. There were no significant early or late postoperative complications. Results of postoperative hematologic and biochemical studies were unremarkable. At necropsy (following euthanasia, 9 months after surgery) the heart and pulmonary arteries of all dogs were free of adult heartworms; pathologic changes attributable to residual infection were not found.

  12. Use of a portable, single-use negative pressure wound therapy device in home care patients with low to moderately exuding wounds: a case series.

    PubMed

    Hurd, Theresa; Trueman, Paul; Rossington, Alan

    2014-03-01

    Negative pressure wound therapy (NPWT) is widely used in the management of acute and chronic wounds. The purpose of this 8-week study was to evaluate outcomes of using a new canisterless, portable, single-use NPWT system in patients with wounds treated in a Canadian community healthcare setting. The device is designed to provide negative pressure at 80±20 mm Hg, 24 hours a day of continuous usage, for a maximum wear time of 7 days. Data on wound outcomes, including exudate levels, wound appearance, and wound area, were collected weekly by a Registered Nurse as part of routine practice. When treatment was discontinued, patients and nurses were asked to rate their satisfaction with the device. Data from patients who had used a conventional NPWT device to manage their wounds were retrospectively abstracted from their medical records. In the prospective study, conducted between October 2011 and July 2012, 326 patients (median age=61 years; range 17-91 years) with wounds of mixed etiology (53 pressure ulcers, 21 venous leg ulcers, 16 diabetic foot ulcers, and 15 traumatic and 221 surgical wounds) were treated for a maximum of 8 weeks with the portable NPWT device. The majority of patients (228 out of 326; 68%) achieved complete wound closure within 8 weeks of treatment. The Kaplan-Meier estimate of median time to healing of all wounds was 9 weeks. The majority of patients (318 patients, 97%) reported they were pleased or satisfied with the dressing performance. Nurses indicated satisfaction with the dressing performance for all but two patients (99%). The majority (89%) of patients managed with conventional NPWT (n=539) had an open surgical wound with moderate or high levels of exudate. Healing rates in the portable and conventional NPWT group were similar (10% to 11% per week). Portable, single-use NPWT has the potential to deliver good wound outcomes in community care settings and simplify the use of negative pressure for nurses and patients. Additional research is

  13. [Maggots in the wound, debridement, disinfection and wound healing].

    PubMed

    Schouten, Helga W; Knippels, Marion C J; Franken, Ralph J P M

    2009-01-01

    An 87-year-old man had a longstanding untreated large basosquamous carcinoma on his right ear. He was admitted to the emergency department at our hospital. A large portion of the auricle had perished, together with part of the tumour. Surgery was planned but two days before, the patient complained of an irritating loud noise in his ear. We discovered this was caused by maggots in his external acoustic meatus: myiasis. Dozens of maggots were removed. A striking finding was that the smell of the wound had disappeared and that the wound was much cleaner, with a reddish aspect and less necrosis. The surgical procedure was uneventful. Larval therapy has been known for centuries. In recent years it has gained renewed interest as it may enhance wound debridement, wound disinfection, and may promote wound healing.

  14. Murine model of wound healing.

    PubMed

    Dunn, Louise; Prosser, Hamish C G; Tan, Joanne T M; Vanags, Laura Z; Ng, Martin K C; Bursill, Christina A

    2013-05-28

    Wound healing and repair are the most complex biological processes that occur in human life. After injury, multiple biological pathways become activated. Impaired wound healing, which occurs in diabetic patients for example, can lead to severe unfavorable outcomes such as amputation. There is, therefore, an increasing impetus to develop novel agents that promote wound repair. The testing of these has been limited to large animal models such as swine, which are often impractical. Mice represent the ideal preclinical model, as they are economical and amenable to genetic manipulation, which allows for mechanistic investigation. However, wound healing in a mouse is fundamentally different to that of humans as it primarily occurs via contraction. Our murine model overcomes this by incorporating a splint around the wound. By splinting the wound, the repair process is then dependent on epithelialization, cellular proliferation and angiogenesis, which closely mirror the biological processes of human wound healing. Whilst requiring consistency and care, this murine model does not involve complicated surgical techniques and allows for the robust testing of promising agents that may, for example, promote angiogenesis or inhibit inflammation. Furthermore, each mouse acts as its own control as two wounds are prepared, enabling the application of both the test compound and the vehicle control on the same animal. In conclusion, we demonstrate a practical, easy-to-learn, and robust model of wound healing, which is comparable to that of humans.

  15. [Guideline 'Wound Care': recommendations for 5 challenging areas].

    PubMed

    Brölmann, Fleur E; Vermeulen, Hester; Go, Peter M N Y H; Ubbink, Dirk T

    2013-01-01

    The interdisciplinary evidence-based guideline 'Wound Care' covers the treatment and management of acute wounds in adults and children and by all wound care disciplines. This guideline answers 5 basic questions with 38 recommendations covering wound cleansing, pain relief, instructing the patient, various dressings and the organisational aspects of wound care. The guideline recommendations include not to cleanse wounds that are primarily closed, to cleanse acute open wounds with clean tap water, to use the WHO pain ladder as the basis for the choice of analgesics for continuous wound pain, to administer lidocaine or prilocaine for localized pain relief during manipulation, not to cover primarily closed wounds with dressings, to use simple dressings for open wounds and to give the patient clear instructions. The guideline also advises about wound registration, documentation and hand-over of wound care, and recommends making clear agreements about referrals and responsibilities.

  16. Effects of the Topical Application of Hydroalcoholic Leaf Extract of Oncidium flexuosum Sims. (Orchidaceae) and Microcurrent on the Healing of Wounds Surgically Induced in Wistar Rats

    PubMed Central

    de G. de Gaspi, Fernanda Oliveira; Foglio, Mary Ann; de Carvalho, João Ernesto; Santos, Gláucia Maria T.; Testa, Milene; Passarini, José Roberto; de Moraes, Cristiano Pedroso; Esquisatto, Marcelo A. Marreto; Mendonça, Josué S.; Mendonça, Fernanda A. Sampaio

    2011-01-01

    This study evaluated the wound healing activity of hydroalcoholic leaf extract of Oncidium flexuosum Sims. (Orchidaceae), an important native plant of Brazil, combined or not with microcurrent stimulation. Wistar rats were randomly divided into four groups of nine animals: control (C), topical application of the extract (OF), treated with a microcurrent (10 μA/2 min) (MC), and topical application of the extract plus microcurrent (OF + MC). Tissue samples were obtained 2, 6, and 10 days after injury and submitted to structural and morphometric analysis. The simultaneous application of OF + MC was found to be highly effective in terms of the parameters analyzed (P < .05), with positive effects on the area of newly formed tissue, number of fibroblasts, number of newly formed blood vessels, and epithelial thickness. Morphometric data confirmed the structural findings. The O. flexuosum leaf extract contains active compounds that speed the healing process, especially when applied simultaneously with microcurrent stimulation. PMID:21716707

  17. Surgical resection of invasive adenoid cystic carcinoma of the lacrimal gland and wound closure using a vertical rectus abdominis myocutaneous free flap.

    PubMed

    Andrade, João Paulo; Figueiredo, Sergio; Matias, Julio; Almeida, Ana Catarina

    2016-01-01

    A 64-year-old man presented with a 3-month history of recurrent conjunctivitis. He was evaluated by an ophthalmologist and submitted to a CT scan that revealed an intraconic mass with invasion of the lateral orbital wall. He was operated, the mass was completely removed (with preservation of the intraorbital structures) and the lateral orbital wall rebuilt. The histopathological analysis revealed an adenoid cystic carcinoma of the lacrimal gland. 4 months later a painful recurrence of the lesion was diagnosed with invasion of the orbital roof and eyelids. After a multidisciplinary discussion and request from the patient, an exenteration of the orbit and removal of the lateral and superior orbital wall and dura mater was performed with the objective of a total resection. The wound and orbit were closed with a vertical rectus abdominis myocutaneous free flap to ensure closure. PMID:27646316

  18. Dressings and Products in Pediatric Wound Care

    PubMed Central

    King, Alice; Stellar, Judith J.; Blevins, Anne; Shah, Kara Noelle

    2014-01-01

    Significance: The increasing complexity of medical and surgical care provided to pediatric patients has resulted in a population at significant risk for complications such as pressure ulcers, nonhealing surgical wounds, and moisture-associated skin damage. Wound care practices for neonatal and pediatric patients, including the choice of specific dressings or other wound care products, are currently based on a combination of provider experience and preference and a small number of published clinical guidelines based on expert opinion; rigorous evidence-based clinical guidelines for wound management in these populations is lacking. Recent Advances: Advances in the understanding of the pathophysiology of wound healing have contributed to an ever-increasing number of specialized wound care products, most of which are predominantly marketed to adult patients and that have not been evaluated for safety and efficacy in the neonatal and pediatric populations. This review aims to discuss the available data on the use of both more traditional wound care products and newer wound care technologies in these populations, including medical-grade honey, nanocrystalline silver, and soft silicone-based adhesive technology. Critical Issues: Evidence-based wound care practices and demonstration of the safety, efficacy, and appropriate utilization of available wound care dressings and products in the neonatal and pediatric populations should be established to address specific concerns regarding wound management in these populations. Future Directions: The creation and implementation of evidence-based guidelines for the treatment of common wounds in the neonatal and pediatric populations is essential. In addition to an evaluation of currently marketed wound care dressings and products used in the adult population, newer wound care technologies should also be evaluated for use in neonates and children. In addition, further investigation of the specific pathophysiology of wound healing in

  19. [Surgical indications in coexisting cataracts and glaucoma].

    PubMed

    Collignon-Brach, J D; Ravet, O; Robe-Collignon, N

    2000-01-01

    Cataract surgery in glaucoma patients remains a controversial subjects. Indication of surgery depends on a lot of clinical parameters: diagnosis, state, evolution of glaucoma as well as compliance with medical treatment--surgical procedures of cataract and glaucoma--sites of the surgery--use of antifibrosis agents and surgeon's experience. As cataract extraction alone decreases the intraocular pressure in open angle glaucoma and mainly in uncomplicated closed angle glaucoma and trabeculectomy alone reduces the intraocular pressure more than combined surgery with less complications we recommended the following surgical options: Cataract extraction alone in patients with controlled open angle glaucoma and in patients with closed angle glaucoma. A two step procedure: filtering surgery followed by cataract extraction in patients with poorly controlled open angle glaucoma or mixed closed angle glaucoma. Ambulatory surgery and topical anesthesia permit a two stages surgery with less inconveniences. A combined procedure in patients with a chronic closed angle glaucoma where filtering procedure alone is associated with important complications. Actually, the best surgical cataract procedure is phacoemulsification with a small supero-corneal incision and implantation of a foldable intraocular lens. The best filtering procedure remains trabeculectomy, or the new non penetrating trabecular surgery for experimented surgeons, in the superior quadrant. In the future new surgical procedures and new safe and non toxic pharmacologic drugs which modulate wound healing could be found in order to increase the efficacity and indications of combined surgery. PMID:11262885

  20. New technique for treating abdominal surgical site infection using CT woundgraphy and NPWT: A case report

    PubMed Central

    Ito, Eisaku; Yoshida, Masashi; Nakashima, Keigo; Suzuki, Norihiko; Imakita, Tomonori; Tsutsui, Nobuhiro; Ohdaira, Hironori; Kitajima, Masaki; Suzuki, Yutaka

    2016-01-01

    Introduction Negative pressure wound therapy (NPWT) for abdominal surgical site infection (SSI) is becoming increasingly common, although enterocutaneous fistula (ECF) has been reported as a complication. To avoid ECF, we used computed tomography (CT) woundgraphy to evaluate the relationship between the wound and the intestine, and then safely treated the abdominal SSI with NPWT. Case presentation Following a laparoscopic intersphincteric resection for low rectal neuroendocrine tumor and covering ileostomy, a 59-year-old woman underwent stoma closure. Six days after surgery, we diagnosed SSI. We suspected ECF, because the wound was deep and the pus resembled enteric fluid. However, CT woundgraphy showed that the wound was separated from the abdominal cavity and the intestine by the abdominal rectus muscle. Accordingly, we performed NPWT. SSI was cured and the wound was well granulated. Twenty-three days after surgery, the patient was discharged. Eventually, the wound was completely epithelialized. Discussion Although successful NPWT has been reported for open abdominal wounds, ECF is a common complication. ECF can be prevented by separating the wound from the intestine by the omentum or muscle fascia, protecting the intestinal serosa during surgery, and applying low vacuum pressure. The relationships among the wound, the fascia, and the intestine must be evaluated before abdominal SSI treatment. One good method is CT woundgraphy, which evaluates wound extent and depth, closure of muscle fascia, and the relationship between the wound and the intestine. Conclusion We report a case of CT woundgraphy before NPWT for abdominal SSI. CT woundgraphy is a good candidate for evaluating wound condition. PMID:27002290

  1. Deep Sternal Wound Complications: An Overview of Old and New Therapeutic Options

    PubMed Central

    Rupprecht, Leopold; Schmid, Christof

    2013-01-01

    Deep sternal wound complications represent a significant problem in current open heart surgery and still pose a tremendous challenge to surgeons. Over the years, many treatment modalities have been proposed, but only few found their way into daily clinical practice of cardiothoracic surgeons. A gold standard has not been defined yet. This review was designed to give an overview of the preferred surgical strategies. PMID:25512698

  2. Ultraviolet light and hyperpigmentation in healing wounds

    SciTech Connect

    Wiemer, D.R.; Spira, M.

    1983-10-01

    The concept of permanent hyperpigmentation in wounds following ultraviolet light exposure during the postoperative period has found a place in plastic surgical literature but has not been documented. This study evaluates the effect of ultraviolet light on healing wounds in paraplegics. It failed to confirm permanent alteration in pigmentation response to ultraviolet exposure and suggests that other factors are of greater importance in the development of hyperpigmentation in the healing wound.

  3. Caustic burn caused by intradermal self administration of muriatic acid for suicidal attempt: optimal wound healing and functional recovery with a non surgical treatment

    PubMed Central

    FINO, P.; SPAGNOLI, A.M.; RUGGIERI, M.; ONESTI, M.G.

    2015-01-01

    Background Caustic burns are burns of third and fourth degree caused by strong acids or strong bases. Muriatic acid is often used for suicidal attempt by ingestion. We describe a case of a caustic skin lesion caused by intravenous failed attempt of suicide by injection of Muriatic acid in a woman affected with bipolar-syndrome. Generally, caustic burns are treated by cleansing, escarectomy and coverage with skin grafts. Case report We treated the patient with a non invasive technique with collagenase and hyaluronic acid sodium salt cream (Bionect start®), hyaluronic acid-based matrix (Hyalomatrix®) and Vacuum-Assisted Closure (VAC) Therapy®. Results We obtained complete healing in 6 weeks. Conclusions Combined use of non invasive techniques seems to ensure only advantages for both the patients and the Health System. It reduces health care costs and risks for the patients such as nosocomial infections. Patient’s compliance is high, as its quality of life. Complete healing of the wound is fast and recovery of function is full. PMID:26712258

  4. Factors Associated with Post-Surgical Delirium in Patients Undergoing Open Heart Surgery

    PubMed Central

    Jannati, Yadollah; Bagheri-Nesami, Masoumeh; Sohrabi, Maryam; Yazdani-Cherati, Jamshid; Mazdarani, Shahrzad

    2014-01-01

    Objective The objective of the present study is to determine the incidence of delirium and the associated factors in patients undergoing open heart surgery. Method This is an Analytic-descriptive study conducted on 404 patients undergoing elective open heart surgery in Fatemeh Zahra Heart Center, Sari, over the period of 6 months from July to December 2011. Sampling was achieved in a nonrandomized targeted manner and delirium was assessed using NeeCham questionnaire. A trained nurse evaluated the patients for delirium and completed the risk factor checklist on days 1 to 5 after surgery. Data analyses were accomplished using survival analysis (Kaplan-Meier and Cox regression) on SPSS software version 15. Results We found that variables, including ventilation time, increased drainage during the first 24 hours, the need for re-operation in the first 24 hours, dysrhythmias, use of inotropic agents, increased use of analgesics, increased arterial carbon dioxide, lack of visitors, and use of physical restrainers were associated with the development of delirium. In addition, we found a delirium incidence of 29%. Conclusion Diagnosis of cognitive disorders is of utmost value; therefore, further studies are required to clarify the risk factors because controlling them will help prevent delirium. PMID:25337310

  5. Impact of surgical approach on postoperative delirium in elderly patients undergoing gastrectomy: laparoscopic versus open approaches

    PubMed Central

    Shin, Young-Hee; Jeong, Hee-Joon

    2015-01-01

    Background Postoperative delirium is a frequent complication in elderly patients undergoing major abdominal surgery and is associated with a poor outcome. We compared postoperative delirium in elderly patients following laparoscopic gastrectomy (LG) versus open gastrectomy (OG). Methods In total, 130 patients aged ≥ 65 years with gastric cancer undergoing LG and OG were enrolled prospectively. Postoperative delirium and cognitive status were assessed daily using the Confusion Assessment Method (CAM) and Mini-Mental Status Examination (MMSE), respectively, for 3 days postoperatively. For CAM-positive patients, delirium severity was then assessed using the Delirium Index (DI). Results In total, 123 subjects (LG, n = 60; OG, n = 63) were included in the analysis. In both groups, the overall incidences of postoperative delirium were similar: 31.6% (19/60) in the LG group and 41.2% (26/63) in the OG group. When considering only those with delirium, the severity, expressed as the highest DI score, was similar between the groups. A decline in cognitive function (reduction in MMSE ≥ 2 points from baseline) during 3 days postoperatively was observed in 23 patients in the LG group (38.3%) and 27 patients in the OG group (42.9%) (P = 0.744). In both groups, postoperative cognitive decline was significantly associated with postoperative delirium (P < 0.001). Conclusions We found that, compared with traditional open gastrectomy, laparoscopic gastrectomy did not reduce either postoperative delirium or cognitive decline in elderly patients with gastric cancer. PMID:26257851

  6. An American Board of Orthodontics case report. A combined face mask-orthognathic surgical approach in the treatment of skeletal open bite and maxillary deficiency.

    PubMed

    Paz, M E; Subtelny, J D; Iranpour, B

    1989-01-01

    This case report is presented following the specifications of the American Board of Orthodontics. The patient had a true skeletal open bite with maxillary and mandibular asymmetry. She was treated with an orthognathic surgical approach and face mask therapy to stabilize the postsurgical result.

  7. PRE-OPERATIVE PLANNING AND SURGICAL TECHNIQUE OF THE OPEN WEDGE SUPRACONDYLAR OSTEOTOMY FOR CORRECTION OF VALGUS KNEE AND FIXATION WITH A FIXED-ANGLE IMPLANT

    PubMed Central

    Paccola, Cleber Antonio Jansen

    2015-01-01

    The step-by-step preoperative planning for supracondylar opening wedge osteotomy of the femur for precise correction of the load axis of the lower limb using a fixed-angle implant (95° AO blade plate) is presented. The surgical technique and the use of a bone graft from the same site for filling in the defect are also presented. PMID:27026976

  8. Evaluation of LHP® (1% hydrogen peroxide) cream versus petrolatum and untreated controls in open wounds in healthy horses: a randomized, blinded control study

    PubMed Central

    2011-01-01

    Background Treatment and protection of wounds in horses can be challenging; protecting bandages may be difficult to apply on the proximal extremities and the body. Unprotected wounds carry an increased risk of bacterial contamination and subsequent infection which can lead to delayed wound healing. Topical treatment with antimicrobials is one possibility to prevent bacterial colonization or infection, but the frequent use of antimicrobials ultimately leads to development of bacterial resistance which is an increasing concern in both human and veterinary medicine. Methods Standardized wounds were created in 10 Standardbred mares. Three wounds were made in each horse. Two wounds were randomly treated with LHP® or petrolatum and the third wound served as untreated control. All wounds were assessed daily until complete epithelization. Protocol data were recorded on day 2, 6, 11, 16, 21 and 28. Data included clinical scores for inflammation and healing, photoplanimetry for calculating wound areas and swab cytology to assess bacterial colonization and inflammation. Bacterial cultures were obtained on day 2, 6 and 16. Results Mean time to complete healing for LHP® treated wounds was 32 days (95%CI = 26.9-37.7). Mean time to complete healing for petrolatum and untreated control wounds were 41.6 days (95%CI = 36.2-47.0) and 44.0 days (95%CI = 38.6-49.4) respectively. Wound healing occurred significantly faster in LHP® wounds compared to both petrolatum (p = 0.0004) and untreated controls (p < 0.0001). There was no significant difference in time for healing between petrolatum and untreated controls. Total scores for bacteria and neutrophils were significantly (p < 0.0001) lower for LHP® treated wounds compared to petrolatum from day 16 and onwards. Staphylococcus aureus and Streptococcus zooepidemicus were only found in cultures from petrolatum treated wounds and untreated controls. Conclusions Treatment with LHP® reduced bacterial colonization and was associated with

  9. Orthodontic and surgical perspectives in management of a severe skeletal open bite

    PubMed Central

    Vadgaonkar, Vaishali; Gangurde, Parag; Deshmukh, Vijay; Shah, Alok

    2014-01-01

    In orthognathic correction of skeletal discrepancy, different treatment options should be considered to give optimum results to the patient with minimal postoperative problems caused by extensive bi-jaw surgery. In a case of severe vertical dysplasia with a large open bite, the orthodontist with the help of advanced diagnostic tools such as imaging software had planned bi-jaw surgery. However, there was a difference in opinion with the oral surgeon who considered only single jaw surgery to get adequate results. The possibility of only maxillary Le Fort I surgery creating autorotation of the mandible was considered, as 0.5° of autorotation results with 1° of maxillary posterior segment clockwise rotation thus avoiding bi-jaw surgery. After performing the Le Fort I superior repositioning of maxilla, the mandibular autorotation was not adequate, so a mandibular bilateral sagittal split osteotomy (BSSO) for mandibular advancement had to be performed to achieve favourable results. PMID:24835800

  10. Biofilms: do they affect wound healing?

    PubMed

    Thomson, Collette H

    2011-02-01

    Biofilms are known to exist in wounds, and it is suspected that their presence may delay wound healing, especially in chronic wounds; however, the evidence to support or refute this is not yet conclusive. This literature review has found that there is some evidence, both in vitro and in vivo, that the extracellular polysaccharide (EPS) matrix protects the biofilm from some inflammatory processes key to wound healing. The mechanisms of these effects and how this translates into clinical practice are still unknown. Strategies to manage biofilms within wounds are being investigated and may include use of silver, surgical debridedment, antibiotics and quorum-sensing inhibitors but no firm conclusions can yet be drawn from these studies. In conclusion, while there is a growing body of evidence to suggest that biofilms do indeed influence aspects of wound healing, there is still a large gap in our understanding of how this affects the wounds of clinical patients or how to improve rates of healing.

  11. 21 CFR 878.4410 - Low energy ultrasound wound cleaner.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Low energy ultrasound wound cleaner. 878.4410... (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4410 Low energy ultrasound wound cleaner. (a) Identification. A low energy ultrasound wound cleaner is a device that...

  12. 21 CFR 878.4410 - Low energy ultrasound wound cleaner.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Low energy ultrasound wound cleaner. 878.4410... (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4410 Low energy ultrasound wound cleaner. (a) Identification. A low energy ultrasound wound cleaner is a device that...

  13. 21 CFR 878.4410 - Low energy ultrasound wound cleaner.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Low energy ultrasound wound cleaner. 878.4410... (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4410 Low energy ultrasound wound cleaner. (a) Identification. A low energy ultrasound wound cleaner is a device that...

  14. 21 CFR 878.4410 - Low energy ultrasound wound cleaner.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Low energy ultrasound wound cleaner. 878.4410... (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4410 Low energy ultrasound wound cleaner. (a) Identification. A low energy ultrasound wound cleaner is a device that...

  15. 21 CFR 878.4410 - Low energy ultrasound wound cleaner.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Low energy ultrasound wound cleaner. 878.4410... (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4410 Low energy ultrasound wound cleaner. (a) Identification. A low energy ultrasound wound cleaner is a device that...

  16. Evaluation of opening pattern and bone neoformation at median palatal suture area in patients submitted to surgically assisted rapid maxillary expansion (SARME) through cone beam computed tomography

    PubMed Central

    SALGUEIRO, Daniel Gomes; RODRIGUES, Vitor Hugo Leite de Oliveira; TIEGHI, Victor; de MENEZES, Carolina Carmo; GONÇALES, Eduardo Sanches; FERREIRA, Osny

    2015-01-01

    Surgically assisted rapid maxillary expansion (SARME) is the treatment of choice to adult patients even with severe transversal maxillary discrepancies. However, the adequate retention period to achieve the bone remodeling, thus assuring treatment stability, is controversial. Objective To evaluate the opening pattern and bone neoformation process at the midpalatal suture in patients submitted to surgically assisted (SARME) through cone beam computed tomography (CBCT). Material and Methods Fourteen patients were submitted to SARME through subtotal Le Fort I osteotomy. Both the opening pattern and the mean bone density at midpalatal suture area to evaluate bone formation were assessed pre- and post-operatively (15, 60 and 180 days) through CBCT. Results Type I opening pattern (from anterior to posterior nasal spine) occurred in 12 subjects while type II opening pattern (from anterior nasal spine to transverse palatine suture) occurred in 2 individuals. The 180-day postoperative mean (PO 180) of bone density value was 49.9% of the preoperative mean (Pre) value. Conclusions The opening pattern of midpalatal suture is more related to patients’ age (23.9 years in type I and 33.5 years in type II) and surgical technique. It was not possible to observe complete bone formation at midpalatal suture area at the ending of the retention period studied (180 days). PMID:26398512

  17. Evaluation of opening pattern and bone neoformation at median palatal suture area in patients submitted to surgically assisted rapid maxillary expansion (SARME) through cone beam computed tomography.

    PubMed

    Salgueiro, Daniel Gomes; Rodrigues, Vitor Hugo Leite de Oliveira; Tieghi Neto, Victor; Menezes, Carolina Carmo de; Gonçales, Eduardo Sanches; Ferreira Júnior, Osny

    2015-01-01

    Surgically assisted rapid maxillary expansion (SARME) is the treatment of choice to adult patients even with severe transversal maxillary discrepancies. However, the adequate retention period to achieve the bone remodeling, thus assuring treatment stability, is controversial.Objective To evaluate the opening pattern and bone neoformation process at the midpalatal suture in patients submitted to surgically assisted (SARME) through cone beam computed tomography (CBCT).Material and Methods Fourteen patients were submitted to SARME through subtotal Le Fort I osteotomy. Both the opening pattern and the mean bone density at midpalatal suture area to evaluate bone formation were assessed pre- and post-operatively (15, 60 and 180 days) through CBCT.Results Type I opening pattern (from anterior to posterior nasal spine) occurred in 12 subjects while type II opening pattern (from anterior nasal spine to transverse palatine suture) occurred in 2 individuals. The 180-day postoperative mean (PO 180) of bone density value was 49.9% of the preoperative mean (Pre) value.Conclusions The opening pattern of midpalatal suture is more related to patients' age (23.9 years in type I and 33.5 years in type II) and surgical technique. It was not possible to observe complete bone formation at midpalatal suture area at the ending of the retention period studied (180 days).

  18. [Pneumonia in wounded].

    PubMed

    Ovchinnikov, Iu V; Kharitonov, M A; Sadykov, R R; Shelukhin, V A; Gaĭduk, S V; Bogomolov, A B; Ivanov, V V; Dobrovol'skaia, L M

    2015-02-01

    Pneumonia is one of the common complications of wounds of any localization. Therapists are involved into the treatment of lung lesions in wounded in the ICU, in the surgical and if the patient arrives "on follow-up care,"--in the medical ward. The article analyzes the main statistical indicators reflecting the prevalence and clinical and pathogenetic characteristics of lung pathology in wounded during the Great Patriotic War, during the fighting Soviet troops in the Republic of Afghanistan, the 1st and 2nd Chechen campaign. Pneumonia as a manifestation of traumatic disease can occur in two ways. Primary pneumonia is in close connection with the pathogenetic traumatic injury. Secondary lung lesions complicate the injury at a later date and are due to the introduction of a nosocomial infection process flora. We describe the clinical picture of pneumonia in the affected, the basic pathogenesis, principles of therapy. Successful treatment of lung pathology in wounded depends on the performance of a complex of activities involving a wide range of doctors of various specialties. PMID:25920173

  19. Surgical Scar Revision: An Overview

    PubMed Central

    Garg, Shilpa; Dahiya, Naveen; Gupta, Somesh

    2014-01-01

    Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods. PMID:24761092

  20. Open Surgical versus Minimal Invasive Necrosectomy of the Pancreas—A Retrospective Multicenter Analysis of the German Pancreatitis Study Group

    PubMed Central

    Rasch, Sebastian; Phillip, Veit; Reichel, Stephanie; Rau, Bettina; Zapf, Christian; Rosendahl, Jonas; Halm, Ulrich; Zachäus, Markus; Müller, Martin; Kleger, Alexander; Neesse, Albrecht; Hampe, Jochen; Ellrichmann, Mark; Rückert, Felix; Strauß, Peter; Algül, Hana

    2016-01-01

    Background Necrotising pancreatitis, and particularly infected necrosis, are still associated with high morbidity and mortality. Since 2011, a step-up approach with lower morbidity rates compared to initial open necrosectomy has been established. However, mortality and complication rates of this complex treatment are hardly studied thereafter. Methods The German Pancreatitis Study Group performed a multicenter, retrospective study including 220 patients with necrotising pancreatitis requiring intervention, treated at 10 hospitals in Germany between January 2008 and June 2014. Data were analysed for the primary endpoints "severe complications" and "mortality" as well as secondary endpoints including "length of hospital stay", "follow up", and predisposing or prognostic factors. Results Of all patients 13.6% were treated primarily with surgery and 86.4% underwent a step-up approach. More men (71.8%) required intervention for necrotising pancreatitis. The most frequent etiology was biliary (41.4%) followed by alcohol (29.1%). Compared to open necrosectomy, the step-up approach was associated with a lower number of severe complications (primary composite endpoint including sepsis, persistent multiorgan dysfunction syndrome (MODS) and erosion bleeding: 44.7% vs. 73.3%), lower mortality (10.5% vs. 33.3%) and lower rates of diabetes mellitus type 3c (4.7% vs. 33.3%). Low hematocrit and low blood urea nitrogen at admission as well as a history of acute pancreatitis were prognostic for less complications in necrotising pancreatitis. A combination of drainage with endoscopic necrosectomy resulted in the lowest rate of severe complications. Conclusion A step-up approach starting with minimal invasive drainage techniques and endoscopic necrosectomy results in a significant reduction of morbidity and mortality in necrotising pancreatitis compared to a primarily surgical intervention. PMID:27668746

  1. Effects of topical application of honey on cutaneous wound healing in rabbits.

    PubMed

    Oryan, A; Zaker, S R

    1998-04-01

    Although it has been known for many centuries that honey can accelerate wound healing, there have only been isolated reports of its use in the healing of burns, ulcers, infected wounds and open wounds. None of these reports developed a model to assess the changes in morphological and biochemical properties due to topical application of honey on cutaneous wounds. In the present investigation, efficacy of honey in the healing of cutaneous wounds of rabbits was studied on the basis of histopathological and biochemical changes. For this reason 40 healthy White New Zealand rabbits were randomly assigned to four equal groups. Using aseptic surgical technique, a 3 cm incision was made on the skin of the left thigh of each rabbit and the wounds of five rabbits in each group were twice daily treated with topical application of 5 ml pure unheated honey. The other half remained as untreated controls. Rabbits in groups A, B, C and D were biopsied on days 2, 7, 14 and 21 postoperatively respectively, and biopsies from the lesions of all groups were collected for histopathological studies and from groups C and D for biomechanical evaluations as well. Treated lesions showed less oedema, fewer polymorphonuclear and mononuclear cell infiltration, less necrosis, better wound contraction, improved epithelialization and lower glycosaminoglycan and proteoglycan concentration on days 2 and 7 postoperatively and better tissue organization and consequently an improved tissue ultimate strength and yield strength on days 14 and 21 postoperation. These findings suggest that honey applied topically on cutaneous wounds accelerates the healing processes and appears to have an important property that makes it ideal as a dressing for cutaneous wounds. PMID:9673575

  2. Effects of pulsed infra-red low level-laser irradiation on open skin wound healing of healthy and streptozotocin-induced diabetic rats by biomechanical evaluation.

    PubMed

    Dadpay, Masoomeh; Sharifian, Zanelabedien; Bayat, Mohammad; Bayat, Mehrnoush; Dabbagh, Ali

    2012-06-01

    Diabetes is one of the most common causes of delayed wound healing. Low-level laser therapy (LLLT) are one of the therapeutic modalities used for the treatment of wounds. The aim of present study is to evaluate the effect of LLLT in experimentally-induced diabetic rats. Two full thickness skin incisions were made on dorsal regions of each rat. The wounds were randomly divided into laser-treated and placebo. Laser-treated wounds of the healthy (non-diabetic) animals were submitted to a pulsed-infrared 890nm laser with an 80Hz frequency and 0.03J/cm(2) for each wound point in the first healthy group and 0.2J/cm(2) in the second healthy group. Laser-treated wounds of the diabetic animals received the same pulsed-infrared laser treatments as the second group for each wound point. On day 15, a sample from each wound was extracted and submitted for tensile strength evaluation. Laser irradiation with 0.03J/cm(2) significantly decreased the maximum load for wound repair in healthy rats (p=0.015). Laser irradiation with 0.2J/cm(2) significantly increased the maximum load in wounds from the healthy control (p=0.021) and diabetic (p<001) groups. Laser treatments with a pulsed infrared laser at 0.2J/cm(2) significantly accelerated wound healing in both healthy and diabetic rats.

  3. Surgical robotics through a keyhole: from today's translational barriers to tomorrow's "disappearing" robots.

    PubMed

    Marcus, Hani; Nandi, Dipankar; Darzi, Ara; Yang, Guang-Zhong

    2013-03-01

    In the last century, engineering advances have transformed the practice of surgery. Keyhole surgical techniques offer a number of advantages over traditional open approaches including less postoperative pain, fewer wound complications, and reduced length of stay in hospital. However, they also present considerable technical challenges, particularly to surgeons performing new operative approaches, such as those through natural orifices. Advances in surgical robots have improved surgical visualization, dexterity, and manipulation consistency, thus greatly enhancing surgical performance and patient care. Clinically, however, robotic surgery is still in its infancy, and its use has remained limited to relatively few operations. In the paper, we will discuss the economic-, clinical-, and research-related factors that may act as barriers to the widespread utilization and development of surgical robots. In overcoming these barriers through a synergistic effort of both engineering and medicine, we highlight our future vision of robotic surgery, in both the short and long term.

  4. Ballistics and gunshot wounds: effects on musculoskeletal tissues.

    PubMed

    Bartlett, C S; Helfet, D L; Hausman, M R; Strauss, E

    2000-01-01

    As a result of the increasing number of weapons in this country, as many as 500,000 missile wounds occur annually, resulting in 50,000 deaths, significant morbidity, and striking socioeconomic costs. Wounds are generally classified as low-velocity (less than 2,000 ft/sec) or high-velocity (more than 2,000 ft/sec). However, these terms can be misleading; more important than velocity is the efficiency of energy transfer, which is dependent on the physical characteristics of the projectile, as well as kinetic energy, stability, entrance profile and path traveled through the body, and the biologic characteristics of the tissues injured. Although bullets are not sterilized on discharge, most low-velocity gunshot wounds can be safely treated nonoperatively with local wound care and outpatient management. Typically, associated fractures are treated according to accepted protocols for each area of injury. Treatment of low-velocity, low-energy fractures is generally dictated by the osseous injuries, as these are similar in many regards to closed fractures. Soft tissues play a more critical role in high-velocity and shotgun fractures, which are essentially open injuries. Aside from perioperative prophylaxis, antibiotics are probably required only for grossly contaminated wounds; however, because contamination is not always apparent, most authors still recommend routine prophylaxis. High-energy injuries and grossly contaminated wounds mandate aggressive irrigation and debridement, including a thorough search for foreign material. Open fracture protocols including external fixation or intramedullary nailing and intravenous antibiotic therapy for 48 to 72 hours should be instituted. If there is vascular damage, exploration and repair are best performed after prompt fracture stabilization. Evaluation of the "four Cs"-color, consistency, contractility, and capacity to bleed-provides valuable information regarding the viability of muscle. Skin grafting is preferable when tension

  5. Comparison of Surgical Outcomes Between Short-Segment Open and Percutaneous Pedicle Screw Fixation Techniques for Thoracolumbar Fractures.

    PubMed

    Fu, Zhiguo; Zhang, Xi; Shi, Yaohua; Dong, Qirong

    2016-01-01

    BACKGROUND This study aimed to compare the surgical outcomes between open pedicle screw fixation (OPSF) and percutaneous pedicle screw fixation (PPSF) for the treatment of thoracolumbar fractures, which has received scant research attention to date. MATERIAL AND METHODS Eight-four patients with acute and subacute thoracolumbar fractures who were treated with SSPSF from January 2013 to June 2014 at the Changzhou Hospital of Traditional Chinese Medicine (Changzhou, China) were retrospectively reviewed. The patients were divided into 4 groups: the OPSF with 4 basic screws (OPSF-4) group, the OPSF with 4 basic and 2 additional screws (OPSF-6) group, the PPSF with 4 basic screws (PPSF-4) group, and the PPSF with 4 basic and 2 additional screws (PPSF-6) group. The intraoperative, immediate postoperative, and over 1-year follow-up outcomes were evaluated and compared among these groups. RESULTS Blood loss in the PPSF-4 group and the PPSF-6 group was significantly less than in the OPSF-4 group and the OPSF-6 group (P<0.05). The OPSF-6 group exhibited significantly higher immediate postoperative correction percentage of anterior column height of fractured vertebra than the other 3 groups (P<0.05), and higher correction of sagittal regional Cobb angle and kyphotic angle of injured vertebra than in the PPSF-4 and -6 groups (P<0.05). In addition, there was no significant difference in the correction loss of percentage of anterior column height, and loss of sagittal Cobb angle and kyphotic angle of fractured vertebrae at final follow-up among the 4 groups (P>0.05). CONCLUSIONS OPSF with 6 screws had an advantage in the correction of injured vertebral height and kyphosis, and PPSF reduced the intraoperative blood loss of patients. PMID:27602557

  6. Seventeen Years’ Experience of Late Open Surgical Conversion after Failed Endovascular Abdominal Aortic Aneurysm Repair with 13 Variant Devices

    SciTech Connect

    Wu, Ziheng; Xu, Liang; Qu, Lefeng; Raithel, Dieter

    2015-02-15

    PurposeTo investigate the causes and results of late open surgical conversion (LOSC) after failed abdominal aortic aneurysm repair (EVAR) and to summarize our 17 years’ experience with 13 various endografts.MethodsRetrospective data from August 1994 to January 2011 were analyzed at our center. The various devices’ implant time, the types of devices, the rates and causes of LOSC, and the procedures and results of LOSC were analyzed and evaluated.ResultsA total of 1729 endovascular aneurysm repairs were performed in our single center (Nuremberg South Hospital) with 13 various devices within 17 years. The median follow-up period was 51 months (range 9–119 months). Among them, 77 patients with infrarenal abdominal aortic aneurysms received LOSC. The LOSC rate was 4.5 % (77 of 1729). The LOSC rates were significantly different before and after January 2002 (p < 0.001). The reasons of LOSC were mainly large type I endoleaks (n = 51) that were hard to repair by endovascular techniques. For the LOSC procedure, 71 cases were elective and 6 were emergent. The perioperative mortality was 5.2 % (4 of 77): 1 was elective (due to septic shock) and 3 were urgent (due to hemorrhagic shock).ConclusionLarge type I endoleaks were the main reasons for LOSC. The improvement of devices and operators’ experience may decrease the LOSC rate. Urgent LOSC resulted in a high mortality rate, while selective LOSC was relatively safe with significantly lower mortality rate. Early intervention, full preparation, and timely LOSC are important for patients who require LOSC.

  7. Comparison of Surgical Outcomes Between Short-Segment Open and Percutaneous Pedicle Screw Fixation Techniques for Thoracolumbar Fractures

    PubMed Central

    Fu, Zhiguo; Zhang, Xi; Shi, Yaohua; Dong, Qirong

    2016-01-01

    Background This study aimed to compare the surgical outcomes between open pedicle screw fixation (OPSF) and percutaneous pedicle screw fixation (PPSF) for the treatment of thoracolumbar fractures, which has received scant research attention to date. Material/Methods Eight-four patients with acute and subacute thoracolumbar fractures who were treated with SSPSF from January 2013 to June 2014 at the Changzhou Hospital of Traditional Chinese Medicine (Changzhou, China) were retrospectively reviewed. The patients were divided into 4 groups: the OPSF with 4 basic screws (OPSF-4) group, the OPSF with 4 basic and 2 additional screws (OPSF-6) group, the PPSF with 4 basic screws (PPSF-4) group, and the PPSF with 4 basic and 2 additional screws (PPSF-6) group. The intraoperative, immediate postoperative, and over 1-year follow-up outcomes were evaluated and compared among these groups. Results Blood loss in the PPSF-4 group and the PPSF-6 group was significantly less than in the OPSF-4 group and the OPSF-6 group (P<0.05). The OPSF-6 group exhibited significantly higher immediate postoperative correction percentage of anterior column height of fractured vertebra than the other 3 groups (P<0.05), and higher correction of sagittal regional Cobb angle and kyphotic angle of injured vertebra than in the PPSF-4 and -6 groups (P<0.05). In addition, there was no significant difference in the correction loss of percentage of anterior column height, and loss of sagittal Cobb angle and kyphotic angle of fractured vertebrae at final follow-up among the 4 groups (P>0.05). Conclusions OPSF with 6 screws had an advantage in the correction of injured vertebral height and kyphosis, and PPSF reduced the intraoperative blood loss of patients. PMID:27602557

  8. Management of Traumatic Wounds and a Novel Approach to Delivering Wound Care in Children.

    PubMed

    Bernabe, Kathryn Q; Desmarais, Thomas J; Keller, Martin S

    2014-04-01

    Significance: The costs and morbidity of pediatric traumatic wounds are not well known. The literature lacks a comprehensive review of the volume, management, and outcomes of children sustaining soft tissue injury. We briefly review the existing literature for traumatic wounds such as open fractures and burns. Such injuries require dedicated wound care and we propose a novel approach for more efficient and more effective delivery of dedicated pediatric wound care. Recent Advances: New pediatric literature is emerging regarding the long-term effects of wound care pain in traumatic injuries-especially burns. A variety of wound dressings and alternative management techniques exist and are geared toward reducing wound care pain. Our institution utilizes a unique model to provide adequate sedation and pain control through a dedicated pediatric wound care unit. We believe that this model reduces the cost of wound care by decreasing emergency department and operating room visits as well as hospital length of stay. Critical Issues: First, medical costs related to pediatric traumatic wound care are not insignificant. The need for adequate pain control and sedation in children with complex wounds is traditionally managed with operating room intervention. Afterward, added costs can be from a hospital stay for ongoing acute wound management. Second, morbidities of complex traumatic wounds are shown to be related to the acute wound care received. Future Directions: Further guidelines are needed to determine the most effective and efficient care of complex traumatic soft tissue injuries in the pediatric population.

  9. Microwave Tissue Soldering for Immediate Wound Closure

    NASA Technical Reports Server (NTRS)

    Arndt, G. Dickey; Ngo, Phong H.; Phan, Chau T.; Byerly, Diane; Dusl, John; Sognier, Marguerite A.; Carl, James

    2011-01-01

    A novel approach for the immediate sealing of traumatic wounds is under development. A portable microwave generator and handheld antenna are used to seal wounds, binding the edges of the wound together using a biodegradable protein sealant or solder. This method could be used for repairing wounds in emergency settings by restoring the wound surface to its original strength within minutes. This technique could also be utilized for surgical purposes involving solid visceral organs (i.e., liver, spleen, and kidney) that currently do not respond well to ordinary surgical procedures. A miniaturized microwave generator and a handheld antenna are used to deliver microwave energy to the protein solder, which is applied to the wound. The antenna can be of several alternative designs optimized for placement either in contact with or in proximity to the protein solder covering the wound. In either case, optimization of the design includes the matching of impedances to maximize the energy delivered to the protein solder and wound at a chosen frequency. For certain applications, an antenna could be designed that would emit power only when it is in direct contact with the wound. The optimum frequency or frequencies for a specific application would depend on the required depth of penetration of the microwave energy. In fact, a computational simulation for each specific application could be performed, which would then match the characteristics of the antenna with the protein solder and tissue to best effect wound closure. An additional area of interest with potential benefit that remains to be validated is whether microwave energy can effectively kill bacteria in and around the wound. Thus, this may be an efficient method for simultaneously sterilizing and closing wounds.

  10. Evaluation of a training course on open vascular surgical techniques in aortoiliac pathology - 5 years of experience

    PubMed Central

    STANCU, BOGDAN; BETEG, FLORIN; MIRONIUC, AUREL; MUSTE, AUREL; GHERMAN, CLAUDIA

    2015-01-01

    Introduction The aim of this prospective study was to assess the efficacy of a vascular surgery course (2008–2012), and to verify the viability and the feasibility of vascular anastomoses. Material and method The vascular surgical techniques performed simultaneously on pigs were: enlargement prosthetic angioplasty, abdominal aortic interposition graft and aortoiliac bypass. The endpoints of the study were the surgical skills and the technical quality, assessed on a scale ranging from 1 (satisfactory) to 3 (very good) for our participants. Results A significant improvement in vascular surgical skills tasks was observed during the study years and we also found a significant statistical association between the quality of the suture and the surgical technique used (Kendall coefficient=0.71, p=0.001<0.05). Conclusions Our course contributed to the improvement of the technical vascular surgical skills of the operator teams, reproducing in vivo, in pigs, the intraoperative environment of human patients. PMID:26528071

  11. Bacterial Wound Culture

    MedlinePlus

    ... Home Visit Global Sites Search Help? Bacterial Wound Culture Share this page: Was this page helpful? Also known as: Aerobic Wound Culture; Anaerobic Wound Culture Formal name: Culture, wound Related ...

  12. Negative Pressure Wound Therapy: Experience in 45 Dogs

    PubMed Central

    Pitt, Kathryn A.; Stanley, Bryden J.

    2016-01-01

    Objective To report experience with negative pressure wound therapy (NPWT) in 45 consecutive dogs admitted with extensive cutaneous wounds and to determine if NPWT is feasible in veterinary hospital practice. Study Design Prospective descriptive study Animals Dogs (n = 45) Methods Collected data were organized into 6 categories: patient data, wound data, NPWT data, adjunctive treatments, complications, and final outcome Results Wounds (53 in 45 dogs) were largely traumatic in origin, and distributed fairly evenly to the trunk, proximal and distal aspects of the limbs. Most wounds (34 dogs, 76%) had no granulation tissue and were treated a mean of 4.2 days after wounding, whereas 11 dogs had granulating wounds that were initially treated a mean of 87 days after wounding. Median NPWT use was 3 days with a mean hospitalization of 7.8 days. Most wounds (33; 62%) were closed surgically after NPWT and were healed by 14 days. The other 18 wounds healed (mean, 21 days) by second intention after hospital discharge. Overall, 96% of the wounds healed; 2 dogs died before definitive closure could be attempted. Conclusion NPWT is applicable to a wide variety of canine wounds is well tolerated, allows for several days between dressing changes, and can used to optimize the wound bed for surgical closure or second intention healing. PMID:24512302

  13. Management of gunshot wounds

    SciTech Connect

    Ordog, G.; Drew, R.

    1987-01-01

    Management of Gunshot Wounds provides a review of wound ballistics and a systemic review of gunshot wound management of all major body areas and systems. This volume includes information on pre-hospital care, nursing care, and care of infants, children, and the elderly patient with gunshot wounds. This volume also features information on: lead toxicity; complications of gunshot wounds; socioeconomic aspects of gunshot wounds; the forensic and pathological aspects of gunshot wounds; future directions in the care of gunshot wounds.

  14. The value of esophagectomy surgical apgar score (eSAS) in predicting the risk of major morbidity after open esophagectomy

    PubMed Central

    Xing, Xue-Zhong; Wang, Hai-Jun; Qu, Shi-Ning; Huang, Chu-Lin; Zhang, Hao; Wang, Hao; Yang, Quan-Hui

    2016-01-01

    Background Recently, surgical apgar score (SAS) has been reported to be strongly associated with major morbidity after major abdominal surgery. The aim of this study was to assess the value of esophagectomy SAS (eSAS) in predicting the risk of major morbidity after open esophagectomy in a high volume cancer center. Methods The data of all patients who admitted to intensive care unit (ICU) after open esophagectomy at Cancer Hospital of Chinese Academy of Medical Sciences & Peking Union Medical College from September 2008 through August 2010 was retrospectively collected and reviewed. Preoperative and perioperative variables were recorded and compared. The eSAS was calculated as the sum of the points of EBL, lowest MAP and lowest HR for each patient. Patients were divided into high-risk (below the cutoff) and low-risk (above the cutoff) eSAS groups according to the cutoff score with optimal accuracy of eSAS for major morbidity. Univariable and multivariable regression analysis were used to define risk factors of the occurrence of major morbidity. Results Of 189 patients, 110 patients developed major morbidities (58.2%) and 30-day operative mortality was 5.8% (11/189). There were 156 high risk patients (eSAS ≤7) and 33 low risk (eSAS >7) patients. Univariable analysis demonstrated that forced expiratory volume in one second of predicted (FEV1%) ≤78% (44% vs. 61%, P=0.024), McKeown approach (22.7% vs. 7.6%, P=0.011), duration of operation longer than 230 minutes, intraoperative estimated blood loss (347±263 vs. 500±510 mL, P=0.015) and eSAS ≤7 (62.2% vs. 90.0%, P=0.001) were predictive of major morbidity. Multivariable analysis demonstrated that FEV1% ≤78% (OR, 2.493; 95% CI, 1.279–4.858, P=0.007) and eSAS ≤7 (OR, 2.810; 95% CI, 1.105–7.144; P=0.030) were independent predictors of major morbidity after esophagectomy. Compared with patients who had eSAS >7, patients who had eSAS ≤7 had longer hospital length of stay (25.39±14.36 vs. 32.22±22.66 days

  15. [Local treatment of chronic skin wounds in a Swiss out-patient wound centre 2010].

    PubMed

    Baumgartner, Marc; Tanner, Daniel; Hunziker, Thomas

    2011-03-01

    In Switzerland around 30,000 patients suffer from chronic skin wounds. Appropriate topical wound care along with treatment of the causes of the wounds enables to heal a lot of these patients and to avoid secondary disease such as infections. Thereby, the final goal of wound care is stable reepithelisation. Based on experience with chronic leg ulcers mainly in our out-patient wound centre, we give a survey of the wound dressings we actually use and discuss their wound-phase adapted application. Furthermore, we address the two tissue engineering products reimbursed in Switzerland, Apligraf and EpiDex, as well as the biological matrix product Oasis. The crucial question, which treatment options will be offered in future to the wound patients by our health regulatory and insurance systems, is open to debate.

  16. Hidradenitis Suppurativa and Wound Management.

    PubMed

    Dini, Valentina; Oranges, Teresa; Rotella, Luca; Romanelli, Marco

    2015-09-01

    Hidradenitis suppurativa (HS) is a chronic, burdensome, debilitating disease of the hair follicle. It presents with recurrent painful inflamed and noninflamed lesions usually in specific body areas such as axillary, inguinal, perineal, and genital areas. It is associated with a large range of other diseases and conditions, such as obesity, arthropathy, inflammatory bowel diseases, and sqaumous cell carcinoma. Medical therapy may be systemic or topical, mainly based on antibiotics, retinoids, hormones and immunosuppressive drugs, including biological therapies. Surgical and laser therapies may be a valid therapeutic approach in order to treat locally recurring lesions. The aim of this article is to review the wound healing options after skin excision and laser treatments, with a focus on lesions left to heal by secondary intention, analyzing the efficacy of moist wound dressings, negative pressure wound therapy, bioactive dressings, such as platelet-rich plasma gel and hylarunoic acid scaffold, or autologous keratinocyte suspension in platelet concentrate and skin-grafting tecniques.

  17. Microwave Tissue Soldering for Immediate Wound Closure

    NASA Technical Reports Server (NTRS)

    Arndt, G. Dickey; Ngo, Phong H.; Plan, Chau T.; Byerly, Diane; Dusl, John; Sognier, Marguerite A.

    2011-01-01

    A novel approach for the immediate sealing of traumatic wounds is under development. A portable microwave generator and handheld antenna are used to seal wounds, binding the edges of the wound together using a biodegradable protein sealant or solder. This method could be used for repairing wounds in emergency settings, by restoring the wound surface to its original strength within minutes. This technique could also be utilized for surgical purposes involving solid visceral organs (i.e., liver, spleen, and kidney) that currently do not respond well to ordinary surgical procedures. A miniaturized microwave generator and a handheld antenna are used to deliver microwave energy to the protein solder, which is applied to the wound. The antenna can be of several alternative designs optimized for placement either in contact with or proximity to the protein solder covering the wound. In either case, optimization of the design includes the matching of impedances to maximize the energy delivered to the protein solder and wound at a chosen frequency. For certain applications, an antenna could be designed that would emit power only when it is in direct contact with the wound. The optimum frequency or frequencies for a specific application would depend on the required depth of penetration of the microwave energy. In fact, a computational simulation for each specific application could be performed, which would then match the characteristics of the antenna with the protein solder and tissue to best effect wound closure. An additional area of interest with potential benefit that remains to be validated is whether microwave energy can effectively kill bacteria in and around the wound. Thus, this may be an efficient method for simultaneously sterilizing and closing wounds. Using microwave energy to seal wounds has a number of advantages over lasers, which are currently in experimental use in some hospitals. Laser tissue welding is unsuitable for emergency use because its large, bulky

  18. Hypercapnia Improves Tissue Oxygenation in Morbidly Obese Surgical Patients

    PubMed Central

    Hager, Helmut; Reddy, Dayakar; Mandadi, Goutham; Pulley, Debra; Eagon, J Chris; Sessler, Daniel I; Kurz, Andrea

    2006-01-01

    Risk of wound infection is increased in morbidly obese surgical patients, in part because a major determinant of wound infection risk, tissue oxygenation, is marginal. Unlike in lean patients, supplemental inspired oxygen (FIO2) only slightly improves tissue oxygenation in obese patients. Mild hypercapnia improves tissue oxygenation in lean, but has not been evaluated in obese patients. We thus tested the hypothesis that mild hypercapnia markedly improves tissue oxygenation in morbidly obese patients given FIO2 80% during major abdominal surgery. Thirty obese patients (body mass index 61.5±17 kg/m2) scheduled for open gastric bypass were randomly assigned to normocapnia (n=15, end-tidal PCO2 35 mmHg) or hypercapnia (n=15, end-tidal PCO2 50 mmHg); FIO2 was 80%. Anesthetic management and other confounding factors were controlled. Tissue oxygen tension was measured subcutaneously at the upper arm using a polarographic probe in a silastic tonometer. Demographic characteristics, cardiovascular measurements, and PaO2 (222±48 versus 230±68 mmHg in normocapnic versus hypercapnic; mean±SD, P=0.705) were comparable in the groups. Tissue oxygen tension, however, was greater in hypercapnic than in normocapnic patients (78±31 versus 56±13 mmHg, P=0.029). Mild hypercapnia increased tissue oxygenation by an amount believed to be clinically important and could potentially reduce the risk of surgical wound infection in morbidly obese patients. PMID:16931680

  19. Evidence-Based Care of Acute Wounds: A Perspective

    PubMed Central

    Ubbink, Dirk T.; Brölmann, Fleur E.; Go, Peter M. N. Y. H.; Vermeulen, Hester

    2015-01-01

    Significance: Large variation and many controversies exist regarding the treatment of, and care for, acute wounds, especially regarding wound cleansing, pain relief, dressing choice, patient instructions, and organizational aspects. Recent Advances: A multidisciplinary team developed evidence-based guidelines for the Netherlands using the AGREE-II and GRADE instruments. A working group, consisting of 17 representatives from all professional societies involved in wound care, tackled five controversial issues in acute-wound care, as provided by any caregiver throughout the whole chain of care. Critical Issues: The guidelines contain 38 recommendations, based on best available evidence, additional expert considerations, and patient experiences. In summary, primarily closed wounds need no cleansing; acute open wounds are best cleansed with lukewarm (drinkable) water; apply the WHO pain ladder to choose analgesics against continuous wound pain; use lidocaine or prilocaine infiltration anesthesia for wound manipulations or closure; primarily closed wounds may not require coverage with a dressing; use simple dressings for open wounds; and give your patient clear instructions about how to handle the wound. Future Directions: These evidence-based guidelines on acute wound care may help achieve a more uniform policy to treat acute wounds in all settings and an improved effectiveness and quality of wound care. PMID:26005594

  20. Treatment of a perforating thoracic bite wound in a dog with negative pressure wound therapy.

    PubMed

    Nolff, Mirja C; Pieper, Korbinian; Meyer-Lindenberg, Andrea

    2016-10-01

    CASE DESCRIPTION A 4-year-old male Dachshund was examined following a bite attack that had occurred 5 days previously. The dog had acutely deteriorated despite IV antimicrobial treatment and fluid therapy. CLINICAL FINDINGS On initial examination, the patient was recumbent with signs of septic shock and a flail chest. Three penetrating wounds in the left thoracic wall with malodorous discharge were evident. The animal trauma triage score was 8 out of 18. Thoracic and abdominal radiography revealed displaced fractures of the left seventh, eighth, and ninth ribs and extensive subcutaneous emphysema. Additionally, a marked diffuse bronchointerstitial pattern, areas of alveolar pattern, and pneumothorax were present bilaterally. TREATMENT AND OUTCOME Open surgical debridement with left lateral lung lobectomy and resection of portions of the left thoracic wall were performed. Extensive soft tissue loss precluded primary reconstruction. The defect was stabilized with a polypropylene mesh implant, and negative pressure wound therapy (NPWT) at -100 mm Hg was initiated. Microbial culture and susceptibility testing of tissue samples indicated the presence of multidrug-resistant Staphylococcus pseudintermedius. The NPWT dressing was changed 2, 5, and 7 days after surgery. Treatment was well tolerated, and the mesh was completely covered with granulation tissue 10 days after surgery. On follow-up 5, 7, 12, and 19 months after surgery, the dog was clinically normal with no apparent complications. CLINICAL RELEVANCE Findings suggested that NPWT may be a valuable adjunct when treating small animal patients with severe thoracic trauma. PMID:27654166

  1. Postoperative wound care after dermatologic procedures: a comparison of 2 commonly used petrolatum-based ointments.

    PubMed

    Morales-Burgos, Adisbeth; Loosemore, Michael P; Goldberg, Leonard H

    2013-02-01

    An appropriate selection of topical agents for wound care is important to promote uncomplicated healing. Petrolatum-based ointments, such as Aquaphor Healing Ointment (AHO) and white petroleum jelly, are commonly employed to keep wounds moist postoperatively. While they have beneficial properties for wound healing, they also may cause wound redness and swelling. We decided to evaluate for wound reactivity postoperatively for these 2 commonly used petrolatum-based ointments. We found that surgical wounds treated with AHO had a higher incidence of wound redness (52%) than those treated with plain white petrolatum (12%).

  2. Talus fractures: surgical principles.

    PubMed

    Rush, Shannon M; Jennings, Meagan; Hamilton, Graham A

    2009-01-01

    Surgical treatment of talus fractures can challenge even the most skilled foot and ankle surgeon. Complicated fracture patterns combined with joint dislocation of variable degrees require accurate assessment, sound understanding of principles of fracture care, and broad command of internal fixation techniques needed for successful surgical care. Elimination of unnecessary soft tissue dissection, a low threshold for surgical reduction, liberal use of malleolar osteotomy to expose body fracture, and detailed attention to fracture reduction and joint alignment are critical to the success of treatment. Even with the best surgical care complications are common and seem to correlate with injury severity and open injuries. PMID:19121756

  3. Treatment of non-healing sternum wound after open-heart surgery with allogenic platelet-rich plasma and fibrin glue-preliminary outcomes

    PubMed Central

    Tashnizi, Mohammad Abbasi; Alamdari, Daryoush Hamidi; Khayami, Mohammad Esmail; Rahimi, Hamid Reza; Moeinipour, Aliasghar; Amouzeshi, Ahmad; Seifalian, Alexander M.

    2013-01-01

    Introduction: Non-healing wound in the sternal region after coronary arteries bypass graft surgery is a serious complication. For healing a chronic wound, several novel approaches have been proposed recently such as using bone marrow stem cells, platelets and fibrin glue (PFG); but a non-invasive method is highly desirable in the first approach for treatment. The current study was undertaken to evaluate the effect of the combination of PFG in one treatment. Materials and Methods: We report on the treatment of six patients with life-threatening chronic sternum wounds, which caused septicemia with multi-drug resistant pathogens. The ulcers were extensively debrided initially and were measured and photographed at weekly intervals. The combination of PFG was applied topically on the wound after every 2 days. Results: The wounds were completely closed in five patients and significantly reduced in size in one. There was no evidence of local or systemic complications and any abnormal tissue formation, keloid or hypertrophic scarring. Conclusions: Our study suggests, in the first approach, PFG can be used safely in order to heal a non healing sternum wound following coronary artery bypass surgery. PMID:24459346

  4. How wounds heal

    MedlinePlus

    ... How scrapes heal; How puncture wounds heal; How burns heal; How pressure sores heal; How lacerations heal ... from germs. Not all wounds bleed. For example, burns, some puncture wounds, and pressure sores do not ...

  5. Surgical bleeding in microgravity

    NASA Technical Reports Server (NTRS)

    Campbell, M. R.; Billica, R. D.; Johnston, S. L. 3rd

    1993-01-01

    A surgical procedure performed during space flight would occur in a unique microgravity environment. Several experiments performed during weightlessness in parabolic flight were reviewed to ascertain the behavior of surgical bleeding in microgravity. Simulations of bleeding using dyed fluid and citrated bovine blood, as well as actual arterial and venous bleeding in rabbits, were examined. The high surface tension property of blood promotes the formation of large fluid domes, which have a tendency to adhere to the wound. The use of sponges and suction will be adequate to prevent cabin atmosphere contamination with all bleeding, with the exception of temporary arterial droplet streams. The control of the bleeding with standard surgical techniques should not be difficult.

  6. 21 CFR 878.4018 - Hydrophilic wound dressing.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hydrophilic wound dressing. 878.4018 Section 878.4018 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4018 Hydrophilic wound...

  7. 21 CFR 878.4018 - Hydrophilic wound dressing.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hydrophilic wound dressing. 878.4018 Section 878.4018 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4018 Hydrophilic wound...

  8. 21 CFR 878.4018 - Hydrophilic wound dressing.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hydrophilic wound dressing. 878.4018 Section 878.4018 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4018 Hydrophilic wound...

  9. 21 CFR 878.4018 - Hydrophilic wound dressing.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hydrophilic wound dressing. 878.4018 Section 878.4018 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4018 Hydrophilic wound...

  10. 21 CFR 878.4020 - Occlusive wound dressing.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Occlusive wound dressing. 878.4020 Section 878.4020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4020 Occlusive wound...

  11. 21 CFR 878.4018 - Hydrophilic wound dressing.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hydrophilic wound dressing. 878.4018 Section 878.4018 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4018 Hydrophilic wound...

  12. 21 CFR 878.4020 - Occlusive wound dressing.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Occlusive wound dressing. 878.4020 Section 878.4020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4020 Occlusive wound...

  13. 21 CFR 878.4020 - Occlusive wound dressing.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Occlusive wound dressing. 878.4020 Section 878.4020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4020 Occlusive wound...

  14. 21 CFR 878.4020 - Occlusive wound dressing.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Occlusive wound dressing. 878.4020 Section 878.4020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4020 Occlusive wound...

  15. 21 CFR 878.4020 - Occlusive wound dressing.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Occlusive wound dressing. 878.4020 Section 878.4020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4020 Occlusive wound...

  16. The Falklands war: Army field surgical experience.

    PubMed Central

    Jackson, D. S.; Batty, C. G.; Ryan, J. M.; McGregor, W. S.

    1983-01-01

    In the recent Falklands campaign four Army Field Surgical Teams were deployed in the two phases of the war. They functioned as Advanced Surgical Centres and operated on 233 casualties. There were 3 deaths. The patterns of wounding and the methods of casualty management are discussed and compared with other recent campaigns. Images Fig. 1 PMID:6614760

  17. Surgical treatment of supra- and infratentorial epidural hematoma.

    PubMed

    Xiaoyu, Wang; Guoping, Li

    2013-01-01

    Supra- and infratentorial acute epidural hematoma (SIEDH) is a common type of posterior fossa epidural hematoma (PFEDH), representing 11- 64% of all PFEDHs. Although SIEDH is associated with typical characteristics, it might be difficult to diagnose when presenting as infratentorial acute epidural hematoma, which is clinically silent and has nonspecific symptoms. However, this type of hematoma can often be rapidly deteriorating, causing a sharp rise in intracranial pressure that leads to a life-threatening foramen magnum herniation. Early diagnosis and management of SIEDH are imperative. Traditional surgical management has always required relatively large craniotomies, larger than the hematoma itself, to expose its edge, and then tack up the dura matter). It usually opens the window and emphasizes retention of the bone bridge outside the transverse sinus. This method can effectively eliminate the hematoma, but it is associated with larger postoperative wound, longer operation time, larger skull defect, and more complications. Hence, exploration into a better surgical method is direly needed.

  18. A vapour-permeable film dressing used on superficial wounds.

    PubMed

    Meuleneire, Frans

    2014-08-12

    Films are an extremely versatile dressing type that can be effectively used in the treatment of many superficial wounds, such as skin grafts, surgical wounds and superficial burns; they provide an optimal moist environment to promote healing, act as a barrier to bacteria, and afford protection from urine and faecal contamination. Unfortunately, many film dressings are difficult to handle and use traditional adhesives, which can cause trauma to the wound and surrounding skin, as well as increased wound pain at dressing removal. Mepitel® Film is a new, easy-to-use wound dressing designed with Safetac® technology that helps to minimise dressing-related trauma and pain and assist undisturbed wound healing. This article presents case studies that examine Mepitel Film's use on a variety of wounds, and reviews the findings of research that was undertaken to evaluate the benefits of using this recently developed dressing.

  19. Grand challenge in Biomaterials-wound healing.

    PubMed

    Salamone, Joseph C; Salamone, Ann Beal; Swindle-Reilly, Katelyn; Leung, Kelly Xiaoyu-Chen; McMahon, Rebecca E

    2016-06-01

    Providing improved health care for wound, burn and surgical patients is a major goal for enhancing patient well-being, in addition to reducing the high cost of current health care treatment. The introduction of new and novel biomaterials and biomedical devices is anticipated to have a profound effect on the future improvement of many deleterious health issues. This publication will discuss the development of novel non-stinging liquid adhesive bandages in healthcare applications developed by Rochal Industries. The scientists/engineers at Rochal have participated in commercializing products in the field of ophthalmology, including rigid gas permeable contact lenses, soft hydrogel contact lenses, silicone hydrogel contact lenses, contact lens care solutions and cleaners, intraocular lens materials, intraocular controlled drug delivery, topical/intraocular anesthesia, and in the field of wound care, as non-stinging, spray-on liquid bandages to protect skin from moisture and body fluids and medical adhesive-related skin injuries. Current areas of entrepreneurial activity at Rochal Industries pertain to the development of new classes of biomaterials for wound healing, primarily in regard to microbial infection, chronic wound care, burn injuries and surgical procedures, with emphasis on innovation in product creation, which include cell-compatible substrates/scaffolds for wound healing, antimicrobial materials for opportunistic pathogens and biofilm reduction, necrotic wound debridement, scar remediation, treatment of diabetic ulcers, amelioration of pressure ulcers, amelioration of neuropathic pain and adjuvants for skin tissue substitutes.

  20. Grand challenge in Biomaterials-wound healing

    PubMed Central

    Salamone, Joseph C.; Salamone, Ann Beal; Swindle-Reilly, Katelyn; Leung, Kelly Xiaoyu-Chen; McMahon, Rebecca E.

    2016-01-01

    Providing improved health care for wound, burn and surgical patients is a major goal for enhancing patient well-being, in addition to reducing the high cost of current health care treatment. The introduction of new and novel biomaterials and biomedical devices is anticipated to have a profound effect on the future improvement of many deleterious health issues. This publication will discuss the development of novel non-stinging liquid adhesive bandages in healthcare applications developed by Rochal Industries. The scientists/engineers at Rochal have participated in commercializing products in the field of ophthalmology, including rigid gas permeable contact lenses, soft hydrogel contact lenses, silicone hydrogel contact lenses, contact lens care solutions and cleaners, intraocular lens materials, intraocular controlled drug delivery, topical/intraocular anesthesia, and in the field of wound care, as non-stinging, spray-on liquid bandages to protect skin from moisture and body fluids and medical adhesive-related skin injuries. Current areas of entrepreneurial activity at Rochal Industries pertain to the development of new classes of biomaterials for wound healing, primarily in regard to microbial infection, chronic wound care, burn injuries and surgical procedures, with emphasis on innovation in product creation, which include cell-compatible substrates/scaffolds for wound healing, antimicrobial materials for opportunistic pathogens and biofilm reduction, necrotic wound debridement, scar remediation, treatment of diabetic ulcers, amelioration of pressure ulcers, amelioration of neuropathic pain and adjuvants for skin tissue substitutes. PMID:27047680

  1. Grand challenge in Biomaterials-wound healing.

    PubMed

    Salamone, Joseph C; Salamone, Ann Beal; Swindle-Reilly, Katelyn; Leung, Kelly Xiaoyu-Chen; McMahon, Rebecca E

    2016-06-01

    Providing improved health care for wound, burn and surgical patients is a major goal for enhancing patient well-being, in addition to reducing the high cost of current health care treatment. The introduction of new and novel biomaterials and biomedical devices is anticipated to have a profound effect on the future improvement of many deleterious health issues. This publication will discuss the development of novel non-stinging liquid adhesive bandages in healthcare applications developed by Rochal Industries. The scientists/engineers at Rochal have participated in commercializing products in the field of ophthalmology, including rigid gas permeable contact lenses, soft hydrogel contact lenses, silicone hydrogel contact lenses, contact lens care solutions and cleaners, intraocular lens materials, intraocular controlled drug delivery, topical/intraocular anesthesia, and in the field of wound care, as non-stinging, spray-on liquid bandages to protect skin from moisture and body fluids and medical adhesive-related skin injuries. Current areas of entrepreneurial activity at Rochal Industries pertain to the development of new classes of biomaterials for wound healing, primarily in regard to microbial infection, chronic wound care, burn injuries and surgical procedures, with emphasis on innovation in product creation, which include cell-compatible substrates/scaffolds for wound healing, antimicrobial materials for opportunistic pathogens and biofilm reduction, necrotic wound debridement, scar remediation, treatment of diabetic ulcers, amelioration of pressure ulcers, amelioration of neuropathic pain and adjuvants for skin tissue substitutes. PMID:27047680

  2. Surgical outcomes of mini-open Wiltse approach and conventional open approach in patients with single-segment thoracolumbar fractures without neurologic injury

    PubMed Central

    Li, Haijun; Yang, Lei; Xie, Hao; Yu, Lipeng; Wei, Haifeng; Cao, Xiaojian

    2015-01-01

    Abstract This study aimed to introduce a novel mini-open pedicle screw fixation technique via Wiltse approach, and compared it with the traditional posterior open method. A total of 72 cases of single-segment thoracolumbar fractures without neurologic injury underwent pedicle screw fixation via two different approaches. Among them, 37 patients were treated using posterior open surgery, and 35 patients received mini-open operation via Wiltse approach. Crew placement accuracy rate, operative time, blood loss, postoperative drainage, postoperative hospitalization time, radiation exposure time, postoperative improvement in R value, Cobb's angle and visual analog scale (VAS) scores of the two methods were compared. There were no significant differences in the accuracy rate of pedicle screw placement, radiation exposure and postoperative R value and Cobb's angle improvement between the two groups. However, the mini-open method had obvious advantages over the conventional open method in operative time, blood loss, postoperative drainage, postoperative hospitalization time, and postoperative improvement in VAS. The mini-open pedicle screw technique could be applied in treatment of single-segment thoracolumbar fracture without neurologic injury and had advantages of less tissue trauma, short operative and rehabilitative time on the premise of guaranteed accuracy rate and no increased radiation exposure. PMID:25745479

  3. Elements affecting wound healing time: An evidence based analysis.

    PubMed

    Khalil, Hanan; Cullen, Marianne; Chambers, Helen; Carroll, Matthew; Walker, Judi

    2015-01-01

    The purpose of this study was to identify the predominant client factors and comorbidities that affected the time taken for wounds to heal. A prospective study design used the Mobile Wound Care (MWC) database to capture and collate detailed medical histories, comorbidities, healing times and consumable costs for clients with wounds in Gippsland, Victoria. There were 3,726 wounds documented from 2,350 clients, so an average of 1.6 wounds per client. Half (49.6%) of all clients were females, indicating that there were no gender differences in terms of wound prevalence. The clients were primarily older people, with an average age of 64.3 years (ranging between 0.7 and 102.9 years). The majority of the wounds (56%) were acute and described as surgical, crush and trauma. The MWC database categorized the elements that influenced wound healing into 3 groups--factors affecting healing (FAH), comorbidities, and medications known to affect wound healing. While there were a multitude of significant associations, multiple linear regression identified the following key elements: age over 65 years, obesity, nonadherence to treatment plan, peripheral vascular disease, specific wounds associated with pressure/friction/shear, confirmed infection, and cerebrovascular accident (stroke). Wound healing is a complex process that requires a thorough understanding of influencing elements to improve healing times.© 2015 by the Wound Healing Society.

  4. A Record Book of Open Heart Surgical Cases between 1959 and 1982, Hand-Written by a Cardiac Surgeon

    PubMed Central

    Kim, Won-Gon

    2016-01-01

    A book of brief records of open heart surgery underwent between 1959 and 1982 at Seoul National University Hospital was recently found. The book was hand-written by the late professor and cardiac surgeon Yung Kyoon Lee (1921–1994). This book contains valuable information about cardiac patients and surgery at the early stages of the establishment of open heart surgery in Korea, and at Seoul National University Hospital. This report is intended to analyze the content of the book. PMID:27525246

  5. A Record Book of Open Heart Surgical Cases between 1959 and 1982, Hand-Written by a Cardiac Surgeon.

    PubMed

    Kim, Won-Gon

    2016-08-01

    A book of brief records of open heart surgery underwent between 1959 and 1982 at Seoul National University Hospital was recently found. The book was hand-written by the late professor and cardiac surgeon Yung Kyoon Lee (1921-1994). This book contains valuable information about cardiac patients and surgery at the early stages of the establishment of open heart surgery in Korea, and at Seoul National University Hospital. This report is intended to analyze the content of the book. PMID:27525246

  6. A retrospective analysis of open fractures sustained by U.S. military personnel during Operation Just Cause.

    PubMed

    Jacob, E; Erpelding, J M; Murphy, K P

    1992-10-01

    A retrospective analysis was conducted of 37 open fracture cases sustained by U.S. military personnel during the recent low-intensity conflict in Panama (Operation Just Cause). The etiology, location, classification, and management of open fractures sustained in combat is presented. A significant difference was noted in the infection rate for type III open fractures that were debrided in Panama (22%) as compared to those that were debrided only after transport to CONUS (66%). This study supports the critical importance of adequate battlefield surgical support in low-intensity conflicts, and reemphasizes the crucial role of early surgical debridement for the prevention of wound infection.

  7. An update on the evaluation and management of plantar puncture wounds and Pseudomonas osteomyelitis.

    PubMed

    Inaba, A S; Zukin, D D; Perro, M

    1992-02-01

    The management of children who present to the ED with plantar puncture wounds is dependent upon the nature of the injury, the examination of the puncture site, and the potential risk of a retained foreign body. Not all patients will require wound enlargement and a search for a retained foreign body. Close follow-up of all children who are being treated as outpatients is of vital importance in detecting an early development of an infectious complication. Pseudomonas osteomyelitis should be suspected in all patients who present with foot pain, swelling, and a decreased ability to bear weight after sustaining a nail puncture through a sneaker. The current consensus favors open surgical débridement followed by a course of intravenous antibiotics. The exact duration of the postoperative antibiotic course is still being debated.

  8. An update on the evaluation and management of plantar puncture wounds and Pseudomonas osteomyelitis.

    PubMed

    Inaba, A S; Zukin, D D; Perro, M

    1992-02-01

    The management of children who present to the ED with plantar puncture wounds is dependent upon the nature of the injury, the examination of the puncture site, and the potential risk of a retained foreign body. Not all patients will require wound enlargement and a search for a retained foreign body. Close follow-up of all children who are being treated as outpatients is of vital importance in detecting an early development of an infectious complication. Pseudomonas osteomyelitis should be suspected in all patients who present with foot pain, swelling, and a decreased ability to bear weight after sustaining a nail puncture through a sneaker. The current consensus favors open surgical débridement followed by a course of intravenous antibiotics. The exact duration of the postoperative antibiotic course is still being debated. PMID:1603689

  9. A case report of a 19-week gravid patient with a dehisced abdominal wound and treated with V.A.C. ATS(®) Therapy System.

    PubMed

    Asukai, Kei; Kashiwazaki, Masaki; Koizumi, Kaori; Nobunaga, Toshikatsu; Yano, Hiroshi

    2016-10-01

    Negative pressure wound therapy (NPWT) is an effective treatment for various non-healing wounds, and V.A.C.(®) Therapy was the first-approved NPWT device by the Japanese government in 2009. We report the case of a 19-week pregnant patient where V.A.C.(®) Therapy was applied to her dehisced laparotomy wound with satisfactory results. The patient was a 30-year-old female who was referred to our hospital from her previous doctor because of the presence of an ovarian cyst on the left ovary. The patient presented at 14 weeks into her pregnancy, and surgery was considered because of no reduction in the size of the cyst. An oophorocystectomy was performed, and then the surgical incision was re-opened at postoperative day (POD) 10 due to a surgical site infection. V.A.C.(®) Therapy was initiated on POD 26 (20 weeks of pregnancy) and continued for 28 days. After 28 days of V.A.C.(®) Therapy (POD 54), the wound was sutured for complete closure. The foetus did not experience any adverse affects from the surgery and, subsequently, normal vaginal delivery was achieved. This case is the first report of the use of V.A.C.(®) Therapy over a dehisced abdominal wound on a pregnant patient in our country.

  10. Surgical Treatment of Perianal Fistulizing Crohn's Disease: From Lay-Open to Cell-Based Therapy—An Overview

    PubMed Central

    2014-01-01

    Background. Perianal Crohn's disease (CD) can be challenging. Despite the high incidence of fistulizing CD, literature lacks clear guidelines. Several medical, surgical, and combined treatment modalities have been proposed, but evidences are scarce. Methods. We searched the literature to assess the facets of perianal CD, with particular focus on complex fistulae. Disease epidemiology, classification, diagnosis, activity scoring systems, and medical-surgical treatments were assessed. Results. Perianal fistulizing CD is common, frequently associated with upper gastrointestinal and colorectal CD. Complex fistulas often require repeated treatments. Continence is a major concern when dealing with repeated procedures. A prudent pathway is to resolve active sepsis and to limit damages, delaying a definitive treatment to the time when acute phase has been controlled. The improved diagnostic techniques allow better preoperative planning and are useful in monitoring the response to treatment. Besides newer devices, cell-based treatments are promising tools which have recently enriched the treatment portfolio. However, the need for proctectomy is still disturbingly high in CD patients with complex perianal fistulae. Conclusions. Perianal CD can impair quality of life and lead to need for proctectomy. A staged approach is reasonable. Treatment success can be improved by multimodal treatment and collaborative management by experienced gastroenterologists and surgeons. PMID:25431776

  11. Penetrating chest wounds: a 10-year review.

    PubMed

    Sett, S S; Busse, E; Boyd, T; Burgess, J

    1987-09-01

    From January 1975 to December 1984, 93 patients with penetrating chest wounds were admitted to three hospitals in Regina. Sixty-three percent of the wounds were caused by knives and 34% by firearms. Sixty-three patients were treated conservatively, 18 patients had thoracotomy and 12 others underwent laparotomy. Of the 18 patients, 16 had wounds between the nipples; 8 of the 16 had injuries to the heart or great vessels. Whereas the majority of penetrating wounds to the chest may be treated by observation or thoracostomy alone, a surgical approach is recommended when penetrating injuries are thought to have traversed the mediastinum, because of the high incidence of associated cardiac injuries. In doubtful cases the decision should favour early thoracotomy.

  12. Risk factors for surgical infection.

    PubMed

    Leaper, D J

    1995-06-01

    In the last century remarkable advances have been made in surgery, associated with the lowest recorded rates of infection or sepsis. Many surgical practices are time honoured but have little scientific basis to prevent postoperative infection whereas some local and systemic factors are well recognized and can be modified to lower infection risks. Surgical skill is not easily measurable but shorter operations in experienced hands leaving the minimum of tissue damage, haematoma or dead space have the lowest infection rates in general surgery: < 2% in clean and < 10% in contaminated operations. Adequate surgical scrub, appropriate suture materials and antibiotic prophylaxis, perioperative correction of dehydration and poor nutrition are examples of effective therapy which can be conformed to by all surgeons. Other factors, such as the use of wound guards, drains and surgical dressings are less easy to estimate for effectiveness or be sure that they could be changed or left out of surgical ritual.

  13. 21 CFR 878.4011 - Tissue adhesive with adjunct wound closure device for topical approximation of skin.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY... approximated skin edges of wounds from surgical incisions, including punctures from minimally invasive...

  14. 21 CFR 878.4011 - Tissue adhesive with adjunct wound closure device for topical approximation of skin.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY... approximated skin edges of wounds from surgical incisions, including punctures from minimally invasive...

  15. 21 CFR 878.4011 - Tissue adhesive with adjunct wound closure device for topical approximation of skin.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY... approximated skin edges of wounds from surgical incisions, including punctures from minimally invasive...

  16. 21 CFR 878.4011 - Tissue adhesive with adjunct wound closure device for topical approximation of skin.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY... approximated skin edges of wounds from surgical incisions, including punctures from minimally invasive...

  17. Single port laparoscopic and open surgical accesses of chronic peritoneal dialysis in children: A single center experience over 12 years

    PubMed Central

    Bıçakcı, Ünal; Genç, Gürkan; Tander, Burak; Günaydın, Mithat; Demirel, Dilek; Özkaya, Ozan; Rızalar, Rıza; Arıtürk, Ender; Bernay, Ferit

    2016-01-01

    INTRODUCTION: The aim of this study was to evaluate patients with end stage renal failure (ESRD) who underwent chronic peritoneal dialysis (CPD). The clinical outcomes of laparoscopic and open placements of catheters were compared. MATERIALS AND METHODS: We reviewed 49 (18 male and 31 female) children with CPD according to age, sex, cause of ESRD, catheter insertion method, kt/V rate, complications, presence of peritonitis, catheter survival rate between January 2002 and February 2014. RESULTS: Thirty-three patients were with open placement and 16 patients were with laparoscopic placement. The rate of the peritonitis is significantly less in patients with laparoscopic access than open access (n = 4 vs n = 25) (P <0.01). Patients with peritonitis were younger than those who had no attack of peritonitis (10.95 ± 0.8 years vs 13.4 ± 0.85 years). According to the development of complications, significant difference has not been found between the open (n = 9) and laparoscopic (n = 3) approaches except the peritonitis. Catheter survival rate for the first year was 95%, and for five years was 87.5%. There was no difference between open and laparoscopic group according to catheter survival rate. The mean kt/V which indicates the effectiveness of peritoneal dialysis was mean 2.26 ± 0.08. No difference was found between laparoscopic and open methods according to kt/V. CONCLUSION: Laparoscopic placement of CPD results in lower peritonitis rate. Catheter survival rate was excellent in both groups. Single port laparoscopic access for CPD catheter insertion is an effective and safe method. PMID:27073310

  18. Past, present, and future for surgical needles and needle holders.

    PubMed

    Edlich, R F; Thacker, J G; McGregor, W; Rodeheaver, G T

    1993-11-01

    During the last two decades, major advances in surgical needle and needle holder technology have markedly improved surgical wound repair. These advances include quantitative tests for surgical needle and needle holders performance, high nickel maraging stainless steels, compound curved needles, needle sharpening methods, laser-drilled holes for swages, needle:suture ratios of 1:1, and the atraumatic needle holder.

  19. Use of negative pressure wound therapy in the treatment of neonatal and pediatric wounds: a retrospective examination of clinical outcomes.

    PubMed

    Baharestani, Mona Mylene

    2007-06-01

    The clinical effectiveness of negative pressure wound therapy for the management of acute and chronic wounds is well documented in the adult population but information regarding its use in the pediatric population is limited. A retrospective, descriptive study was conducted to examine the clinical outcomes of using negative pressure wound therapy in the treatment of pediatric wounds. The medical records of 24 consecutive pediatric patients receiving negative pressure wound therapy were reviewed. Demographic data, wound etiology, time to closure, closure method, duration of negative pressure wound therapy, complications, dressing change frequency, dressing type used, and pressure settings were analyzed. All categorical variables in the dataset were summarized using frequency (count and percentages) and all continuous variables were summarized using median (minimum, maximum). The 24 pediatric patients (mean age 8.5 years [range 14 days to 18 years old]) had 24 wounds - 12 (50%) were infected at baseline. Sixteen patients had hypoalbuminemia and six had exposed hardware and bone in their wounds. Twenty-two wounds reached full closure in a median time of 10 days (range 2 to 45) following negative pressure wound therapy and flap closure (11), split-thickness skin graft (three), secondary (four), and primary (four) closure. Pressures used in this population ranged from 50 to 125 mm Hg and most wounds were covered with reticulated polyurethane foam. One patient developed a fistula during the course of negative pressure wound therapy. When coupled with appropriate systemic antibiotics, surgical debridement, and medical and nutritional optimization, in this population negative pressure wound therapy resulted in rapid granulation tissue and 92% successful wound closure. Future neonatal and pediatric negative pressure wound therapy usage registries and prospective studies are needed to provide a strong evidence base from which treatment decisions can be made in the management

  20. Healing of Chronic Wounds through Systemic Effects of Electromagnetic Fields

    NASA Astrophysics Data System (ADS)

    Cañedo, L.; Trigos, I.; García-Cantú, R.; Godina-Nava, J. J.; Serrano, G.

    2002-08-01

    Extremely low frequency electromagnetic fields (ELF) were configured to interact with peripheral blood mononuclear cells (PBMC). These ELF were applied in the arm to five patients with chronic wounds resistant to medical and surgical treatment. Wound healing began in all patients during the first two weeks after ELF exposure permiting their previously unresponsive chronic wounds to function as internal controls. All lesions were cured or healed >70% in less than four months. Systemic effects were explained by ELF activation of PBMC and their transportation through the blood to the affected site. This therapy is effective in selected patients with chronic wounds.

  1. Biofilms in chronic wounds.

    PubMed

    James, Garth A; Swogger, Ellen; Wolcott, Randall; Pulcini, Elinor deLancey; Secor, Patrick; Sestrich, Jennifer; Costerton, John W; Stewart, Philip S

    2008-01-01

    Chronic wounds including diabetic foot ulcers, pressure ulcers, and venous leg ulcers are a worldwide health problem. It has been speculated that bacteria colonizing chronic wounds exist as highly persistent biofilm communities. This research examined chronic and acute wounds for biofilms and characterized microorganisms inhabiting these wounds. Chronic wound specimens were obtained from 77 subjects and acute wound specimens were obtained from 16 subjects. Culture data were collected using standard clinical techniques. Light and scanning electron microscopy techniques were used to analyze 50 of the chronic wound specimens and the 16 acute wound specimens. Molecular analyses were performed on the remaining 27 chronic wound specimens using denaturing gradient gel electrophoresis and sequence analysis. Of the 50 chronic wound specimens evaluated by microscopy, 30 were characterized as containing biofilm (60%), whereas only one of the 16 acute wound specimens was characterized as containing biofilm (6%). This was a statistically significant difference (p<0.001). Molecular analyses of chronic wound specimens revealed diverse polymicrobial communities and the presence of bacteria, including strictly anaerobic bacteria, not revealed by culture. Bacterial biofilm prevalence in specimens from chronic wounds relative to acute wounds observed in this study provides evidence that biofilms may be abundant in chronic wounds.

  2. Enhanced Recovery after Elective Open Surgical Repair of Abdominal Aortic Aneurysm: A Complementary Overview through a Pooled Analysis of Proportions from Case Series Studies

    PubMed Central

    Gurgel, Sanderland J. T.; El Dib, Regina; do Nascimento, Paulo

    2014-01-01

    Objectives To evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) programs in elective open surgical repair (OSR) of abdominal aortic aneurysm (AAA). Background Open surgical repair of AAA is associated with high morbidity and mortality, prolonged hospital stay and high costs. ERAS programs contribute to the optimization of treatment by reducing hospital stay and improving clinical outcomes. Methods A review of PubMed, EMBASE and LILACS databases was conducted. As only one randomized controlled trial was found, a pooled analysis of proportions from case series was conducted, considering it a complementary overview of the topic. Inclusion criteria were case series with more than five cases reported, adult patients who underwent an elective OSR of AAA and use of an ERAS program. ERAS was compared to conventional perioperative care. The pooled proportion and the confidence interval (CI) are shown for each outcome. The overlap of the CI suggests similar effect of the interventions studied. Results Thirteen case series studies with ERAS involving 1,250 patients were compared to six case series with conventional care with a total of 1,429 patients. The pooled, respective proportions for ERAS and conventional care were: mortality, 1.51% [95% CI: 0.0091, 0.0226] and 3.0% [95% CI 0.0183, 0.0445]; and incidence of complications, 3.82% [95% CI 0.0259, 0.0528] and 4.0% [95% CI 0.03, 0.05]. Conclusion This review shows that ERAS and conventional care therapies have similar mortality and complication rates in OSR of AAA. PMID:24887022

  3. Surgical treatment of osteomyelitis.

    PubMed

    Cierny, George

    2011-01-01

    Chronic osteomyelitis is refractory to nonsurgical treatment due to a resilient, infective nidus that harbors sessile, matrix-protected pathogens bound to substrate surfaces within the wound. Curative treatment mandates physical (surgical) removal of the biofilm colony, adjunctive use of antibiotics to eliminate residual phenotypes, and efforts to optimize the host response throughout therapy. Patient selection, therapeutic options, and the treatment format are determined by the Cierny/Mader staging system, while reconstruction is governed by the integrity/stability of the affected bone(s) and quality/quantity parameters of the soft-tissue envelope.

  4. The use of negative-pressure therapy in the closure of complex head and neck wounds.

    PubMed

    Strub, Graham Michael; Moe, Kristen S

    2013-02-01

    The evolution of wound care has seen much technological advancement over many decades. Most recently, negative-pressure therapy, by which a vacuum pressure is applied through a wound bed, has dramatically improved the surgical outcomes of complex wounds. Although initial studies focused on wounds to the abdomen, torso, and extremities, more publications are appearing that demonstrate the efficacy of negative-pressure wound therapy in the head and neck. This article reviews the history and evolution of negative-pressure therapy, highlights the current opinions on its mechanism of action, and summarizes its use in complex head and neck wounds.

  5. Advanced Therapeutic Dressings for Effective Wound Healing--A Review.

    PubMed

    Boateng, Joshua; Catanzano, Ovidio

    2015-11-01

    Advanced therapeutic dressings that take active part in wound healing to achieve rapid and complete healing of chronic wounds is of current research interest. There is a desire for novel strategies to achieve expeditious wound healing because of the enormous financial burden worldwide. This paper reviews the current state of wound healing and wound management products, with emphasis on the demand for more advanced forms of wound therapy and some of the current challenges and driving forces behind this demand. The paper reviews information mainly from peer-reviewed literature and other publicly available sources such as the US FDA. A major focus is the treatment of chronic wounds including amputations, diabetic and leg ulcers, pressure sores, and surgical and traumatic wounds (e.g., accidents and burns) where patient immunity is low and the risk of infections and complications are high. The main dressings include medicated moist dressings, tissue-engineered substitutes, biomaterials-based biological dressings, biological and naturally derived dressings, medicated sutures, and various combinations of the above classes. Finally, the review briefly discusses possible prospects of advanced wound healing including some of the emerging physical approaches such as hyperbaric oxygen, negative pressure wound therapy and laser wound healing, in routine clinical care.

  6. Improved wound management by regulated negative pressure-assisted wound therapy and regulated, oxygen- enriched negative pressure-assisted wound therapy through basic science research and clinical assessment.

    PubMed

    Topaz, Moris

    2012-05-01

    Regulated negative pressure-assisted wound therapy (RNPT) should be regarded as a state-of-the-art technology in wound treatment and the most important physical, nonpharmaceutical, platform technology developed and applied for wound healing in the last two decades. RNPT systems maintain the treated wound's environment as a semi-closed, semi-isolated system applying external physical stimulations to the wound, leading to biological and biochemical effects, with the potential to substantially influence wound-host interactions, and when properly applied may enhance wound healing. RNPT is a simple, safe, and affordable tool that can be utilized in a wide range of acute and chronic conditions, with reduced need for complicated surgical procedures, and antibiotic treatment. This technology has been shown to be effective and safe, saving limbs and lives on a global scale. Regulated, oxygen-enriched negative pressure-assisted wound therapy (RO-NPT) is an innovative technology, whereby supplemental oxygen is concurrently administered with RNPT for their synergistic effect on treatment and prophylaxis of anaerobic wound infection and promotion of wound healing. Understanding the basic science, modes of operation and the associated risks of these technologies through their fundamental clinical mechanisms is the main objective of this review.

  7. Improved wound management by regulated negative pressure-assisted wound therapy and regulated, oxygen- enriched negative pressure-assisted wound therapy through basic science research and clinical assessment.

    PubMed

    Topaz, Moris

    2012-05-01

    Regulated negative pressure-assisted wound therapy (RNPT) should be regarded as a state-of-the-art technology in wound treatment and the most important physical, nonpharmaceutical, platform technology developed and applied for wound healing in the last two decades. RNPT systems maintain the treated wound's environment as a semi-closed, semi-isolated system applying external physical stimulations to the wound, leading to biological and biochemical effects, with the potential to substantially influence wound-host interactions, and when properly applied may enhance wound healing. RNPT is a simple, safe, and affordable tool that can be utilized in a wide range of acute and chronic conditions, with reduced need for complicated surgical procedures, and antibiotic treatment. This technology has been shown to be effective and safe, saving limbs and lives on a global scale. Regulated, oxygen-enriched negative pressure-assisted wound therapy (RO-NPT) is an innovative technology, whereby supplemental oxygen is concurrently administered with RNPT for their synergistic effect on treatment and prophylaxis of anaerobic wound infection and promotion of wound healing. Understanding the basic science, modes of operation and the associated risks of these technologies through their fundamental clinical mechanisms is the main objective of this review. PMID:23162229

  8. Improved wound management by regulated negative pressure-assisted wound therapy and regulated, oxygen- enriched negative pressure-assisted wound therapy through basic science research and clinical assessment

    PubMed Central

    Topaz, Moris

    2012-01-01

    Regulated negative pressure-assisted wound therapy (RNPT) should be regarded as a state-of-the-art technology in wound treatment and the most important physical, nonpharmaceutical, platform technology developed and applied for wound healing in the last two decades. RNPT systems maintain the treated wound's environment as a semi-closed, semi-isolated system applying external physical stimulations to the wound, leading to biological and biochemical effects, with the potential to substantially influence wound-host interactions, and when properly applied may enhance wound healing. RNPT is a simple, safe, and affordable tool that can be utilized in a wide range of acute and chronic conditions, with reduced need for complicated surgical procedures, and antibiotic treatment. This technology has been shown to be effective and safe, saving limbs and lives on a global scale. Regulated, oxygen-enriched negative pressure-assisted wound therapy (RO-NPT) is an innovative technology, whereby supplemental oxygen is concurrently administered with RNPT for their synergistic effect on treatment and prophylaxis of anaerobic wound infection and promotion of wound healing. Understanding the basic science, modes of operation and the associated risks of these technologies through their fundamental clinical mechanisms is the main objective of this review. PMID:23162229

  9. Surgical smoke.

    PubMed

    Fan, Joe King-Man; Chan, Fion Siu-Yin; Chu, Kent-Man

    2009-10-01

    Surgical smoke is the gaseous by-product formed during surgical procedures. Most surgeons, operating theatre staff and administrators are unaware of its potential health risks. Surgical smoke is produced by various surgical instruments including those used in electrocautery, lasers, ultrasonic scalpels, high speed drills, burrs and saws. The potential risks include carbon monoxide toxicity to the patient undergoing a laparoscopic operation, pulmonary fibrosis induced by non-viable particles, and transmission of infectious diseases like human papilloma virus. Cytotoxicity and mutagenicity are other concerns. Minimisation of the production of surgical smoke and modification of any evacuation systems are possible solutions. In general, a surgical mask can provide more than 90% protection to exposure to surgical smoke; however, in most circumstances it cannot provide air-tight protection to the user. An at least N95 grade or equivalent respirator offers the best protection against surgical smoke, but whether such protection is necessary is currently unknown. PMID:19892630

  10. Organization of wound healing services: the Danish experience and the importance of surgery.

    PubMed

    Gottrup, Finn

    2003-01-01

    Thomas K. Hunt is a general surgeon. Through his basic wound healing research and clinical work with wound patients he has been a great inspiration for my work in wound healing. In order to fulfill Dr. Hunt's vision, the clinical wound healing arena must be organized in an optimal way, and this article focuses on different options. Multidisciplinary wound care teams or centers focusing on all types of problem wounds have proved to be most effective at providing treatment and care for patients with problem wounds. The ultimate model is an outpatient clinic and an inpatient ward joined within a departmental structure, which represents an integrated part of an accepted national expert program on wound healing. Different types of center models can be established with different advantages and disadvantages. Currently, the wound care arena is being organized in Denmark and the model is described in this article. Of all specialties involved in treatment of wounds, surgery is of vital importance. "Wound healing is the keystone on which surgery is founded" (Thomas K. Hunt). This has long been understood in relation to acute wounds, while the importance of surgery in the treatment of chronic wounds has been less widely recognized. Surgical procedures directly related to the wound consist of debridement of all types of problem wounds and, in more specialized procedures such as skin transplantation, different types of flap constructions, bone surgery, and tendo-Achilles lengthening. Arterial reconstruction is a type of surgery that indirectly, through improved tissue perfusion, improves healing of problem wounds. This study concludes that multidisciplinary specialized wound healing concepts integrated into the national health care system as accepted expert functions would be the ideal way to organize wound healing to best benefit patients and society. Emphasis is on the importance of surgical procedures in wound healing and care. The models described can be applied with minor

  11. Open Achilles tendon lacerations.

    PubMed

    Said, M Nader; Al Ateeq Al Dosari, Mohamed; Al Subaii, Nasser; Kawas, Alaa; Al Mas, Ali; Al Ser, Yaser; Abuodeh, Yousef; Shakil, Malik; Habash, Ali; Mukhter, Khalid

    2015-04-01

    In contrast to closed Achilles tendon ruptures, open injuries are rarely reported in the literature. This paper provides information about open Achilles tendon wounds that are eventually seen in the Middle East. The reporting unit, Hamad Medical Corporation, is one of the biggest trauma centers in the Gulf area and the major health provider in Qatar. This is a retrospective study including patients admitted and operated for open Achilles tendon injuries between January 2011 and December 2013. Two hundred and five cases of open Achilles tendon lacerations were operated in Hamad General Hospital in this period. Forty-eight cases showed partial injuries, and the remaining are complete tendons cut. In the same period, fifty-one closed ruptured Achilles tendons were operated in the same trauma unit. In the majority of cases, the open injury resulted from a slip in the floor-leveled traditional toilette seats. Local damage to the toilette seats resulted in sharp edges causing the laceration of the heel if the patient was slipping over the wet floor. This occurrence is the cause in the vast majority of the cases. Wounds were located 1-5 cm proximal to tendon insertion. Standard treatment principles were applied. This included thorough irrigation in the emergency room, intravenous antibiotics, surgical debridement and primary repair within 24 h. Patients were kept in the hospital 1-7 days for intravenous antibiotics and possible dressing changes. Postoperatively below knee slabs were applied in the majority of patients and were kept for about 4 weeks followed by gradual weight bearing and range of motion exercises. Outpatients follow up in 1-2 weeks. Further follow-up visits at around 2-, 4-, 8- and 12-week intervals until complete wound healing and satisfactory rehabilitation outcome. Sixteen cases needed a second procedure. A high incidence of Achilles tendon open injuries is reported. This seems to be related to partially damaged floor-level toilettes in the

  12. [Gunshot wounds: forensic pathology].

    PubMed

    Lorin de la Grandmaison, Geoffroy

    2012-02-01

    Gunshot wounds are among the most complex traumatic lesions encountered in forensic pathology. At the time of autopsy, careful scrutiny of the wounds is essential for correct interpretation of the lesions. Complementary pathological analysis has many interests: differentiation between entrance and exit wounds, estimation of firing distance, differentiation between vital and post mortem wounds and wounds dating. In case of multiple headshots, neuropathological examination can provide arguments for or against suicide. Sampling of gunshot wounds at autopsy must be systematic. Pathological data should be confronted respectively to autopsy and death scene investigation data and also ballistic studies. Forensic pathologist must be aware of the limits of optic microscopy.

  13. Quantitative Peptidomics Study Reveals That a Wound-Induced Peptide from PR-1 Regulates Immune Signaling in Tomato[W][OPEN

    PubMed Central

    Chen, Ying-Lan; Lee, Chi-Ying; Cheng, Kai-Tan; Chang, Wei-Hung; Huang, Rong-Nan; Nam, Hong Gil

    2014-01-01

    Many important cell-to-cell communication events in multicellular organisms are mediated by peptides, but only a few peptides have been identified in plants. In an attempt to address the difficulties in identifying plant signaling peptides, we developed a novel peptidomics approach and used this approach to discover defense signaling peptides in plants. In addition to the canonical peptide systemin, several novel peptides were confidently identified in tomato (Solanum lycopersicum) and quantified to be induced by both wounding and methyl jasmonate (MeJA). A wounding or wounding plus MeJA-induced peptide derived from the pathogenesis-related protein 1 (PR-1) family was found to induce significant antipathogen and minor antiherbivore responses in tomato. This study highlights a role for PR-1 in immune signaling and suggests the potential application of plant endogenous peptides in efforts to defeat biological threats in crop production. As PR-1 is highly conserved across many organisms and the putative peptide from At-PR1 was also found to be bioactive in Arabidopsis thaliana, our results suggest that this peptide may be useful for enhancing resistance to stress in other plant species. PMID:25361956

  14. Comparison of open surgical discectomy versus plasma-laser nucleoplasty in patients with single lumbar disc herniation

    PubMed Central

    Abrishamkar, Saeid; Kouchakzadeh, Masih; Mirhosseini, Ahmad; Tabesh, Homayoun; Rezvani, Majid; Moayednia, Amir; Ganjeifar, Babak; Mahabadi, Amir; Yousefi, Elham; Kooshki, Ali Mehrabi

    2015-01-01

    Background: Intervertebral disc herniation is a major cause of low back pain. Several treatment methods are available for lumbar disc herniation including Chemonucleolysis, open surgery, nucleoplasty, laser disc decompression, and intradiscal electrothermal therapy. The high prevalence of lumbar disc herniation necessitates a minimally invasive yet effective treatment method. In this study, we compared the outcomes of open surgery and nucleoplasty method in patients with single lumbar disc herniation. Materials and Methods: This study was a noninferiority randomized clinical trial conducted in one of the University Hospitals of Isfahan Medical University; The Alzahra Hospital. About 200 patients with the diagnosis of lumbar disc herniation were recruited and were assigned to either the treatment or control groups using block randomization. One group received open surgery and the other group received nucleoplasty as the method of treatment. Patients were revisited at 14 days, 1, 2, 3 months, and 1-year after surgery and were assessed for the following variables: Lower back pain, lower limb pain, common complications of surgery (e.g., discitis, infection and hematoma) and recurrence of herniation. Results: The mean (standard deviation) severity of low back pain was reduced from 6.92 (2.5) to 3.43 (2.3) in the nucleoplasty group (P = 0.04) and from 7.5 (2.2) to 3.04 (1.61) in the discectomy group (P = 0.73). Between group difference was not statistically significant (P = 0.44), however, time and treatment interaction was significant (P = 0.001). The level of radicular pain evaluated 1 year after treatment was reduced from 8.1 (1.2) to 2.9 (1.2) (P = 0.004) and from 7.89 (2.1) to 3.6 (2.5) (P =0.04) in the discectomy and the nucleoplasty groups respectively, significant interaction between time and treatment options was observed (P < 0.001) while there was no significant difference between two treatment groups (P = 0.82). Conclusion: Our results show that while

  15. Postoperative irradiation impairs or enhances wound strength depending on time of administration

    SciTech Connect

    Vegesna, V.; McBride, W.H.; Withers, H.R.

    1995-08-01

    Irradiation can complicate surgical wound healing, yet little is known of the importance of the time between surgery and irradiation on this process. This study investigated the impact of post-operative irradiation on gain in wound tensile strength in a murine skin model. Irradiation on the same day as wounding or to 2-day-old wounds reduced wound tensile strength. In contrast, postoperative irradiation delivered at 7, 9 and 14 days transiently enhanced wound tensile strength, as measure d 3 but not 4 or 5 weeks later. This effect was independent of the inclusion (hemi-body) or exclusion (skin alone) of the hematopoietic system in the field of irradiation. Radiation-enhanced wound tensile strength was greater and occurred earlier after higher radiation doses. Even though the effect of irradiation in enhancing wound tensile strength is transitory, it could be important in assisting early wound healing. 14 refs., 3 figs., 1 tab.

  16. Wound healing and treating wounds: Chronic wound care and management.

    PubMed

    Powers, Jennifer G; Higham, Catherine; Broussard, Karen; Phillips, Tania J

    2016-04-01

    In the United States, chronic ulcers--including decubitus, vascular, inflammatory, and rheumatologic subtypes--affect >6 million people, with increasing numbers anticipated in our growing elderly and diabetic populations. These wounds cause significant morbidity and mortality and lead to significant medical costs. Preventative and treatment measures include disease-specific approaches and the use of moisture retentive dressings and adjunctive topical therapies to promote healing. In this article, we discuss recent advances in wound care technology and current management guidelines for the treatment of wounds and ulcers.

  17. [Standardized wound documentation of chronic wounds].

    PubMed

    Deutschle, G; Coerper, S; Witte, M; Becker, H D

    1999-01-01

    Owing to the long periods of treatment and multi-factoral etiology of chronic wounds, standardized wound documentation is necessary to enable judgement of the course of healing. We have developed a documentation system which permits a standardized assessment of chronic wounds by means of defined parameters and graded divisions. Besides containing the diagnostic and therapeutic measures which have been carried out, the documentation should also contain parameters of wound healing. These are the following: wound localisation, size of wound, degree of injury, infection, and wound morphology. Planimetry and photographic documentation complete the documentation. Thus a documented course of healing can be presented, which enables rapid retrospective analysis and, if needed, a change in therapeutic approach at an early stage. This complete, exact documentation is required by modern administration of justice and is a protection against the reversal of the onus of proof in lawsuits. The extent of documentation can be adapted to the individual needs of the institution responsible for treatment. However, a minimal amount of documentation should always include localisation of the wound, size, the diagnostic and therapeutic measures, and complications if any. PMID:10436529

  18. Serum angiotensin-converting enzyme 2 is an independent risk factor for in-hospital mortality following open surgical repair of ruptured abdominal aortic aneurysm

    PubMed Central

    Nie, Wanpin; Wang, Yan; Yao, Kai; Wang, Zheng; Wu, Hao

    2016-01-01

    Open surgical repair (OSR) is a conventional surgical method used in the repair a ruptured abdominal aortic aneurysm (AAA); however, OSR results in high perioperative mortality rates. The level of serum angiotensin-converting enzyme 2 (ACE2) has been reported to be an independent risk factor for postoperative in-hospital mortality following major cardiopulmonary surgery. In the present study, the association of serum ACE2 levels with postoperative in-hospital mortality was investigated in patients undergoing OSR for ruptured AAA. The study enrolled 84 consecutive patients underwent OSR for ruptured AAA and were subsequently treated in the intensive care unit. Patients who succumbed postoperatively during hospitalization were defined as non-survivors. Serum ACE2 levels were measured in all patients prior to and following the surgery using ELISA kits. The results indicated that non-survivors showed significantly lower mean preoperative and postoperative serum ACE2 levels when compared with those in survivors. Multivariate logistic regression analysis also showed that, subsequent to adjusting for potential confounders, the serum ACE2 level on preoperative day 1 showed a significant negative association with the postoperative in-hospital mortality. This was confirmed by multivariate hazard ratio analysis, which showed that, subsequent to adjusting for the various potential confounders, the risk of postoperative in-hospital mortality remained significantly higher in the two lowest serum ACE2 level quartiles compared with that in the highest quartile on preoperative day 1. In conclusion, the present study provided the first evidence supporting that the serum ACE2 level is an independent risk factor for the in-hospital mortality following OSR for ruptured AAA. Furthermore, low serum ACE2 levels on preoperative day 1 were found to be associated with increased postoperative in-hospital mortality. Therefore, the serum ACE2 level on preoperative day 1 may be a potential

  19. Electrospun nitric oxide releasing bandage with enhanced wound healing.

    PubMed

    Lowe, A; Bills, J; Verma, R; Lavery, L; Davis, K; Balkus, K J

    2015-02-01

    Research has shown that nitric oxide (NO) enhances wound healing. The incorporation of NO into polymers for medical materials and surgical devices has potential benefits for many wound healing applications. In this work, acrylonitrile (AN)-based terpolymers were electrospun to form non-woven sheets of bandage or wound dressing type materials. NO is bound to the polymer backbone via the formation of a diazeniumdiolate group. In a 14 day NO release study, the dressings released 79 μmol NO g(-1) polymer. The NO-loaded dressings were tested for NO release in vivo, which demonstrate upregulation of NO-inducible genes with dressing application compared to empty dressings. Studies were also conducted to evaluate healing progression in wounds with dressing application performed weekly and daily. In two separate studies, excisional wounds were created on the dorsa of 10 mice. Dressings with NO loaded on the fibers or empty controls were applied to the wounds and measurements of the wound area were taken at each dressing change. The data show significantly enhanced healing progression in the wounds with weekly NO application, which is more dramatic with daily application. Further, the application of daily NO bandages results in improved wound vascularity. These data demonstrate the potential for this novel NO-releasing dressing as a valid wound healing therapy. PMID:25463501

  20. Acute Management of Open Fractures: An Evidence-Based Review.

    PubMed

    Halawi, Mohamad J; Morwood, Michael P

    2015-11-01

    Open fractures are complex injuries associated with high morbidity and mortality. Despite advances made in fracture care and infection prevention, open fractures remain a therapeutic challenge with varying levels of evidence to support some of the most commonly used practices. Additionally, a significant number of studies on this topic have focused on open tibial fractures. A systematic approach to evaluation and management should begin as soon as immediate life-threatening conditions have been stabilized. The Gustilo classification is arguably the most widely used method for characterizing open fractures. A first-generation cephalosporin should be administered as soon as possible. The optimal duration of antibiotics has not been well defined, but they should be continued for 24 hours. There is inconclusive evidence to support either extending the duration or broadening the antibiotic prophylaxis for type Gustilo type III wounds. Urgent surgical irrigation and debridement remains the mainstay of infection eradication, although questions persist regarding the optimal irrigation solution, volume, and delivery pressure. Wound sampling has a poor predictive value in determining subsequent infections. Early wound closure is recommended to minimize the risk of infection and cannot be substituted by negative-pressure wound therapy. Antibiotic-impregnated devices can be important adjuncts to systemic antibiotics in highly contaminated or comminuted injuries. Multiple fixation techniques are available, each having advantages and disadvantages. It is extremely important to maintain a high index of suspicion for compartment syndrome, especially in the setting of high-energy trauma. PMID:26558667

  1. Approach to chronic wound infections.

    PubMed

    Leaper, D; Assadian, O; Edmiston, C E

    2015-08-01

    Infection is the likeliest single cause of delayed healing in healing of chronic open wounds by secondary intention. If neglected it can progress from contamination to colonization and local infection through to systemic infection, sepsis and multiple organ dysfunction syndrome, and it can be life-threatening. Infection in chronic wounds is not as easy to define as in acute wounds, and is complicated by the presence of biofilms. There is, as yet, no diagnostic for biofilm presence, but it contributes to excessive inflammation - through excessive and prolonged stimulation of nitric oxide, inflammatory cytokines and free radicals - and activation of immune complexes and complement, leading to a delay in healing. Control of biofilm is a key part of chronic wound management. Maintenance debridement and use of topical antimicrobials (antiseptics) are more effective than antibiotics, which should be reserved for treating spreading local and systemic infection. The continuing rise of antimicrobial resistance to antibiotics should lead us to reserve their use for these indications, as no new effective antibiotics are in the research pipeline. Antiseptics are effective through many mechanisms of action, unlike antibiotics, which makes the development of resistance to them unlikely. There is little evidence to support the theoretical risk that antiseptics select resistant pathogens. However, the use of antiseptic dressings for preventing and managing biofilm and infection progression needs further research involving well-designed, randomized controlled trials.

  2. Approach to chronic wound infections.

    PubMed

    Leaper, D; Assadian, O; Edmiston, C E

    2015-08-01

    Infection is the likeliest single cause of delayed healing in healing of chronic open wounds by secondary intention. If neglected it can progress from contamination to colonization and local infection through to systemic infection, sepsis and multiple organ dysfunction syndrome, and it can be life-threatening. Infection in chronic wounds is not as easy to define as in acute wounds, and is complicated by the presence of biofilms. There is, as yet, no diagnostic for biofilm presence, but it contributes to excessive inflammation - through excessive and prolonged stimulation of nitric oxide, inflammatory cytokines and free radicals - and activation of immune complexes and complement, leading to a delay in healing. Control of biofilm is a key part of chronic wound management. Maintenance debridement and use of topical antimicrobials (antiseptics) are more effective than antibiotics, which should be reserved for treating spreading local and systemic infection. The continuing rise of antimicrobial resistance to antibiotics should lead us to reserve their use for these indications, as no new effective antibiotics are in the research pipeline. Antiseptics are effective through many mechanisms of action, unlike antibiotics, which makes the development of resistance to them unlikely. There is little evidence to support the theoretical risk that antiseptics select resistant pathogens. However, the use of antiseptic dressings for preventing and managing biofilm and infection progression needs further research involving well-designed, randomized controlled trials. PMID:25772951

  3. Raman spectroscopy and the spectral correlation index for predicting wound healing outcome: towards in vivo application

    NASA Astrophysics Data System (ADS)

    Berger, Adam G.; Crane, Nicole J.; Elster, Eric A.

    2016-03-01

    Combat wounds are sometimes confounded by healing complications that are not as prevalent in civilian wounds due to their high energy etiology. One complication of wound healing is dehiscence, where a surgically closed wound reopens after closure. This complication can have serious consequences for the patient, but knowledge about the molecular composition of the wound bed beyond what is readily visible may help clinicians mitigate these complications. It is necessary to develop techniques that can be used in vivo to assess and predict wound healing pointof- care so that care-takers can decide the best way to make informed clinical decisions regarding their patient's healing. Raman spectroscopy is a perfect candidate for predicting wound healing due to its ability to provide a detailed molecular fingerprint of the wound bed noninvasively. Here, we study the spectral correlation index, a measure of orthogonality, with ten reference tissue components to stratify wounds based on how they heal. We analyze these indexes over time to show the modulation of these tissue components over the wound healing process. Results show that qualitative observation of the spectra cannot reveal major differences between the dehisced and normal healing wounds, but the spectral correlation index can. Analysis of the spectral correlations across the wound healing process demonstrates the changes throughout the wound healing process, showing that early differences in tissue components may portend wound healing. Furthermore, Raman spectroscopy coupled with the spectral correlation index presents as a possible point-of-care tool for enabling discrimination of wounds with impaired healing.

  4. Colocutaneous fistula management in a dehisced wound: a case study.

    PubMed

    Reed, Terri; Economon, Diana; Wiersema-Bryant, Laurel

    2006-04-01

    A fistula is an abnormal opening between two or more organs or structures. Wound drainage containment is a key component of nonsurgical fistula management and may include pouches, skin barriers, transparent dressings, troughing procedures, saddle bagging, bridging, and condom and suction catheters used in combination with complex or routine pouching. Following extensive abdominal surgery, the wound of a 50-year-old woman dehisced and a colocutaneous fistula formed inside the wound. The wound containing the fistula, which was draining liquid stool, was too large for existing commercial pouching systems. When initial management efforts, including negative pressure wound therapy, failed to achieve containment goals, clinicians adapted the negative pressure wound therapy dressing to surround the fistula, which helped facilitate therapy while providing a platform for an ostomy appliance to contain the fistula drainage. The system was changed every 2 days until discharge. The wound and fistula management combination improved patient comfort and mobility, facilitated healing, and reduced patient dietary restrictions.

  5. A cross-sectional study of chronic wound-related pain and itching.

    PubMed

    Paul, Julia

    2013-07-01

    Persons with chronic wounds may experience wound-related itch (pruritus) and pain. A cross-sectional study was conducted to examine the occurrence of itch and pain in chronic wounds and the relationship of the intensity between these factors. Patients in an outpatient wound care center, 18 years and older with an open wound, were recruited consecutively over a 5-month period. The 199 participants (112 [56%] men) had a mean age of 67 years (range 21-98 years); one wound per person was addressed and included venous (31), arterial (23), neuropathic (31), pressure-related (33), traumatic (37), and "other" (41) wounds. Wound-related pain and itch data were obtained using a modified Paul-Pieper Itching Questionnaire and Characteristics of Itch Questionnaire. Responses were hand-recorded and coded without personal identifiers and analyzed using descriptive statistics, and associations among data were assessed using Pearson chi-square, Mantel-Haenszel chi-square, and Cochran-Armitage trend tests. Wound-related itch was significantly associated with participant age (P = 0.011) and employment status (P = 0.003). Wound-related pain was significantly associated only with education level (P = 0.048). Persons with venous wounds had both the largest proportion with wound-related itch (45.2%) and the largest proportion with wound-related pain (61.2%) out of all of the wound types. Persons with diabetic neuropathy had both the smallest proportion with wound-related itch (16.1%) and the smallest proportion with wound-related pain (35.4%) among all of the wound types. Associations between wound type and wound-related itch or pain were not significant. When venous wounds were compared to all other wound types combined, wound-related itch was significantly associated (P = 0.021) with wound type - ie, venous wound type and itch was statistically significant when venous wounds were compared to a combination of all other wound types. Wound-related pain and itch occurred together in 35

  6. Ultrasonographic assessment of standing laparotomy wound healing in dairy cows.

    PubMed

    Buczinski, S; Bourel, C; Bélanger, A M

    2012-08-01

    The surgical wounds of 40 cows with a standing clean laparotomy were assessed 10-15 days after surgery. The abdominal wall thickness on the upper (w1), the middle (w2) and the lower (w3) third of the wound (and the contralateral flank n1, n2, and n3), the presence of edema, cavitary lesion, capsulated lesion, or visualization of shadow artifact in the wound were assessed ultrasonographically. On day 30, wound healing status (normal or surgical site infection (SSI)) was determined. Five out of 39 cows (12.8%) had SSI. A significant positive correlation was found between w3 and edema (p<0.01; r=0.44), w3/n3 and edema (p<0.05; r=0.32), w3 and pain on wound palpation (p<0.01; r=0.41); w3/n3 and the presence of pain (p<0.002; r=0.49) and w2/n2 and pain when palpating the wound (p<0.05; r=0.33). No association was found between the ultrasonographic evidence of edema and SSI (p=0.10), cavitary lesion and SSI (p=0.65), encapsulated lesion and SSI (p=1), and shadow artefact and SSI (p=1). The wound ultrasonography 10-15 days after surgery was not predictive of abnormal wound healing.

  7. Influence of Two Colloidal Extracorporeal Primes on Coagulation of Cardiac Surgical Patients: A Prospectively Randomized Open-Label Pilot Trial.

    PubMed

    Bethlehem, Irene; Wierda, Korry; Visser, Cornelis; Jekel, Lilian; Koopmans, Matty; Kuiper, Michael A

    2014-12-01

    The search for the ideal priming fluid continues as more evidence is discovered about side effects of volume expanders. With the availability of modern, balanced hydroxyethyl starch (HES) solutions with less side effects than former HES solutions, we considered to replace our gelatin- (modified gelatin) based extracorporeal circuit prime for a HES (130/.42) prime. Therefore, we studied the influence of two colloidal priming fluids on postoperative coagulation in patients undergoing cardiac surgery. The primary endpoint was to compare clot formation time between the HES group and the gelatin group with rotational thromboelastometry (ROTEM). Additionally we compared colloid osmotic pressure and fluid balance of both groups. Forty patients, undergoing elective first time coronary artery bypass grafting or single-valve surgery, were included in this prospectively randomized open-label pilot study. Laboratory data and ROTEM data were collected and analyzed for differences between the two groups. ROTEM data show significantly more prolongation in Extem clot formation time and significant more decrease in Extem alpha in the HES group. Fibtem maximum clot firmness was significantly smaller in the HES group; this was consistent with fibrinogen concentration measurement, which decreased more in the HES group than in the gelatin group and recovered more over time in the gelatin group. We found no significant difference in colloid. osmotic pressure between the groups. In this trial, HES (130/.42) impairs coagulation significantly more compared with gelatin. These differences in influence on coagulation did not lead to a difference in blood loss or fluid balance, so clinical relevance could not be proven. PMID:26357798

  8. Surgical Airway

    PubMed Central

    Patel, Sapna A; Meyer, Tanya K

    2014-01-01

    Close to 3% of all intubation attempts are considered difficult airways, for which a plan for a surgical airway should be considered. Our article provides an overview of the different types of surgical airways. This article provides a comprehensive review of the main types of surgical airways, relevant anatomy, necessary equipment, indications and contraindications, preparation and positioning, technique, complications, and tips for management. It is important to remember that the placement of a surgical airway is a lifesaving procedure and should be considered in any setting when one “cannot intubate, cannot ventilate”. PMID:24741501

  9. Systems-based approaches toward wound healing

    PubMed Central

    Buganza-Tepole, Adrian; Kuhl, Ellen

    2013-01-01

    Wound healing in the pediatric patient is of utmost clinical and social importance, since hypertrophic scarring can have aesthetic and psychological sequelae, from early childhood to late adolescence. Wound healing is a well-orchestrated reparative response affecting the damaged tissue at the cellular, tissue, organ, and system scales. While tremendous progress has been made towards understanding wound healing at the individual temporal and spatial scales, its effects across the scales remain severely understudied and poorly understood. Here we discuss the critical need for systems-based computational modeling of wound healing across the scales, from short-term to long-term and from small to large. We illustrate the state of the art in systems modeling by means of three key signaling mechanisms: oxygen tension regulating angiogenesis and revascularization; TGF-β kinetics controlling collagen deposition; and mechanical stretch stimulating cellular mitosis and extracellular matrix remodeling. The complex network of biochemical and biomechanical signaling mechanisms and the multi-scale character of the healing process make systems modeling an integral tool in exploring personalized strategies for wound repair. A better mechanistic understanding of wound healing in the pediatric patient could open new avenues in treating children with skin disorders such as birth defects, skin cancer, wounds, and burn injuries. PMID:23314298

  10. Progress in corneal wound healing.

    PubMed

    Ljubimov, Alexander V; Saghizadeh, Mehrnoosh

    2015-11-01

    Corneal wound healing is a complex process involving cell death, migration, proliferation, differentiation, and extracellular matrix remodeling. Many similarities are observed in the healing processes of corneal epithelial, stromal and endothelial cells, as well as cell-specific differences. Corneal epithelial healing largely depends on limbal stem cells and remodeling of the basement membrane. During stromal healing, keratocytes get transformed to motile and contractile myofibroblasts largely due to activation of transforming growth factor-β (TGF-β) system. Endothelial cells heal mostly by migration and spreading, with cell proliferation playing a secondary role. In the last decade, many aspects of wound healing process in different parts of the cornea have been elucidated, and some new therapeutic approaches have emerged. The concept of limbal stem cells received rigorous experimental corroboration, with new markers uncovered and new treatment options including gene and microRNA therapy tested in experimental systems. Transplantation of limbal stem cell-enriched cultures for efficient re-epithelialization in stem cell deficiency and corneal injuries has become reality in clinical setting. Mediators and course of events during stromal healing have been detailed, and new treatment regimens including gene (decorin) and stem cell therapy for excessive healing have been designed. This is a very important advance given the popularity of various refractive surgeries entailing stromal wound healing. Successful surgical ways of replacing the diseased endothelium have been clinically tested, and new approaches to accelerate endothelial healing and suppress endothelial-mesenchymal transformation have been proposed including Rho kinase (ROCK) inhibitor eye drops and gene therapy to activate TGF-β inhibitor SMAD7. Promising new technologies with potential for corneal wound healing manipulation including microRNA, induced pluripotent stem cells to generate corneal

  11. [Experimental stab wound].

    PubMed

    Hirt, Miroslav; Vorel, František; Zelený, Michal

    2015-01-01

    Stab wounds caused by knives and daggers are usually of different appearances. The knife wound has one edge sharp while the second one is blunt. The wound caused by blow of dagger has both edges sharp. The forensic expert must very often decide whether the knife or dagger was used. The aim of this experimental work was to show how a single-edged knife penetrates the skin and causes the wound typical for the double-edged dagger. The fact was verified. The wound typical for dagger can be found if the knife is used only according to the scheme. The forensic expert can say that a one cutting edge knife was used if the one edge of wound is squared and the other one is sharp. If the both of them are sharp, forensic expert must be very careful in his decision.Key words: stab wounds - knife - dagger - forensic expertise. PMID:25671417

  12. Biofilm in wound care.

    PubMed

    Rajpaul, Kumal

    2015-03-01

    A biofilm can be described as a microbial colony encased in a polysaccharide matrix which can become attached to a wound surface. This can affect the healing potential of chronic wounds due to the production of destructive enzymes and toxins which can promote a chronic inflammatory state within the wound. Biofilms can be polymicrobial and can result in delayed wound healing and chronic wound infection resistant to antibiotics, leading to prolonged hospitalisation for some patients. There appears to be a correlation between biofilms and non-healing in chronic wounds. It is suggested that biofilms are a major player in the chronicity of wounds. They are a complex concept to diagnose and management needs to be multifactorial.

  13. Critical Review of Noninvasive Optical Technologies for Wound Imaging

    PubMed Central

    Jayachandran, Maanasa; Rodriguez, Suset; Solis, Elizabeth; Lei, Jiali; Godavarty, Anuradha

    2016-01-01

    Significance: Noninvasive imaging approaches can provide greater information about a wound than visual inspection during the wound healing and treatment process. This review article focuses on various optical imaging techniques developed to image different wound types (more specifically ulcers). Recent Advances: The noninvasive optical imaging approaches in this review include hyperspectral imaging, multispectral imaging, near-infrared spectroscopy (NIRS), diffuse reflectance spectroscopy, optical coherence tomography, laser Doppler imaging, laser speckle imaging, spatial frequency domain imaging, and fluorescence imaging. The various wounds imaged using these techniques include open wounds, chronic wounds, diabetic foot ulcers, decubitus ulcers, venous leg ulcers, and burns. Preliminary work in the development and implementation of a near-infrared optical scanner for wound imaging as a noncontact hand-held device is briefly described. The technology is based on NIRS and has demonstrated its potential to differentiate a healing from nonhealing wound region. Critical Issues: While most of the optical imaging techniques can penetrate few hundred microns to a 1–2 mm from the wound surface, NIRS has the potential to penetrate deeper, demonstrating the potential to image internal wounds. Future Directions: All the technologies are currently at various stages of translational efforts to the clinic, with NIRS holding a greater promise for physiological assessment of the wounds internal, beyond the gold-standard visual assessment. PMID:27602254

  14. Critical Review of Noninvasive Optical Technologies for Wound Imaging

    PubMed Central

    Jayachandran, Maanasa; Rodriguez, Suset; Solis, Elizabeth; Lei, Jiali; Godavarty, Anuradha

    2016-01-01

    Significance: Noninvasive imaging approaches can provide greater information about a wound than visual inspection during the wound healing and treatment process. This review article focuses on various optical imaging techniques developed to image different wound types (more specifically ulcers). Recent Advances: The noninvasive optical imaging approaches in this review include hyperspectral imaging, multispectral imaging, near-infrared spectroscopy (NIRS), diffuse reflectance spectroscopy, optical coherence tomography, laser Doppler imaging, laser speckle imaging, spatial frequency domain imaging, and fluorescence imaging. The various wounds imaged using these techniques include open wounds, chronic wounds, diabetic foot ulcers, decubitus ulcers, venous leg ulcers, and burns. Preliminary work in the development and implementation of a near-infrared optical scanner for wound imaging as a noncontact hand-held device is briefly described. The technology is based on NIRS and has demonstrated its potential to differentiate a healing from nonhealing wound region. Critical Issues: While most of the optical imaging techniques can penetrate few hundred microns to a 1–2 mm from the wound surface, NIRS has the potential to penetrate deeper, demonstrating the potential to image internal wounds. Future Directions: All the technologies are currently at various stages of translational efforts to the clinic, with NIRS holding a greater promise for physiological assessment of the wounds internal, beyond the gold-standard visual assessment.

  15. Modifiable risk factors for surgical site infection.

    PubMed

    Moucha, Calin S; Clyburn, Terry A; Evans, Richard P; Prokuski, Laura

    2011-01-01

    Multiple risk factors for orthopaedic surgical site infection have been identified. Some of these factors directly affect the wound-healing process, whereas others can lead to blood-borne sepsis or relative immunosuppression. Modifying a patient's medications; screening for comorbidities, such as HIV or diabetes mellitus; and advising the patient on options to diminish or eliminate adverse behaviors, such as smoking, should lower the risk for surgical site infections.

  16. Surgical tracheotomy.

    PubMed

    Rowshan, Henry H; Baur, Dale A

    2010-03-01

    Tracheotomy is a surgical procedure that dates back to early history and medical advancement. The oral and maxillofacial surgeon routinely operates around the airway and should be able to master this procedure by adhering to the surgical principles outlined in this article.

  17. The prevalence, aetiology and management of wounds in a community care area in Ireland.

    PubMed

    Skerritt, Louise; Moore, Zena

    2014-06-01

    This study aimed to establish the prevalence and aetiology of wounds, allowing an insight into the management of wound care, the use of dressings and the nursing time allocated to the provision of wound care in a community setting in Ireland. A cross-sectional survey was used, with data collected on all clients in the community who received treatment from public health nurses or community registered general nurses for wound care over a 1-week period in April 2013. A 98.9% response rate was realised, and 188 people were identified as having wounds, equating to a crude prevalence of 5% of the active community nursing caseload. A total of 60% (n=112) had leg ulcers, 22% (n=42) had pressure ulcers, 16% (n=30) had an acute wound (surgical or traumatic wounds), 1% (n=2) had a diabetic foot wound and a further 1% (n=2) had wounds of other aetiologies. The mean duration of wounds was 5.41 months. A total of 18% of wounds were identified as infected; however, 60% (n=112) of wounds had antimicrobial products in use as either a primary or secondary dressing. The study established that there is a significant prevalence of wounds in this community care area. There was absence of a clinical diagnosis in many cases, and evidence of inappropriate dressing use, risking an increase in costs and a decrease in good clinical outcomes. It also highlighted the importance of ongoing education and auditing in the provision of wound care.

  18. Recombinant human erythropoietin stimulates angiogenesis and healing of ischemic skin wounds.

    PubMed

    Buemi, Michele; Galeano, Mariarosaria; Sturiale, Alessio; Ientile, Riccardo; Crisafulli, Costantino; Parisi, Alessandra; Catania, MariaAntonietta; Calapai, Gioacchino; Impalà, Patrizia; Aloisi, Carmela; Squadrito, Francesco; Altavilla, Domenica; Bitto, Alessandra; Tuccari, Giovanni; Frisina, Nicola

    2004-08-01

    Wound healing in ischemic tissues such as flap margins due to inadequate blood supply is still a source of considerable morbidity in surgical practice. Adequate tissue perfusion is particularly important in wound healing. We investigated the effects of recombinant human erythropoietin (rHuEPO) on wound healing in an ischemic skin wound model. Sixty-three Sprague-Dawley rats were used. Normal incisional wound and H-shaped double flaps were used as the wound models. Animals were treated with rHuEPO (400 IU/kg) or its vehicle. Rats were killed on different days (3, 5, and 10 days after skin injury) and the wounded skin tissues were used for immunohistochemistry and for analysis of vascular endothelial growth factor content and collagen content. Tissue transglutaminase immunostaining of histological specimens was used as a vascular marker to determine the level of microvessel density. The results showed a higher level of vascular endothelial growth factor protein and an increased microvessel density in ischemic wounds with rHuEPO treatment than the normal incisional wounds and ischemic control wounds. Collagen content was higher in the incisional wounds and in the ischemic wounds with rHuEPO treatment compared with the ischemic control wounds. Our results suggest that erythropoietin may be an effective therapeutic approach in improving healing in ischemic skin wounds.

  19. Sutureless Adult Voluntary Male Circumcision with Topical Anesthetic: A Randomized Field Trial of Unicirc, a Single-Use Surgical Instrument

    PubMed Central

    2016-01-01

    Introduction The World Health Organization has solicited rapid and minimally invasive techniques to facilitate scale-up of voluntary medical male circumcision (VMMC). Study design Non-blinded randomized controlled field trial with 2:1 allocation ratio. Participants 75 adult male volunteers. Setting Outpatient primary care clinic. Intervention Open surgical circumcision under local anesthetic with suturing vs. Unicirc disposable instrument under topical anesthetic and wound sealing with cyanoacrylate tissue adhesive. Primary Outcome Intraoperative duration. Secondary Outcomes Intraoperative and postoperative pain; adverse events; time to healing; patient satisfaction; cosmetic result. Results The intraoperative time was less with the Unicirc technique (median 12 vs. 25 min, p < 0.001). Wound healing and cosmetic results were superior in the Unicirc group. Adverse events were similar in both groups. Conclusions VMMC with Unicirc under topical anesthetic and wound sealing with cyanoacrylate tissue adhesive is rapid, heals by primary intention with superior cosmetic results, and is potentially safer and more cost-effective than open surgical VMMC. Trial Registration Clinicaltrials.gov NCT02443792 PMID:27299735

  20. Opioid-sparing effect of selective cyclooxygenase-2 inhibitors on surgical outcomes after open colorectal surgery within an enhanced recovery after surgery protocol

    PubMed Central

    Lohsiriwat, Varut

    2016-01-01

    AIM: To evaluate the opioid-sparing effect of selective cyclooxygenase-2 (COX-2) inhibitors on short-term surgical outcomes after open colorectal surgery. METHODS: Patients undergoing open colorectal resection within an enhanced recovery after surgery protocol from 2011 to 2015 were reviewed. Patients with combined general anesthesia and epidural anesthesia, and those with acute colonic obstruction or perforation were excluded. Patients receiving selective COX-2 inhibitor were compared with well-matched individuals without such a drug. Outcome measures included numeric pain score and morphine milligram equivalent (MME) consumption on postoperative day (POD) 1-3, gastrointestinal recovery (time to tolerate solid diet and time to defecate), complications and length of postoperative stay. RESULTS: There were 75 patients in each group. Pain score on POD 1-3 was not significantly different between two groups. However, MME consumption and MME consumption per kilogram body weight on POD 1-3 was significantly less in patients receiving a selective COX-2 inhibitor (P < 0.001). Median MME consumption per kilogram body weight on POD 1-3 was 0.09, 0.06 and nil, respectively in patients receiving a selective COX-2 inhibitor and 0.22, 0.25 and 0.07, respectively in the comparative group (P < 0.001), representing at least 59% opioid reduction. Patients prescribing a selective COX-2 inhibitor had a shorter median time to resumption of solid diet [1 (IQR 1-2) d vs 2 (IQR 2-3) d; P < 0.001] and time to first defecation [2 (IQR 2-3) d vs 3 (IQR 3-4) d; P < 0.001]. There was no significant difference in overall postoperative complications between two groups. However, median postoperative stay was significantly 1-d shorter in patients prescribing a selective COX-2 inhibitor [4 (IQR 3-5) d vs 5 (IQR 4-6) d; P < 0.001]. CONCLUSION: Perioperative administration of oral selective COX-2 inhibitors significantly decreased intravenous opioid consumption, shortened time to gastrointestinal

  1. Evaluation of a foam dressing for acute and chronic wound exudate management.

    PubMed

    Bullough, Lindsay; Johnson, Sue; Forder, Rebecca

    2015-09-01

    This article discusses the use of a foam dressing for exudate management in both chronic and acute wounds, such as surgical wounds, pressure ulcers, diabetic ulcers, trauma wounds, and leg ulcers. The primary objective of the study was to observe patients' wound progression in terms of wound size and the condition of the wound bed, when using this foam dressing as either a primary or secondary dressing. The outcome of the evaluation demonstrated that ActivHeal Foam Contact dressing effectively managed exudate. It was also observed that the dressing can assist in autolysis and support improvements in peri-wound status. Choosing an appropriate dressing to manage a wound is essential. Clinicians working in the NHS are under pressure to deliver good-quality clinical outcomes, and the ActivHeal Foam Contact dressing supports this outcome.

  2. Wound care in horses.

    PubMed

    Caston, Stephanie S

    2012-04-01

    Care of equine wounds in the field can be a challenging endeavor. Many times, wound care is complicated by chronicity or by prior inappropriate care in addition to the great degree of tissue trauma that occurred when the horse was wounded. Recognizing involvement of synovial structures, loss of skin, and damage to bone are critical in the initial examination of wounds and will guide future care. Education of clients is also important in that preparing them for possible outcomes during healing may help improve compliance and proper treatment of wound. Owners and trainers often perform much of the daily care and monitoring of equine wounds and thus can greatly assist or impede the progress. Bandaging is important to management of equine wounds-especially on the limbs-and is sometimes overlooked because of its labor-intensive nature and the desire for a spray, ointment, or salve that will heal the wound. The practitioner that improves and utilizes his or her understanding of the wound-healing process in concert with his or her knowledge of local anatomy will be the one who is best equipped to care for wounds in ambulatory practice.

  3. Incidence and location of positive surgical margins following open, pure laparoscopic, and robotic-assisted radical prostatectomy and its relation with neurovascular preservation: a single-institution experience.

    PubMed

    Villamil, W; Billordo Peres, N; Martinez, P; Giudice, C; Liyo, J; García Marchiñena, P; Jurado, A; Damia, O

    2013-03-01

    To evaluate whether robotic-assisted radical prostatectomy (dvRP) provides adequate local control of the disease, incidence of positive surgical margins (PSMs) obtained with dvRP was compared with that of laparoscopic radical prostatectomy (LRP) and with that of open radical retropubic prostatectomy (RRP) performed in a single institution by the same surgeons. We also studied whether neurovascular bundle preservation modified PSM rates. The records were retrospectively reviewed from electronic medical data, and three groups of 100 patients were organized. Group 1 included 100 patients who underwent RRP prior to the incorporation of minimally invasive techniques. Group 2 included the first 100 patients who underwent LRP, and group 3 was made up of the first 100 patients who underwent dvRP. All surgical specimens were analyzed by the same pathologist. We used the technique described by Patel et al. for dvRP. LRP was performed using a five-trocar extraperitoneal approach as previously published by the authors. RRP was performed using retrograde dissection as described by Walsh et al. The final decision of preserving neurovascular bundles was made during surgery. Using D'Amico's risk classification, the dvRP group had a lower percentage of patients with low risk (dvRP versus LRP p = 0.017; dvRP versus RRP p = 0.0108). No statistically significant differences were found within high- and intermediate-risk groups. A higher percentage of patients with pT3 disease was found in the dvRP group compared with the RRP group (p = 0.0408). There were no statistically significant differences regarding PSMs among groups (RRP: 25, LRP: 14, dvRP: 18), although when we compared the total number of PSMs we found that the dvRP group had 18 PSMs versus 21 and 50 PSMs for LRP and RRP, respectively. All three groups had more PSMs located posterolaterally. There was a higher percentage of nerve-sparing procedures in the dvRP group (dvRP: 91 patients, LRP: 47 patients, RRP: 5

  4. Current concepts in wound management and wound healing products.

    PubMed

    Davidson, Jacqueline R

    2015-05-01

    Current concepts in wound management are summarized. The emphasis is on selection of the contact layer of the bandage to promote a moist wound environment. Selection of an appropriate contact layer is based on the stage of wound healing and the amount of wound exudate. The contact layer can be used to promote autolytic debridement and enhance wound healing.

  5. The use of desiccation to treat Staphylococcus aureus biofilm-infected wounds.

    PubMed

    Park, Eugene; Long, Sarah A; Seth, Akhil K; Geringer, Matthew; Xu, Wei; Chavez-Munoz, Claudia; Leung, Kai; Hong, Seok Jong; Galiano, Robert D; Mustoe, Thomas A

    2016-03-01

    Chronic wounds colonized with biofilm present a major burden to our healthcare system. While the current paradigm for wound healing is to maintain a moist environment, we sought to evaluate the effects of desiccation, and the ability of honey to desiccate wounds, on wound healing characteristics in Staphylococcus aureus biofilm wounds. In vivo biofilm wound healing after exposure to open-air desiccation, honey, molasses, and saline was analyzed using a rabbit ear model of S. aureus biofilm wounds previously developed by our group. Wound morphology was examined using scanning electron microscopy and granulation tissue deposition was measured using light microscopy with hematoxylin and eosin staining. Viable bacterial counts in rabbit ear biofilm wounds and scabs were measured using a drop dilution method. In vitro S. aureus growth curves were established using tryptic soy broth containing honey and glycerol. Gene expression analysis of rabbit ear wounds was performed using reverse transcription quantitative PCR. Rabbit ear S. aureus biofilm wounds exposed to open-air desiccation, honey, and molasses developed a dry scab, which displaced the majority of biofilm bacteria off of the wound bed. Wounds treated with open-air desiccation, honey, and molasses expressed lower levels of the inflammatory markers tumor necrosis factor-α and interleukin-1β at postoperative day 12 compared with wounds treated with saline, and had increased levels of granulation tissue formation. In vitro growth of S. aureus in tryptic soy broth was inhibited by the presence of honey to a greater extent than by the presence of osmolality-matched glycerol. Desiccation of chronic wounds colonized with biofilm via exposure to open air or honey leads to improved wound healing by decreasing bacterial burden and inflammation, and increasing granulation tissue formation. The ability of honey to help heal chronic wounds is at least in part due to its ability to desiccate bacterial biofilm, but other

  6. [Advances in wound care].

    PubMed

    Raffoul, Wassim

    2008-03-01

    Wound care made great progress during last years related to several factors. The first is an awakening of the importance of wounds. The progress made in the comprehension of the physiopathology of wounds led to innovations in all stages of this complex process which is the wound healing. Autologus platelet concentrate producing growth factors are in use to stimulate the first phase of the healing. The second phase which is the phase of proliferation and secretion is currently better managed with new categories of bandages which are true local treatments. The nutrition became one of the pillars of wound treatments especially among old patients. The reconstructive surgery took great steps since the physiology and the vascular anatomy of the skin and soft tissues are better known. Finally the bio-engineering has entered the treatment of the wound there is more than 20 years ago and methods have improved and become more reliable.

  7. Dressings for chronic wounds.

    PubMed

    Powers, Jennifer Gloeckner; Morton, Laurel M; Phillips, Tania J

    2013-01-01

    Covering wounds, acute and chronic, is one of the most fundamental activities of any medical practitioner. Although wound dressings primarily serve to contain the "good" and keep out the "bad," research has characterized more specifically the sophisticated interaction between the human wound bed and its dressing counterpart. Wound dressings for today's chronic wounds come in many flavors, ranging from the classic types of moisture-retentive dressings to silver-coated varieties to biologic dressings serving as skin substitutes. Moisture-retentive dressing types include foams, films, hydrogels, hydrocolloids, and alginates. Appropriate use of these dressings can help to keep the wound bed moist, which allows for epithelial migration, angiogenesis, retention of growth factors, autolytic debridement, and maintenance of electrical gradients. PMID:23742280

  8. Peyronie's Disease: Intralesional Therapy and Surgical Intervention.

    PubMed

    Aliperti, Louis A; Mehta, Akanksha

    2016-09-01

    Peyronie's disease is a collagen wound healing disorder of the penis that negatively affects the quality of life of afflicted men. According to the 2015 AUA Consensus Guidelines on Peyronie's Disease, minimally invasive intralesional therapies and surgical intervention form the basis of contemporary therapy for this disorder. These therapeutic options, along with selected portions of the guidelines, are explored in this review. PMID:27432377

  9. Simple wound care facilitates full healing in post-earthquake Haiti.

    PubMed

    Stephenson, F J

    2011-01-01

    The author provides an insight into the basic health care needs of two spinal cord injury patients who were cared for in a specially set up 25-bedded spinal cord injury unit in Haiti. While focusing on their extreme wound care requirements, the author highlights the need for adequate fluid, nutrition, hygiene and aseptic technique. Both patients were victims of the January 2010 earthquake in Port au Prince, Haiti. The author describes the basic wound care strategy for a patient with a category IV sacral pressure ulcer and another with a broken down thoracic spine surgical wound with visible metal work. This article describes how simple wound care effected the complete healing of large sacral pressure ulcers and broken down spinal surgical wounds without the need for further surgical intervention.

  10. Umbilical hernia in patients with liver cirrhosis: A surgical challenge

    PubMed Central

    Coelho, Julio C U; Claus, Christiano M P; Campos, Antonio C L; Costa, Marco A R; Blum, Caroline

    2016-01-01

    Umbilical hernia occurs in 20% of the patients with liver cirrhosis complicated with ascites. Due to the enormous intraabdominal pressure secondary to the ascites, umbilical hernia in these patients has a tendency to enlarge rapidly and to complicate. The treatment of umbilical hernia in these patients is a surgical challenge. Ascites control is the mainstay to reduce hernia recurrence and postoperative complications, such as wound infection, evisceration, ascites drainage, and peritonitis. Intermittent paracentesis, temporary peritoneal dialysis catheter or transjugular intrahepatic portosystemic shunt may be necessary to control ascites. Hernia repair is indicated in patients in whom medical treatment is effective in controlling ascites. Patients who have a good perspective to be transplanted within 3-6 mo, herniorrhaphy should be performed during transplantation. Hernia repair with mesh is associated with lower recurrence rate, but with higher surgical site infection when compared to hernia correction with conventional fascial suture. There is no consensus on the best abdominal wall layer in which the mesh should be placed: Onlay, sublay, or underlay. Many studies have demonstrated several advantages of the laparoscopic umbilical herniorrhaphy in cirrhotic patients compared with open surgical treatment. PMID:27462389

  11. The impact of surgical site occurrences and the role of closed incision negative pressure therapy.

    PubMed

    Willy, Christian; Engelhardt, Michael; Stichling, Marcus; Grauhan, Onnen

    2016-09-01

    Surgical site occurrences are observed in up to 60% of inpatient surgical procedures in industrialised countries. The most relevant postoperative complication is surgical site infection (SSI) because of its impact on patient outcomes and enormous treatment costs. Literature reviews ('SSI', 'deep sternal wound infections' (DSWI), 'closed incision negative pressure wound therapy' (ciNPT) were performed by electronically searching MEDLINE (PubMed) and subsequently using a 'snowball' method of continued searches of the references in the identified publications. Search criteria included publications in all languages, various study types and publication in a peer-reviewed journal. The SSI literature search identified 1325, the DSWI search 590 and the ciNPT search 103 publications that fulfilled the search criteria. Patient-related SSI risk factors (diabetes mellitus, obesity, smoking, hypertension, female gender) and operation-related SSI risk factors (re-exploration, emergency operations, prolonged ventilation, prolonged operation duration) exist. We found that patient- and operation-related SSI risk factors were often different for each speciality and/or operative procedure. Based on the evidence, we found that high-risk incisions (sternotomy and incisions in extremities after high-energy open trauma) are principally recommended for ciNPT use. In 'lower'-risk incisions, the addition of patient-related or operation-related risk factors justifies the application of ciNPT. PMID:27547962

  12. Negative pressure wound therapy as an adjunct in healing of chronic wounds.

    PubMed

    Langer, Vijay; Bhandari, Prem S; Rajagopalan, Satyamoorthy; Mukherjee, Mrinal K

    2015-08-01

    Negative pressure wound therapy (NPWT) has emerged as a cutting-edge technology and provides an alternative solution to the problem of wounds. This study was undertaken to assess the efficacy of this technique in the treatment of chronic wounds. A prospective clinical study was used to evaluate our experience in use of NPWT in the healing of pressure ulcers and chronic wounds over 2 years. The primary end point of the study group was the time taken for appearance of healthy granulation tissue and full reepithelialisation without drainage. All patients with sepsis were excluded from the study. The statistical analysis of the data was carried out. Of the 60 patients studied, 41 had associated comorbidities including diabetes mellitus. The commonest site of occurrence was the lower limb. Coverage in the form of a flap was required at presentation in 63·33% of patients. However, after initiation of NPWT, none of them required the procedure and they healed spontaneously either by secondary intention or by skin grafting. The time taken for appearance of healthy granulation tissue was 14·36 ± 4·24 days. Complete healing of wounds occurred by 33·1 ± 10·22 days. There was a statistically significant difference in the volume of the wounds before and after the intervention (P = 0·000). Complications resulting from NPWT were minimal. This technique is an excellent adjunct to surgical debridement.

  13. Innovation and wound healing.

    PubMed

    Harding, Keith

    2015-04-01

    Innovation in medicine requires unique partnerships between academic research, biotech or pharmaceutical companies, and health-care providers. While innovation in medicine has greatly increased over the past 100 years, innovation in wound care has been slow, despite the fact that chronic wounds are a global health challenge where there is a need for technical, process and social innovation. While novel partnerships between research and the health-care system have been created, we still have much to learn about wound care and the wound-healing processes.

  14. Surgical Technologists

    MedlinePlus

    ... in place during the procedure, or set up robotic surgical equipment. Technologists also may handle specimens taken ... sterilization techniques, how to set up technical or robotic equipment, and preventing and controlling infections. In addition ...

  15. Long-term efficacy of endovascular vs open surgical repair for complicated type-B aortic dissection: a single-center retrospective study and meta-analysis

    PubMed Central

    Zhu, Y.; Wang, B.; Meng, Q.; Liu, J.; Zhai, S.; He, J.

    2016-01-01

    This study aimed to evaluate the long-term survival and risk factors of traditional open surgical repair (OSR) vs thoracic endovascular aneurysm repair (TEVAR) for complicated type-B aortic dissection (TBAD). A total of 118 inpatients (45 OSR vs 73 TEVAR) with TBAD were enrolled from January 2004 to January 2015. Kaplan-Meier curves and Cox proportional hazards analysis were performed to identify the long-term survival rate and independent predictors of survival, respectively. Meta-analysis was used to further explore the long-term efficacy of OSR and TEVAR in the eight included studies using Review Manager 5.2 software. An overall 10-year survival rate of 41.9% was found, and it was similar in the two groups (56.7% OSR vs 26.1% TEVAR; log-rank P=0.953). The risk factors of long-term survival were refractory hypertension (OR=11.1; 95%CI=1.428-86.372; P=0.021] and preoperative aortic diameter >55 mm (OR=4.5; 95%CI=1.842-11.346; P=0.001). Long-term survival rate did not differ significantly between OSR and TEVAR (hazard ratio=0.87; 95%CI=0.52-1.47; P=0.61). Compared with OSR, TEVAR did not show long-term advantages for patients with TBAD. Refractory hypertension and total aortic diameter >55 mm can be used to predict the long-term survival of TBAD in the Chinese Han population. PMID:27254661

  16. [General principles of treatment of mine-explosive wounds of ENT-organs].

    PubMed

    Beliakin, S A; Egorov, V I; Luk'ianenko, A V

    2011-11-01

    The relevance of diagnosis and treatment of mine-explosive wounds ENT high. Treatment of explosives, Russian Academy of Sciences-the challenge and consists of a series of sequential steps that need to be applied, taking into account all the particularities of each injury. Concepts of specialized surgical care of the wounded are formulated. The main are: 1) one-stage surgical treatment of comprehensive primary wounds with detent of bone fragments, reconstruction of defects of soft tissue with positive wound and related fascial spatium drainage; 2) general intensive care during the postoperative period, including water-electrolytic balance correction, sympathetic block, controlled hemodilution and adequate analgesia; 3) intensive therapy of postoperative wounds, aimed at creating favorable conditions for its healing and includes targeted selective influence on hemophoresis in the wound and the local proteoclastic processes.

  17. Serum amyloid P inhibits dermal wound healing

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The repair of open wounds depends on granulation tissue formation and contraction, which is primarily mediated by myofibroblasts. A subset of myofibroblasts originates from bone-marrow-derived monocytes which differentiate into fibroblast-like cells called fibrocytes. Serum amyloid P (SAP) inhibits ...

  18. Understanding methods of wound debridement.

    PubMed

    Atkin, Leanne

    Autolytic debridement describes the body's natural method of wound-bed cleansing, helping it to prepare the wound bed for healing. In acute wounds, autolytic debridement occurs automatically and often does not require intervention, as during the inflammatory stage of a wound, neutrophils and macrophages digest and removes devitalised tissue, cell debris and contaminants, clearing the wound of any cellular barriers to healing. In chronic wounds, by contrast, healing is often delayed, frequently because of inadequate debridement. The autolytic process becomes overwhelmed by high levels of endotoxins released from damaged tissue (Broadus, 2013). Therefore wound debridement becomes an integral part of chronic-wound management and practitioners involved in wound care must be fully competent at wound-bed assessment and have an awareness of the options available for debridement. This article will review wound-bed assessment, highlighting variations in devitalised tissue, and explore options available for wound debridement, taking into consideration patients’ pain and quality of life.

  19. Effect of plasma flow on regeneration of skin wounds and on reactivity of the body

    SciTech Connect

    Stupin, I.V.; Mikaelyan, N.P.; Ul'yanov, M.I.; Belous, G.G.

    1987-10-01

    The aim of this investigation was to provide more research data on the behavior of the plasma scalpel, a surgical tool based on the use of the energy flow of ionized gases for the treatment of skin wounds. The effect of the ionized gas flow on wound skin wound healing was tested on three series of six rabbits. Experimental methods and results are given for the biochemical interaction of the skin with the plasma.

  20. Postoperative cerebral myiasis: A rare cause of wound dehiscence in developing countries

    PubMed Central

    Navarro, Juliano N.; Alves, Raphael V.

    2016-01-01

    Background: Cerebral myiasis is a rare parasitic disease, especially in postoperative neurological surgery. Case Description: We report a case of postoperative myiasis in a patient who underwent a craniotomy for resection of metastatic melanoma, evolving with wound dehiscence due to myiasis in the operative wound. Conclusion: Myiasis infestation should be a differential diagnosis of surgical wound dehiscence, particularly when the classic signs of inflammation are not present and computed tomography of the brain shows signs suggestive of this disease entity. PMID:27413581

  1. Postoperative posterior spinal wound infections.

    PubMed

    Massie, J B; Heller, J G; Abitbol, J J; McPherson, D; Garfin, S R

    1992-11-01

    The incidence of postoperative spinal infections increases with the complexity of the procedure. Diskectomy is associated with less than a 1% risk of infection; spinal fusion without instrumentation is associated with a 1%-5% risk; and fusion with instrumentation may be associated with a risk of 6% or more. Twenty-two postoperative posterior spinal infections that occurred during a three-year period were reviewed for this report. Staphylococcus aureus was the most frequent organism cultured (more than 50% of the cases). Other recurring organisms were Staphylococcus epidermis, Peptococcus, Enterobacter cloacae, and Bacteroides. Many patients had multiple organisms. Risk factors appeared to include advanced age, prolonged hospital bed rest, obesity, diabetes, immunosuppression, and infection at remote sites. Operative factors included prolonged surgery (greater than five hours), high volume of personnel moving through the operating room, and instrumentation. Postoperative contamination may occur and may be related to prolonged postoperative bed rest, skin maceration (thoracolumbosacral orthoses), and drainage tubes exiting distally from lumbar wounds (toward the rectum). Effective treatment includes early diagnosis, surgical debridement and irrigation, and parenteral antibiotics. Superficial infections were treated successfully with wound closure over outflow tubes, and deep infections with inflow-outflow systems. Maintaining the instrumentation in place was possible in most cases. Parenteral antibiotics were maintained for six weeks in every case. PMID:1395319

  2. First case of Chlorella wound infection in a human in Australia

    PubMed Central

    Hart, J; Mooney, L; Arthur, I; Inglis, T J J; Murray, R

    2014-01-01

    A 30-year-old man developed an infected knee wound 2 days after jumping his bicycle into a freshwater dam. He required repeated debridement and tissue grew bright green colonies typical of the alga Chlorella plus Aeromonas hydrophila. This, and one previously reported case, responded to surgical debridement and careful wound management. PMID:25356359

  3. Debridement of the noninfected wound.

    PubMed

    Cornell, Rhonda S; Meyr, Andrew J; Steinberg, John S; Attinger, Christopher E

    2010-01-01

    The utility of wound debridement has expanded to include the management of all chronic wounds, even in the absence of infection and gross necrosis. Biofilms, metalloproteases on the wound base, and senescent cells at the wound edge irreversibly change the physiologic features of wound healing and contribute to a pathologic, chronic inflammatory environment. The objective of this review is to provide surgeons with a basic understanding of the processes of debridement in the noninfected wound.

  4. Saliva and wound healing.

    PubMed

    Brand, Henk S; Veerman, Enno C I

    2013-01-01

    Wounds in the oral cavity heal faster and with less scarring than wounds in other parts of the body. One of the factors implicated in this phenomenon is the presence of saliva, which promotes the healing of oral wounds in several ways. Saliva creates a humid environment, which improves the survival and functioning of inflammatory cells that are crucial for wound healing. Furthermore, saliva contains a variety of proteins that play a role in the various stages of the intraoral wound healing. Tissue factor, present in salivary exosomes, accelerates the clotting of blood dramatically. The subsequent proliferation of epithelial cells is promoted by growth factors in saliva, especially epidermal growth factor. The importance of secretory leucocyte protease inhibitor is demonstrated by the observation that in the absence of this salivary protein, oral wound healing is considerably delayed. Members of the salivary histatin family promote wound closure in vitro by enhancing cell spreading and cell migration. Cell proliferation is not enhanced by histatin. Cyclization of histatin increased its biological activity approximately 1,000-fold compared to linear histatin. These studies suggest that histatins could potentially be used for the development of new wound healing medications.

  5. Burn wound management.

    PubMed

    Davies, M R; Rode, H; Cywes, S; van der Riet, R L

    1981-01-01

    In this chapter the local therapy for burns is discussed. Between 400 and 500 children with burns are treated every year at the Red Cross War Memorial Children's Hospital in Cape Town, but in only 10% of them do the burns affect over 20% of the body surface. These latter patients are treated in special rooms equipped for intensive therapy. Open and closed methods of treatment for burns used in addition to early excision are compared. The first aim is early skin cover for areas with skin loss preserving as much function as possible and achieving the best possible cosmetic result. Local therapy must be atraumatic to prevent extension of the skin lesion. Bacterial contamination must be prevented as far as possible by keeping the wound clean. Emergency treatment and the course of wound healing up to the third week after the injury using the appropriate dressings are described. Early excision until the fifth day after the accident should be used mainly for burns of the hand, deep second degree burns of up to 10% of the body surface, deep second degree burns over the joints and deep second degree burns of the neck. It must be admitted that the depth of the burn can only be definitely estimated between the seventh and tenth day after the accident. If no autografts are available homografts or grafts from animals are used. The age of the patient, associated injuries, associated diseases and the extent of the burn all play a role in determining the prognosis. Furthermore endogenous bacterial infections, absorption of local therapeutic agents and the state of the surrounding skin do also influence the healing process. Finally the various local therapeutic agents like sulphamylon, silver sulphadiazine and betadine are discussed. A 0.05% solution of silver nitrate is also active against gram-negative infections. Skin transplants are disinfected with a solution containing one third 0.25% acetic acid, one third 3% cent hydrogen peroxide and one third saline. Hydrogen peroxide

  6. Wound healing in glaucoma filtering surgery.

    PubMed

    Skuta, G L; Parrish, R K

    1987-01-01

    Successful glaucoma filtering surgery is characterized by the passage of aqueous humor from the anterior chamber to the subconjunctival space, which results in the formation of a filtering bleb. Aqueous in the subconjunctival space may then exit by multiple pathways. Bleb failure most often results from fibroblast proliferation and subconjunctival fibrosis. Factors associated with an increased risk of bleb failure include youth, aphakia, active anterior segment neovascularization, inflammation, previously failed glaucoma filtering surgery, and, possibly, race. Several surgical and pharmacologic techniques have recently been introduced to enhance success in eyes with poor surgical prognoses. To elucidate the scientific rationale of these methods, we summarize the process of wound healing after glaucoma filtering surgery and describe postoperative clinical and histopathologic features, factors which may affect success, and specific methods to improve surgical success.

  7. A surgical glove port technique for laparoscopic-assisted ovariohysterectomy for pyometra in the bitch.

    PubMed

    Becher-Deichsel, Anja; Aurich, Jörg E; Schrammel, Nadine; Dupré, Gilles

    2016-07-15

    The objective of the study was to describe the feasibility of a glove port technique for laparoscopic-assisted surgical treatment of canine pyometra. In this retrospective case series, a total of 10 female dogs (median age 7 years, range 5.5-10.5 years; median weight 37.0 kg, range 12.9-64.0 kg) with pyometra were included. A multiaccess port was created from a surgical glove attached to an Alexis wound retractor and placed in the ventral midline between the middle and caudal third of the distance between umbilicus and pubic rim. A vessel sealing device was used for transection of the ovarian pedicle. The port size was selected on the basis of maximum uterine diameter determined by ultrasound. Median incision length was 5.0 cm (range 3.1-7.7 cm) for a maximum uterine diameter of 4.0 cm (range 2.0-7.0 cm). Median surgical time was 57 minutes (range 48-65 minutes). No case had to be converted to open celiotomy. Complications included one case of minor, self-limiting splenic trauma by the endoscope. In eight dogs, the distended uterine horns endangered safe access to the ovarian pedicle, and the vessel sealing device was inserted through a second cannula placed periumbilically. Extension of the original incision was necessary to exteriorize organs in two dogs. All dogs recovered quickly and were discharged either on the day of surgery or 1 day thereafter. In conclusion, a surgical glove port technique in combination with an Alexis wound retractor is feasible for surgical laparoscopic treatment of canine pyometra up to a diameter of 7 cm. PMID:27039076

  8. The use of urinary bladder matrix in the treatment of trauma and combat casualty wound care.

    PubMed

    Valerio, Ian L; Campbell, Paul; Sabino, Jennifer; Dearth, Christopher L; Fleming, Mark

    2015-01-01

    Treatment of combat injuries and resulting wounds can be difficult to treat due to compromised and evolving tissue necrosis, environmental contaminants, multidrug resistant microbacterial and/or fungal infections, coupled with microvascular damage and/or hypovascularized exposed vital structures. Our group has developed surgical care algorithms with identifiable salvage techniques to achieve stable, definitive wound coverage often with the aid of certain regenerative medicine biologic scaffold materials and advanced wound care to facilitate tissue coverage and healing. This case series reports on the role of urinary bladder matrix scaffolds in the wound care and reconstruction of traumatic and combat wounds. Urinary bladder matrix was found to facilitate definitive soft tissue reconstruction by establishing a neovascularized soft tissue base acceptable for second stage wound and skin coverage options within traumatic and combat-related wounds. PMID:26237704

  9. Negative pressure wound therapy with saline instillation: 131 patient case series.

    PubMed

    Brinkert, David; Ali, Mazen; Naud, Magali; Maire, Nicolas; Trial, Chloé; Téot, Luc

    2013-12-01

    Negative pressure wound therapy combined with timed, cyclical instillation (NPWTi) of topical wound solutions has been recently presented as a new adjunctive modality for treating wounds with signs of infection. Normal saline, antiseptics and antimicrobials all have been proposed in scientific and clinical studies as potentially effective when used with NPWTi for treating heavily infected wounds. This is a prospective clinical study of 131 patients with 131 wounds treated with NPWTi using saline between January 2012 and December 2012 in two orthopaedic centres and one surgical wound healing centre in France. Saline was exclusively used. Results were favourable: in 98% of the cases, the wounds could be closed after debridement and following the use of NPWTi. Mean duration of NPWTi was 12·19 days. This does not preclude the need for treating the biofilm appropriately with more active antibacterial products when biofilm has been documented.

  10. The use of urinary bladder matrix in the treatment of trauma and combat casualty wound care.

    PubMed

    Valerio, Ian L; Campbell, Paul; Sabino, Jennifer; Dearth, Christopher L; Fleming, Mark

    2015-01-01

    Treatment of combat injuries and resulting wounds can be difficult to treat due to compromised and evolving tissue necrosis, environmental contaminants, multidrug resistant microbacterial and/or fungal infections, coupled with microvascular damage and/or hypovascularized exposed vital structures. Our group has developed surgical care algorithms with identifiable salvage techniques to achieve stable, definitive wound coverage often with the aid of certain regenerative medicine biologic scaffold materials and advanced wound care to facilitate tissue coverage and healing. This case series reports on the role of urinary bladder matrix scaffolds in the wound care and reconstruction of traumatic and combat wounds. Urinary bladder matrix was found to facilitate definitive soft tissue reconstruction by establishing a neovascularized soft tissue base acceptable for second stage wound and skin coverage options within traumatic and combat-related wounds.

  11. Expert advice provided through telemedicine improves healing of chronic wounds: prospective cluster controlled study.

    PubMed

    Zarchi, Kian; Haugaard, Vibeke B; Dufour, Deirdre N; Jemec, Gregor B E

    2015-03-01

    Telemedicine is widely considered as an efficient approach to manage the growing problem of chronic wounds. However, to date, there is no convincing evidence to support the clinical efficacy of telemedicine in wound management. In this prospective cluster controlled study, we tested the hypothesis that advice on wound management provided by a team of wound-care specialists through telemedicine would significantly improve the likelihood of wound healing compared with the best available conventional practice. A total of 90 chronic wound patients in home care met all study criteria and were included: 50 in the telemedicine group and 40 in the conventional group. Patients with pressure ulcers, surgical wounds, and cancer wounds were excluded. During the 1-year follow-up, complete wound healing was achieved in 35 patients (70%) in the telemedicine group compared with 18 patients (45%) in the conventional group. After adjusting for important covariates, offering advice on wound management through telemedicine was associated with significantly increased healing compared with the best available conventional practice (telemedicine vs. conventional practice: adjusted hazard ratio 2.19; 95% confidence interval: 1.15-4.17; P=0.017). This study strongly supports the use of telemedicine to connect home-care nurses to a team of wound experts in order to improve the management of chronic wounds.

  12. Superficial Wound Swabbing

    PubMed Central

    Schmohl, Michael; Beckert, Stefan; Joos, Thomas O.; Königsrainer, Alfred; Schneiderhan-Marra, Nicole; Löffler, Markus W.

    2012-01-01

    OBJECTIVE In diabetic foot ulcers, wound fluid inflammatory mediators have previously been proposed as surrogate markers for nonhealing. However, currently available wound fluid sampling techniques are not suitable for clinical practice due to low levels of exudate and a high logistical effort. The aim of this investigation was to assess 1) the technique of superficial wound swabbing for harvesting wound fluid; and 2) the quality of the collected fluid for immunoassay analysis of inflammatory mediators. RESEARCH DESIGN AND METHODS Both nylon-flocked swabs and film dressings were used to collect wound fluid from foot ulcers of diabetic patients. In randomly selected patients, levels of wound fluid inflammatory mediators and matrix metalloproteases were determined using multiplexed bead-based sandwich immunoassays with respect to both sampling methods. Wound fluid spike-in experiments were performed to evaluate the impact of different sample processing protocols on subsequent immunoassay analysis. RESULTS Using the swabbing technique, a median amount of 40 µL (2–120 µL) wound exudate was collected, which allowed the measurement of several multiplex panels. Comparing both sampling methods, a similar qualitative protein recovery was observed with a trend to analyte enrichment by swabbing. Sample processing using swabs did not affect analyte recovery, with the exception of interleukin (IL)-8, thymus and activation-regulated chemokine, IL-17A, interferon-γ–induced protein 10, and IL-4. CONCLUSIONS The quality of wound fluid collected by superficial swabbing is not inferior to the current standard technique. Combined with subsequent bead-based sandwich immunoassay analysis, this new method offers a noninvasive technique, suitable for daily clinical routines, for assessment of inflammatory activity in diabetic foot ulcers. PMID:22837363

  13. Skin wound healing and phytomedicine: a review.

    PubMed

    Pazyar, Nader; Yaghoobi, Reza; Rafiee, Esmail; Mehrabian, Abolfath; Feily, Amir

    2014-01-01

    Skin integrity is restored by a physiological process aimed at repairing the damaged tissues. The healing process proceeds in four phases: hemostasis, inflammation, proliferation and remodeling. Phytomedicine presents remedies, which possess significant pharmacological effects. It is popular amongst the general population in regions all over the world. Phytotherapeutic agents have been largely used for cutaneous wound healing. These include Aloe vera, mimosa, grape vine, Echinacea, chamomile, ginseng, green tea, jojoba, tea tree oil, rosemary, lemon, soybean, comfrey, papaya, oat, garlic, ginkgo, olive oil and ocimum. Phytotherapy may open new avenues for therapeutic intervention on cutaneous wounds. This article provides a review of the common beneficial medicinal plants in the management of skin wounds with an attempt to explain their mechanisms.

  14. Biomechanics and Wound Healing in the Cornea

    PubMed Central

    Dupps, William J.; Wilson, Steven E.

    2009-01-01

    The biomechanical and wound healing properties of the cornea undermine the predictability and stability of refractive surgery and contribute to discrepancies between attempted and achieved visual outcomes after LASIK, surface ablation and other keratorefractive procedures. Furthermore, patients predisposed to biomechanical failure or abnormal wound healing can experience serious complications such as keratectasia or clinically significant corneal haze, and more effective means for the identification of such patients prior to surgery are needed. In this review, we describe the cornea as a complex structural composite material with pronounced anisotropy and heterogeneity, summarize current understanding of major biomechanical and reparative pathways that contribute to the corneal response to laser vision correction, and review the role of these processes in ectasia, intraocular pressure measurement artifact, diffuse lamellar keratitis (DLK) and corneal haze. The current understanding of differences in the corneal response after photorefractive keratectomy (PRK), LASIK and femtosecond-assisted LASIK are reviewed. Surgical and disease models that integrate corneal geometric data, substructural anatomy, elastic and viscoelastic material properties and wound healing behavior have the potential to improve clinical outcomes and minimize complications but depend on the identification of preoperative predictors of biomechanical and wound healing responses in individual patients. PMID:16720023

  15. A Plutonium-Contaminated Wound, 1985, USA

    SciTech Connect

    Doran M. Christensen, DO, REAC /TS Associate Director and Staff Physician Eugene H. Carbaugh, CHP, Staff Scientist, Internal Dosimetry Manager, Pacific Northwest National Laboratory, Richland, Washington

    2012-02-02

    A hand injury occurred at a U.S. facility in 1985 involving a pointed shaft (similar to a meat thermometer) that a worker was using to remove scrap solid plutonium from a plastic bottle. The worker punctured his right index finger on the palm side at the metacarpal-phalangeal joint. The wound was not through-and- through, although it was deep. The puncture wound resulted in deposition of ~48 kBq of alpha activity from the weapons-grade plutonium mixture with a nominal 12 to 1 Pu-alpha to {sup 241}Am-alpha ratio. This case clearly showed that DTPA was very effective for decorporation of plutonium and americium. The case is a model for management of wounds contaminated with transuranics: (1) a team approach for dealing with all of the issues surrounding the incident, including the psychological, (2) early surgical intervention for foreign-body removal, (3) wound irrigation with DTPA solution, and (4) early and prolonged DTPA administration based upon bioassay and in vivo dosimetry.

  16. Gentamicin-impregnated collagen sponge for preventing sternal wound infection after cardiac surgery.

    PubMed

    Kozioł, Małgorzata; Targońska, Sylwia; Stążka, Janusz; Kozioł-Montewka, Maria

    2014-03-01

    The frequency of sternal wound infection (SWI) after cardiac surgery ranges from 0.5% to 8% and is associated with significant morbidity, mortality, and treatment cost. Perioperative antibiotic prophylaxis is not sufficient to fully prevent the contamination of the surgical access site. One of the most effective methods for the prevention of wound infection seems to be the use of gentamicin-impregnated collagen sponge, which is successfully used in abdominal and orthopedic surgery. Surgically implantable topical antibiotics can reduce wound infection in cardiac patients as well, but the efficacy of SWI prevention in cardiac surgery still raises many questions.

  17. Best practice in wound assessment.

    PubMed

    Benbow, Maureen

    2016-03-01

    Accurate and considered wound assessment is essential to fulfil professional nursing requirements and ensure appropriate patient and wound management. This article describes the main aspects of holistic assessment of the patient and the wound, including identifying patient risk factors and comorbidities, and factors affecting wound healing to ensure optimal outcomes.

  18. [Surgical treatment of persisting chylothorax].

    PubMed

    Andreieshchev, S A; Miasoiedov, S D; Bul'ba, M V; Driuk, M F; Chernukha, L M; Vakhnenko, L M

    2008-09-01

    Results of surgical treatment of 8 patients, suffering chylothorax, persisting during 1-14 months are presented. The desease have appeared also resistant to complex conservative treatment trial. This kind of treatment was conducted with simultaneous intensive preoperative preparation, surgical intervention consisted of open thoracotomy with thoracic duct suturing and ligature. The operative treatment had appeared primarily ultimately successful in 5 (62.5%) patients, and after postoperative pleurodesis conduction--in 3 (37.5%). One week of intensive conservative therapy trial with simultaneous preoperative preparation and subsequent shift to surgical intervention constitutes an optimal tactical principle in the persisting chylothorax treatment. PMID:19278039

  19. Surgical Adhesives in Facial Plastic Surgery.

    PubMed

    Toriumi, Dean M; Chung, Victor K; Cappelle, Quintin M

    2016-06-01

    In facial plastic surgery, attaining hemostasis may require adjuncts to traditional surgical techniques. Fibrin tissue adhesives have broad applications in surgery and are particularly useful when addressing the soft tissue encountered in facial plastic surgery. Beyond hemostasis, tissue adhesion and enhanced wound healing are reported benefits associated with a decrease in operating time, necessity for drains and pressure dressings, and incidence of wound healing complications. These products are clinically accessible to most physicians who perform facial plastic surgery, including skin grafts, flaps, rhytidectomy, and endoscopic forehead lift. PMID:27267012

  20. Surgical Adhesive Drape (IO-ban) as Postoperative Surgical Site Dressing

    PubMed Central

    Syed, Hasan R; Snyder, Rita; McGowan, Jason E; Jha, Ribhu T; Nair, Mani N

    2015-01-01

    Study Design: Retrospective chart analysis. Objective: The objective of this study is to describe the senior author’s (MNN) experience applying a widely available surgical drape as a postoperative sterile surgical site dressing for both cranial and spinal procedures. Summary of Background Data: Surgical site infection (SSI) is an important complication of spine surgery that can result in significant morbidity. There is wide variation in wound care management in practice, including dressing type. Given the known bactericidal properties of the surgical drape, there may be a benefit of continuing its use immediately postoperatively. Methods: All of the senior author’s cases from September 2014 through September 2015 were reviewed. These were contrasted to the previous year prior to the institution of a sterile surgical drape as a postoperative dressing. Results: Only one surgical case out of 157 operative interventions (35 cranial, 124 spinal) required operative debridement due to infection. From September 2013 to September 2014, prior to the institution of a sterile surgical drape as dressing, the author had five infections out of 143 operations (46 cranial, 97 spinal) requiring intervention. Conclusion: The implementation of a sterile surgical drape as a closed postoperative surgical site dressing has led to a decrease in surgical site infections. The technique is simple and widely available, and should be considered for use to diminish surgical site infections. PMID:26798570

  1. [SURGICAL HAND WASHING: HANDSCRUBBING OR HANDRUBBING].

    PubMed

    Santacatalina Mas, Roser; Peix Sagues, Ma Teresa; Miranda Salmerón, Josep; Claramunt Jofre, Marta; López López, Alba; Salas Marco, Elena

    2016-02-01

    The importance of protocols for preoperative antisepsis of the hands is given by the risk of transferring bacteria from the hands of the surgical team to the patient during surgery and it is relationship with infection of surgical wound site (SSI). Careful surgical scrub reduces the number of bacteria on the skin, but does not eliminate them completely, remaining transient microorganisms on hands after the surgical scrub. There fore if micropuncture in surgical gloves occurs, the correct preoperative preparation of hands and double gloving will be essential to reduce the risk of bacterial transmission to patients. The protocols for surgical hand antisepsis are two: Surgical scrub with antiseptic soap (hand scrubbing). Surgical scrub by rubbing alcohol (handrubbing). The hand antisepsis by rubbing with an alcohol solution has proved to be significantly more effective compared to soap solutions. We must also see that in surgical hand antisepsis with soap, you must rinse them with water. And often hospitals' taps and keys are contaminated by Pseudomonas spp., including P. aeuinosa. PMID:27101645

  2. Evolving trends in surgically managed patients with proximal humerus fracture: are we different after ten years?

    PubMed Central

    Hong, Choon Chiet; Hey, Dennis Hwee Weng; Murphy, Diarmuid

    2014-01-01

    INTRODUCTION New knowledge, and improved surgical hardware and fixation techniques have changed surgical management. We review the evolving trends of surgically managed proximal humerus fractures. METHODS Patients who underwent surgery for proximal humerus fractures from 1 January 2001 to 31 December 2010 were identified from the hospital’s electronic diagnosis and operative coding database. Data extracted from the database included patient demographics, comorbidities, clinical and radiological findings, operative techniques, and complications. RESULTS In total, 95 patients with 97 surgically managed proximal humerus fractures were identified. The median age of the patients was 50 (range 12–85) years, and the male to female ratio was 1.2:1.0. Male patients tended to present at a younger age than female patients (peak age 30–39 years vs. 70–79 years, p < 0.001). Two-part surgical neck fracture was the most common type of fracture (n = 33, 34.0%). Plate osteosynthesis was predominantly used for two- and three-part surgical neck fractures involving the greater tuberosity (p = 0.03, p = 0.0002, respectively). Hemiarthroplasty was commonly performed for four-part fractures (p < 0.001). Wound infections, implant failure, avascular necrosis of the humeral head and nonunion were seen in 8 (8.3%) cases. Minimally invasive plate osteosynthesis (MIPO) had been in use since 2007 (p < 0.001). CONCLUSION Surgically managed proximal humerus fractures predominantly involved young men following high velocity injury and elderly women following osteoporotic fractures. Open plating was most commonly used for two- and three-part fractures, and hemiarthroplasty for four-part fractures. MIPO techniques have been practised in our institution since 2007. PMID:25631967

  3. Effectively managing wound exudate.

    PubMed

    Chamanga, Edwin

    2015-09-01

    The management of wound exudate remains a clinical challenge despite technological advances in products with better exudate-handling capacities. This clinical challenge is occasionally encountered when thick exudate (viscous exudate) is present, and when most modern dressings do not possess the capabilities to manage the viscosity while enabling exudate absorption. Maceration to the peri-wound area poses another challenge, irrespective of the number of topical barrier application products on the market and the innovation of dressing products that lock exudate away or those that encourage vertical wicking. In addition to all the above, in clinical practice, the assessment and documentation of wound exudate remains sporadic, leading to the challenges of effective wound exudate dressing selection and cost-effective dressings.

  4. Role of negative pressure wound therapy in total hip and knee arthroplasty

    PubMed Central

    Siqueira, Marcelo BP; Ramanathan, Deepak; Klika, Alison K; Higuera, Carlos A; Barsoum, Wael K

    2016-01-01

    Negative-pressure wound therapy (NPWT) has been a successful modality of wound management which is in widespread use in several surgical fields. The main mechanisms of action thought to play a role in enhancing wound healing and preventing surgical site infection are macrodeformation and microdeformation of the wound bed, fluid removal, and stabilization of the wound environment. Due to the devastating consequences of infection in the setting of joint arthroplasty, there has been some interest in the use of NPWT following total hip arthroplasty and total knee arthroplasty. However, there is still a scarcity of data reporting on the use of NPWT within this field and most studies are limited by small sample sizes, high variability of clinical settings and end-points. There is little evidence to support the use of NPWT as an adjunctive treatment for surgical wound drainage, and for this reason surgical intervention should not be delayed when indicated. The prophylactic use of NPWT after arthroplasty in patients that are at high risk for postoperative wound drainage appears to have the strongest clinical evidence. Several clinical trials including single-use NPWT devices for this purpose are currently in progress and this may soon be incorporated in clinical guidelines as a mean to prevent periprosthetic joint infections. PMID:26807353

  5. Role of Surgical Dressings in Total Joint Arthroplasty: A Randomized Controlled Trial.

    PubMed

    Springer, Bryan D; Beaver, Walter B; Griffin, William L; Mason, J Bohannon; Odum, Susan M

    2015-09-01

    We conducted a randomized controlled trial to compare efficacy of an occlusive antimicrobial barrier dressing and a standard surgical dressing in patients who underwent primary total joint arthroplasty. Two hundred sixty-two patients were randomized to receive either an occlusive dressing or a standard dressing. Wounds were closed in identical fashion. Outcomes included wound complications, dressing changes, and patient satisfaction. With use of occlusive dressing (vs standard dressing), wound complications (including skin blistering) were significantly (P = 0.15) reduced; there were significantly (P < .0001) fewer dressing changes; and patient satisfaction was significantly (P < .0001) higher. Use of occlusive dressings can reduce wound complications and promote wound healing after total joint arthroplasty.

  6. Reverse Medial Hemisoleus Flaps for Coverage of Distal Third Leg Wounds: A Technical Trick.

    PubMed

    Houdek, Matthew T; Wagner, Eric R; Wyles, Cody C; Sems, Stephen A; Moran, Steven L

    2016-04-01

    Traditionally, free tissue transfer has been used to cover wounds of the distal third of the leg. Advances in flap anatomy, elevation, and surgical techniques have allowed the use of pedicled flaps to avoid the use of free tissue transfer in certain situations. The authors describe a technique for using a reversed medial hemisoleus flap to provide soft tissue coverage for wounds of the medial distal leg. In the senior authors experience, the use of this flap has achieved wound coverage in 100% of patients with smaller wounds (≤50 cm) of the medial leg.

  7. Aquacel Surgical Dressing after Thigh Lift: A Case–Control Study

    PubMed Central

    Bocchiotti, Maria A.; Baglioni, Elisabetta A.; Spaziante, Luca; Frenello, Ambra

    2016-01-01

    Background: The postoperative dressing in patients undergoing thigh lift is often difficult, not very resistant to movement, and uncomfortable for the patient, and often exposes surgical site to infection, maceration, or delay in wound healing. Methods: We included 40 patients in a case–control crossover study with no period effects, who were treated both by Aquacel Surgical and a traditional wound dressing. Surveys with a 10-point scale evaluation were used to assess nontraumatic removal level, ease of application, adhesion, and strength of the 2 treatments. We reported the number of days necessary for wound healing, the number of infection cases, and wound-related complications. Costs of the 2 medications were also considered. Ten days after surgery, patients answered a questionnaire with 6 multiple-choice questions to assess comfort, pain at dressing change, pruritus, strength, and number of dressing changes. Results: Compared with controls, surveys revealed Aquacel Surgical to be less traumatic to remove, easier to apply, and to be more adherent and stronger. Significant acceleration of the wound healing was also evident with Aquacel Surgical compared with the traditional dressing. Nonsignificant differences were reported about the risk of infection and wound-related complications between the 2 treatments. A statistical analysis of costs revealed that Aquacel Surgical is significantly more expensive than the traditional medication. Conclusion: We recommend the use of Aquacel Surgical in all the surgery procedures where the risk of wound dehiscence and maceration is high. PMID:27757328

  8. Triterpenes for Well-Balanced Scar Formation in Superficial Wounds.

    PubMed

    Kindler, Stefan; Schuster, Matthias; Seebauer, Christian; Rutkowski, Rico; Hauschild, Anna; Podmelle, Fred; Metelmann, Camilla; Metelmann, Bibiana; Müller-Debus, Charlotte; Metelmann, Hans-Robert; Metelmann, Isabella

    2016-01-01

    Triterpenes are demonstrably effective for accelerating re-epithelialisation of wounds and known to improve scar formation for superficial lesions. Among the variety of triterpenes, betuline is of particular medical interest. Topical betuline gel (TBG) received drug approval in 2016 from the European Commission as the first topical therapeutic agent with the proven clinical benefit of accelerating wound healing. Two self-conducted randomized intra-individual comparison clinical studies with a total of 220 patients involved in TBG treatment of skin graft surgical wounds have been screened for data concerning the aesthetic aspect of wound healing. Three months after surgery wound treatment with TBG resulted in about 30% of cases with more discreet scars, and standard of care in about 10%. Patients themselves appreciate the results of TBG after 3 months even more (about 50%) compared to standard of care (about 10%). One year after surgery, the superiority of TBG counts for about 25% in comparison with about 10%, and from the patients' point of view, for 25% compared to 4% under standard of care. In the majority of wound treatment cases, there is no difference visible between TBG treatment and standard of care after 1 year of scar formation. However, in comparison, TBG still offers a better chance for discreet scars and therefore happens to be superior in good care of wounds. PMID:27618886

  9. Immunonutrition: Role in Wound Healing and Tissue Regeneration.

    PubMed

    Chow, Oliver; Barbul, Adrian

    2014-01-01

    Significance: The role of immunonutrition in wound healing has been an area of both interest and controversy for many years. Although deficiencies in certain nutrients have long been known to impair healing, supplementation of specific immune modulating nutrients has not consistently yielded improvements in wound healing. Still, the prospect of optimizing nutrition to assist the immune system in wound repair bears great significance in both medical and surgical fields, as the costs of wound care and repair cannot be ignored. Recent Advances: Recent studies have rekindled efforts to elucidate the roles of specific immunonutrients, and we now have a better understanding of the conditionally essential role of various nutrients such as arginine, which becomes essential in certain clinical situations such as for the trauma patient or patients at high risk for malnutrition. Immunonutrition in its current formulation usually includes supplementation with arginine, glutamine, omega-3 fatty acids, vitamins, and trace minerals, and its use has often been associated with decreased infectious complications and sometimes with improvements in wound healing. Critical Issues: A key to understanding the role of immunonutrition in wound healing is recognizing the distinct contributions and importance of the various elements utilized. Future Directions: Critical areas for future study include identifying the specific populations, timing, and ideal composition of immunomodulating diets in order to optimize the wound healing process.

  10. Immunonutrition: Role in Wound Healing and Tissue Regeneration

    PubMed Central

    Chow, Oliver; Barbul, Adrian

    2014-01-01

    Significance: The role of immunonutrition in wound healing has been an area of both interest and controversy for many years. Although deficiencies in certain nutrients have long been known to impair healing, supplementation of specific immune modulating nutrients has not consistently yielded improvements in wound healing. Still, the prospect of optimizing nutrition to assist the immune system in wound repair bears great significance in both medical and surgical fields, as the costs of wound care and repair cannot be ignored. Recent Advances: Recent studies have rekindled efforts to elucidate the roles of specific immunonutrients, and we now have a better understanding of the conditionally essential role of various nutrients such as arginine, which becomes essential in certain clinical situations such as for the trauma patient or patients at high risk for malnutrition. Immunonutrition in its current formulation usually includes supplementation with arginine, glutamine, omega-3 fatty acids, vitamins, and trace minerals, and its use has often been associated with decreased infectious complications and sometimes with improvements in wound healing. Critical Issues: A key to understanding the role of immunonutrition in wound healing is recognizing the distinct contributions and importance of the various elements utilized. Future Directions: Critical areas for future study include identifying the specific populations, timing, and ideal composition of immunomodulating diets in order to optimize the wound healing process. PMID:24761344

  11. [The results of the treatment of gunshot wounds by applying laser therapy].

    PubMed

    Agakhanian, N V; Ter-Avetikian, Z A; Mkrtchian, M E

    2009-05-01

    The treatment results of not penetrating in cavities surface gunshot wounds of border regional hospitals are studied. The injured are divided into 3 groups depending on the terms of first surgical processing of wounds. It is mentioned that putting dense sutures is not always justified. Very often inflammatory infiltrate and suppuration is arisen after suturing. Inflammatory process develops into tumoral and cicatricial disorders which are removed by surgical intervention. The gunshot wound processing with helium-neon red ray made favorable conditions for early closing of wound surface by means of saturation with bringing the edges of the wound closer and preventing the development of severe suppuration complications as well as reduced the treatment terms promoting good functional and cosmetic results. PMID:19556630

  12. Phytochemicals in Wound Healing

    PubMed Central

    Thangapazham, Rajesh L.; Sharad, Shashwat; Maheshwari, Radha K.

    2016-01-01

    Significance: Traditional therapies, including the use of dietary components for wound healing and skin regeneration, are very common in Asian countries such as China and India. The increasing evidence of health-protective benefits of phytochemicals, components derived from plants is generating a lot of interest, warranting further scientific evaluation and mechanistic studies. Recent Advances: Phytochemicals are non-nutritive substances present in plants, and some of them have the potential to provide better tissue remodeling when applied on wounds and to also act as proangiogenic agents during wound healing. Critical Issues: In this review, we briefly discuss the current understanding, important molecular targets, and mechanism of action(s) of some of the phytochemicals such as curcumin, picroliv, and arnebin-1. We also broadly review the multiple pathways that these phytochemicals regulate to enhance wound repair and skin regeneration. Future Directions: Recent experimental data on the effects of phytochemicals on wound healing and skin regeneration establish the potential clinical utility of plant-based compounds. Additional research in order to better understand the exact mechanism and potential targets of phytochemicals in skin regeneration is needed. Human studies a2nd clinical trials are pivotal to fully understand the benefits of phytochemicals in wound healing and skin regeneration. PMID:27134766

  13. Nutrition and Chronic Wounds

    PubMed Central

    Molnar, Joseph Andrew; Underdown, Mary Jane; Clark, William Andrew

    2014-01-01

    Significance: Nutrition is one of the most basic of medical issues and is often ignored as a problem in the management of our chronic wound patients. Unfortunately, malnutrition is widespread in our geriatric patients even in nursing homes in developed countries. Attention to basic nutrition and providing appropriate supplements may assist in the healing of our chronic wounds. Recent Advances: Recent research has revealed the epidemiology of malnutrition in developed countries, the similarities to malnutrition in developing countries, and some of the physiologic and sociologic causes for this problem. More information is now available on the biochemical effects of nutrient deficiency and supplementation with macronutrients and micronutrients. In some cases, administration of isolated nutrients beyond recommended amounts for healthy individuals may have a pharmacologic effect to help wounds heal. Critical Issues: Much of the knowledge of the nutritional support of chronic wounds is based on information that has been obtained from trauma management. Due to the demographic differences of the patients and differences in the physiology of acute and chronic wounds, it is not logical to assume that all aspects of nutritional support are identical in these patient groups. Before providing specific nutritional supplements, appropriate assessments of patient general nutritional status and the reasons for malnutrition must be obtained or specific nutrient supplementation will not be utilized. Future Directions: Future research must concentrate on the biochemical and physiologic differences of the acute and chronic wounds and the interaction with specific supplements, such as antioxidants, vitamin A, and vitamin D. PMID:25371850

  14. Nutrition and Chronic Wounds.

    PubMed

    Molnar, Joseph Andrew; Underdown, Mary Jane; Clark, William Andrew

    2014-11-01

    Significance: Nutrition is one of the most basic of medical issues and is often ignored as a problem in the management of our chronic wound patients. Unfortunately, malnutrition is widespread in our geriatric patients even in nursing homes in developed countries. Attention to basic nutrition and providing appropriate supplements may assist in the healing of our chronic wounds. Recent Advances: Recent research has revealed the epidemiology of malnutrition in developed countries, the similarities to malnutrition in developing countries, and some of the physiologic and sociologic causes for this problem. More information is now available on the biochemical effects of nutrient deficiency and supplementation with macronutrients and micronutrients. In some cases, administration of isolated nutrients beyond recommended amounts for healthy individuals may have a pharmacologic effect to help wounds heal. Critical Issues: Much of the knowledge of the nutritional support of chronic wounds is based on information that has been obtained from trauma management. Due to the demographic differences of the patients and differences in the physiology of acute and chronic wounds, it is not logical to assume that all aspects of nutritional support are identical in these patient groups. Before providing specific nutritional supplements, appropriate assessments of patient general nutritional status and the reasons for malnutrition must be obtained or specific nutrient supplementation will not be utilized. Future Directions: Future research must concentrate on the biochemical and physiologic differences of the acute and chronic wounds and the interaction with specific supplements, such as antioxidants, vitamin A, and vitamin D.

  15. Combat Wound Initiative program.

    PubMed

    Stojadinovic, Alexander; Elster, Eric; Potter, Benjamin K; Davis, Thomas A; Tadaki, Doug K; Brown, Trevor S; Ahlers, Stephen; Attinger, Christopher E; Andersen, Romney C; Burris, David; Centeno, Jose; Champion, Hunter; Crumbley, David R; Denobile, John; Duga, Michael; Dunne, James R; Eberhardt, John; Ennis, William J; Forsberg, Jonathan A; Hawksworth, Jason; Helling, Thomas S; Lazarus, Gerald S; Milner, Stephen M; Mullick, Florabel G; Owner, Christopher R; Pasquina, Paul F; Patel, Chirag R; Peoples, George E; Nissan, Aviram; Ring, Michael; Sandberg, Glenn D; Schaden, Wolfgang; Schultz, Gregory S; Scofield, Tom; Shawen, Scott B; Sheppard, Forest R; Stannard, James P; Weina, Peter J; Zenilman, Jonathan M

    2010-07-01

    The Combat Wound Initiative (CWI) program is a collaborative, multidisciplinary, and interservice public-private partnership that provides personalized, state-of-the-art, and complex wound care via targeted clinical and translational research. The CWI uses a bench-to-bedside approach to translational research, including the rapid development of a human extracorporeal shock wave therapy (ESWT) study in complex wounds after establishing the potential efficacy, biologic mechanisms, and safety of this treatment modality in a murine model. Additional clinical trials include the prospective use of clinical data, serum and wound biomarkers, and wound gene expression profiles to predict wound healing/failure and additional clinical patient outcomes following combat-related trauma. These clinical research data are analyzed using machine-based learning algorithms to develop predictive treatment models to guide clinical decision-making. Future CWI directions include additional clinical trials and study centers and the refinement and deployment of our genetically driven, personalized medicine initiative to provide patient-specific care across multiple medical disciplines, with an emphasis on combat casualty care. PMID:23634474

  16. Surgical antiseptics.

    PubMed

    Sebben, J E

    1983-11-01

    The skin cannot be sterilized because approximately 20% of the resident flora are beyond the reach of surgical scrubs and antiseptics. The goal of surgical preparation of the skin with antiseptics is to remove transient and pathogenic microorganisms on the skin surface and to reduce the resident flora to a low level. Four antiseptics which have been popular over the past two decades are discussed. Benzalkonium chloride is somewhat unstable on the skin and is too prone to contamination to be in general use. Hexachlorophene is not recommended due to narrow spectrum and risks secondary to percutaneous absorption. The iodophors are excellent antiseptics, but recent studies raise questions about effectiveness and contamination. Chlorhexidine is a very safe and effective antiseptic. Comparison studies with chlorhexidine, hexachlorophene, and iodophors show chlorhexidine to be the most effective agent. Chlorhexidine can be toxic to the middle ear and irritating to the eyes with direct contact. Caution should be used in these areas with chlorhexidine and other antiseptics.

  17. Surgical heuristics.

    PubMed

    Patkin, Michael

    2008-12-01

    Heuristics are rules of thumb. Rarely described in surgical or other publications, they are an essential part of safe and expert performance. This study translates such implicit or procedural knowledge into explicit or declarative knowledge, with a view to improving both training and retraining of surgeons in the steps of dissection. Tools used include ordinary observation accompanied by introspection, and study of operative videos. Validation of the value of such heuristics is yet to be achieved.

  18. Prontosan wound irrigation and gel: management of chronic wounds.

    PubMed

    Horrocks, Ann

    Chronic wounds present a challenge that is costly in terms of quality of life to the patient and in financial terms for the NHS. Several factors contribute to the development of a chronic wound, in particular the influence of bacteria as a biofilm within the wound environment. Irrigating a wound with normal saline has long been advocated as the most appropriate method of wound irrigation but biofilms are now known to be resistant to this method of cleansing. A small (10 patient) evaluation of the use of Prontosan in patients whose duration of chronic wounds exceeded 1 year has demonstrated that Prontosan wound irrigation and Prontosan gel are an appropriate alternative for cleaning, moistening and decontaminating encrusted, contaminated and chronic skin wounds, and can have a dramatic influence of the quality of life for such patients. This article discusses the cause of chronicity within a wound and discusses in depth three of the ten patients in the evaluation.

  19. Immunohistochemical Evaluation of Leptin Expression in Wound Healing: A Clue to Exuberant Scar Formation.

    PubMed

    Seleit, Iman; Bakry, Ola A; Samaka, Rehab M; Tawfik, Amira S

    2016-04-01

    Leptin has been recognized as an important factor for promoting normal cutaneous wound healing. The aim of this work was to explore leptin expression in keloid and hypertrophic scars (HS) compared with surgical scars and normal skin. The relationship of this expression with clinicopathologic parameters of studied cases was also evaluated. Using immunohistochemical techniques, leptin was analyzed in skin biopsies of 60 nonobese subjects without metabolic syndrome who presented with keloids (20), HS (20), and surgical scars (20). Twenty normal skin samples, from age-matched, sex-matched, and body mass index-matched subjects, were enrolled as a control group. Leptin showed positive immunoreactivity in epidermis in all cases of surgical scars and keloids and in 75% of HS cases. Dermal expression in fibroblasts, inflammatory cells, and endothelial cells was positive in all cases of surgical scars and keloids and in 70% of HS cases. Leptin was overexpressed in keloids and HS compared with normal skin in epidermis (P<0.001 for both) and dermis (P<0.001 for both) and to surgical scars both in epidermis (P=0.0006, P=0.01, respectively) and dermis (P=0.0001, P=0.001, respectively). Higher leptin H score was significantly associated with older age (P=0.02) and positive family history (P=0.002) in keloid cases and with axial site in keloid and HS cases (P=0.001, P=0.02, respectively). Significant positive correlation was noted between epidermal and dermal leptin H scores in keloids (r=+0.37, P=0.04) and HS (r=+0.39, P=0.02). This may be due to epithelial-mesenchymal interactions in scar pathogenesis. In conclusion, in situ leptin overexpression may increase the possibility of keloid and HS occurrence through altered cytokine production and prolonged healing phases with excessive deposition and delayed collagen degradation. This may open an avenue for research for new therapeutic modalities based on its inhibition.

  20. The TopClosure® 3S System, for skin stretching and a secure wound closure.

    PubMed

    Topaz, Moris; Carmel, Narin-Nard; Silberman, Adi; Li, Ming Sen; Li, Yong Zhong

    2012-07-01

    The principle of stretching wound margins for primary wound closure is commonly practiced and used for various skin defects, leading at times to excessive tension and complications during wound closure. Different surgical techniques, skin stretching devices and tissue expanders have been utilized to address this issue. Previously designed skin stretching devices resulted in considerable morbidity. They were invasive by nature and associated with relatively high localized tissue pressure, frequently leading to necrosis, damage and tearing of skin at the wound margins. To assess the clinical effectiveness and performance and, to determine the safety of TopClosure® for gradual, controlled, temporary, noninvasive and invasive applications for skin stretching and secure wound closing, the TopClosure® device was applied to 20 patients for preoperative skin lesion removal and to secure closure of a variety of wound sizes. TopClosure® was reinforced with adhesives, staples and/or surgical sutures, depending on the circumstances of the wound and the surgeon's judgment. TopClosure® was used prior to, during and/or after surgery to reduce tension across wound edges. No significant complications or adverse events were associated with its use. TopClosure® was effectively used for preoperative skin expansion in preparation for dermal resection (e.g., congenital nevi). It aided closure of large wounds involving significant loss of skin and soft tissue by mobilizing skin and subcutaneous tissue, thus avoiding the need for skin grafts or flaps. Following surgery, it was used to secure closure of wounds under tension, thus improving wound aesthetics. A sample case study will be presented. We designed TopClosure®, an innovative device, to modify the currently practiced concept of wound closure by applying minimal stress to the skin, away from damaged wound edges, with flexible force vectors and versatile methods of attachment to the skin, in a noninvasive or invasive manner.

  1. Non-surgical deep intrauterine transfer of superfine open pulled straw (SOPS)-vitrified porcine embryos: evaluation of critical steps of the procedure.

    PubMed

    Gomis, J; Cuello, C; Sanchez-Osorio, J; Gil, M A; Parrilla, I; Angel, M A; Maside, C; del Olmo, D; Vazquez, J M; Roca, J; Martinez, E A

    2012-10-01

    Previous trials achieved extremely poor results when using the one-step warming method in a syringe in combination with non-surgical deep intrauterine transfer (NET) of superfine open pulled straw (SOPS)-vitrified embryos. This study aimed to assess the effect of the warming procedure on the in vitro and in vivo development of SOPS-vitrified embryos. The effect of the passage of the vitrified-warmed (VW) embryos through the NET catheter was also evaluated. Groups of 4 to 6 morulae and blastocysts, collected from weaned sows, were SOPS-vitrified in 1 μL of vitrification medium, warmed by the one-step warming method in a dish or in a 1-mL syringe and cultured in vitro for 48 h to evaluate the embryo survival (ES) and hatching rates (HR). Warming in syringe had a deleterious effect (P < 0.05) on the in vitro ES (60.5 ± 10.4%) and HR (39.6 ± 9.5%) of VW embryos in comparison with embryos warmed in a dish (85.4 ± 10.6% and 69.0 ± 8.4%, respectively). This decreased embryonic development was due to the increased time required between the removal of the straws from the liquid nitrogen and the contact of the embryos with the warming medium when the warming was performed in a syringe in comparison with that for the warming in a dish. After verifying that the passage of VW embryos through the NET catheter does not have a damaging effect on their further in vitro development, the negative effect of warming in a syringe was also confirmed after NET. Fifteen fresh and SOPS-vitrified embryos warmed in a syringe or in a dish were transferred to each recipient (n = 28) and recovered 24 h later to assess their developmental progression. All embryos from the syringe group were found to have degenerated at recovery. The in vivo ES and HR from the dish group (80.4 ± 3.4% and 14.2 ± 7.2%, respectively) were lower (P < 0.05) than those from the fresh group (94.0 ± 4.1% and 36.8 ± 7.8%, respectively). Combining the warming in a dish and the NET procedure, 35 VW embryos were

  2. Initial experience using a hyaluronate-iodine complex for wound healing.

    PubMed

    Brenes, Robert A; Ajemian, Michael S; Macaron, Shady H; Panait, Lucian; Dudrick, Stanley J

    2011-03-01

    Hyaluronate-iodine complex is a wound healing adjuvant approved for use in the European Union. The objective of this study is to validate hyaluronate-iodine as a potential wound healing agent. Patients were recruited from the hospital, the outpatient clinic, and the wound healing center. Hyaluronate-iodine soaked gauze was applied to wounds either daily or every other day depending on the amount of wound exudate. Wounds were measured weekly, and progression was documented with digital photography. All wounds were debrided as needed using standard surgical techniques. Fourteen patients (19 wounds) were entered into this prospective study, and 10 patients completed treatment. Fourteen wounds progressed to complete healing with a mean healing time of 18.1 ± 15.1 weeks. Treatment was interrupted in four patients. One patient discontinued treatment due to pain related to application of hyaluronate-iodine, another patient for transportation issues, and the other two patients were lost to follow-up due to relocation out of state and noncompliance with scheduled appointments. Hyaluronate-iodine was helpful in the healing of all types of wounds treated in this pilot study. The antiadhesive and antimicrobial properties of hyaluronate-iodine create a desirable environment conducive to wound healing without apparent detrimental effects.

  3. Improvement of wound tissue repair by chitosan films containing (-)-borneol, a bicyclic monoterpene alcohol, in rats.

    PubMed

    Barreto, Rosana Ss; Quintans, Jullyana Ss; Barreto, André S; Albuquerque-Júnior, Ricardo Lc; Galvão, Juliana G; Gonsalves, Joice Kmc; Nunes, Rogéria S; Camargo, Enilton A; Lucca-Júnior, Waldecy; Soares, Rosilene C; Feitosa, Vera Lúcia C; Quintans-Júnior, Lucindo J

    2016-10-01

    The aim of this study was to investigate the wound-healing activity of (-)-borneol (BOR) incorporated in chitosan film on healing protocol in rodents. To assess the BOR wound-healing potential, male Wistar rats were subjected to a full-thickness excisional wound. The animals were divided into three groups: dressed with chitosan-based film (QUIN); dressed with chitosan-based film containing 0·5% BOR (QUIBO05); or dressed with chitosan-based film containing 1% BOR (QUIBO1). Dressing the wound areas and histological analysis were performed on the 3rd, 7th, 14th, and 21st days. The myeloperoxidase (MPO) activity was assessed on the third and seventh days after surgical procedures. Wounds dressed with chitosan-based film containing BOR reduced significantly the MPO activity (P < 0·001), showed significantly larger wound retraction rates (7 days, P < 0·05), improved the granulation reaction, and also provided better collagenisation density and arrangement during wound healing. It is suggested that BOR modulates the wound-healing process and is a promising compound to be used in wound care. This product may be quite useful in improving wound healing and could be a new biotechnological product with healing properties and clinical application. Further ongoing studies will enable us to understand the precise mechanisms whereby BOR improves the wound-healing process.

  4. Postthrombotic Syndrome: Surgical Possibilities

    PubMed Central

    Khanna, Ajay K.; Singh, Shivanshu

    2012-01-01

    Postthrombotic syndrome (PTS) is a late outcome of deep vein thrombosis characterized by cramping pain, swelling, hyperpigmentation, eczema, lipodermatosclerosis, and ulceration in the leg due to increased venous outflow resistance and reflux venous flow. Newer surgical and endovascular interventions have a promising result in the management of postthrombotic syndrome. Early surgical or endovascular interventions in appropriately selected patients may decrease the incidence of recurrent ulceration and skin changes and provide a better quality of life. Duplex and IVUS (intravenous ultrasound) along with venography serve as cornerstone investigative tools for assessment of reflux and obstruction. Venous obstruction, if present, should be addressed earlier than reflux. It requires endovenous stenting, endophlebectomy, or open bypass procedures. Venous stripping, foam sclerotherapy, radiofrequency, or laser ablation are used to abolish superficial venous reflux. Valvuloplasty procedures are useful for incompetent but intact deep venous valves, while transposition or axillary vein autotransplantation is done for completely destroyed valves. PMID:22084674

  5. Accelerated reepithelialization by triterpenes: proof of concept in the healing of surgical skin lesions.

    PubMed

    Metelmann, Hans-Robert; Brandner, Johanna M; Schumann, Hauke; Bross, Felix; Fimmers, Rolf; Böttger, Kerstin; Scheffler, Armin; Podmelle, Fred

    2015-01-01

    The acceleration of wound healing is a major surgical concern. A triterpene extract from birch bark (Betulae cortex) experimentally enhances keratinocyte differentiation in vitro and accelerates wound healing ex vivo. We conducted an open, blind-evaluated, controlled, prospective, randomized (1:1) phase II clinical trial in patients requiring split-thickness skin graft transplantation at two university hospitals in Germany. Donor sites on the upper legs were covered with a moist silicone-coated dressing. Oleogel-S10 ointment containing 10% birch bark extract was randomly applied to the distal or proximal half of the wound, with the other half serving as an intraindividual control, for 14 days after the skin graft surgery. The primary efficacy variable was faster reepithelialization as determined from macrophotographs by independent, blinded experts. Twenty-four patients were randomized and completed the trial. After the 14-day test period, the planned interim analysis revealed a highly significant (p < 0.0001) superiority of Oleogel-S10 in the primary efficacy variable and the trial was terminated early due to ethical concerns. The treatment side was also better reepithelialized and more similar to normal skin after 3 months. In conclusion, Oleogel-S10 significantly accelerated reepithelialization at split-thickness skin graft donor sites. Treatment with Oleogel-S10 was safe and well tolerated.

  6. Principles of Wound Management and Wound Healing in Exotic Pets.

    PubMed

    Mickelson, Megan A; Mans, Christoph; Colopy, Sara A

    2016-01-01

    The care of wounds in exotic animal species can be a challenging endeavor. Special considerations must be made in regard to the animal's temperament and behavior, unique anatomy and small size, and tendency toward secondary stress-related health problems. It is important to assess the entire patient with adequate systemic evaluation and consideration of proper nutrition and husbandry, which could ultimately affect wound healing. This article summarizes the general phases of wound healing, factors that affect healing, and principles of wound management. Emphasis is placed on novel methods of treating wounds and species differences in wound management and healing.

  7. Principles of Wound Management and Wound Healing in Exotic Pets.

    PubMed

    Mickelson, Megan A; Mans, Christoph; Colopy, Sara A

    2016-01-01

    The care of wounds in exotic animal species can be a challenging endeavor. Special considerations must be made in regard to the animal's temperament and behavior, unique anatomy and small size, and tendency toward secondary stress-related health problems. It is important to assess the entire patient with adequate systemic evaluation and consideration of proper nutrition and husbandry, which could ultimately affect wound healing. This article summarizes the general phases of wound healing, factors that affect healing, and principles of wound management. Emphasis is placed on novel methods of treating wounds and species differences in wound management and healing. PMID:26611923

  8. L-PRP/L-PRF in esthetic plastic surgery, regenerative medicine of the skin and chronic wounds.

    PubMed

    Cieslik-Bielecka, Agata; Choukroun, Joseph; Odin, Guillaume; Dohan Ehrenfest, David M

    2012-06-01

    The use of platelet concentrates for topical use is of particular interest for the promotion of skin wound healing. Fibrin-based surgical adjuvants are indeed widely used in plastic surgery since many years in order to improve scar healing and wound closure. However, the addition of platelets and their associated growth factors opened a new range of possibilities, particularly for the treatment of chronic skin ulcers and other applications of regenerative medicine on the covering tissues. In the 4 families of platelet concentrates available, 2 families were particularly used and tested in this clinical field: L-PRP (Leukocyte- and Platelet-rich Plasma) and L-PRF (Leukocyte- and Platelet-Rich Fibrin). These 2 families have in common the presence of significant concentrations of leukocytes, and these cells are important in the local cleaning and immune regulation of the wound healing process. The main difference between them is the fibrin architecture, and this parameter considerably influences the healing potential and the therapeutical protocol associated to each platelet concentrate technology. In this article, we describe the historical evolutions of these techniques from the fibrin glues to the current L-PRP and L-PRF, and discuss the important functions of the platelet growth factors, the leukocyte content and the fibrin architecture in order to optimize the numerous potential applications of these products in regenerative medicine of the skin. Many outstanding perspectives are appearing in this field and require further research.

  9. Performance Assessment of Suture Type, Water Temperature, and Surgeon Skill in Juvenile Chinook Salmon Surgically Implanted with Acoustic Transmitters

    SciTech Connect

    Deters, Katherine A.; Brown, Richard S.; Carter, Kathleen M.; Boyd, James W.; Eppard, M. B.; Seaburg, Adam

    2010-05-01

    This study assessed performance of seven suture types in subyearling Chinook salmon Oncorhynchus tshawytscha implanted with acoustic microtransmitters. Nonabsorbable (Ethilon) and absorbable (Monocryl) monofilament and nonabsorbable (Nurolon, silk) and absorbable (Vicryl, Vicryl Plus, Vicryl Rapide) braided sutures were used to close incisions in Chinook salmon. Monocryl exhibited greater suture retention than all other suture types 7 d after surgery. Both monofilament suture types were retained better than all braided suture types at 14 d. Incision openness and tag retention did not differ among suture types. Wound inflammation was similar for Ethilon, Monocryl, and Nurolon at 7 d. Wound ulceration was lower for Ethilon, Monocryl, and Nurolon than for all other suture types at 14 d post-surgery. Fish held in 12°C water had more desirable post-surgery healing characteristics (i.e., higher suture and tag retention and lower incision openness, wound inflammation, and ulceration) at 7 and 14 d after surgery than those held in 17°C water. The effect of surgeon was a significant predictor for all response variables at 7 d. This result emphasizes the importance of including surgeon as a variable in telemetry study analyses when multiple surgeons are used. Monocryl performed better with regard to post-surgery healing characteristics in the study fish. The overall results support the conclusion that Monocryl is the best suture material to close incisions created during surgical implantation of acoustic microtransmitters in subyearling Chinook salmon.

  10. Openings

    PubMed Central

    Selwyn, Peter A.

    2015-01-01

    Reviewing his clinic patient schedule for the day, a physician reflects on the history of a young woman he has been caring for over the past 9 years. What starts out as a routine visit then turns into a unique opening for communication and connection. A chance glimpse out the window of the exam room leads to a deeper meditation on parenthood, survival, and healing, not only for the patient but also for the physician. How many missed opportunities have we all had, without even realizing it, to allow this kind of fleeting but profound opening? PMID:26195687

  11. A review of microgravity surgical investigations

    NASA Technical Reports Server (NTRS)

    Campbell, Mark R.; Billica, Roger D.

    1992-01-01

    The likelihood of performing a surgical procedure in space will increase as the Soviet Mir space station is expanded and the Space Station Freedom becomes operational. A review of previous research and hardware development, performed mostly in parabolic flight both in the Soviet Union and the U.S., reveals an interest in surgical chambers to prevent cabin atmosphere contamination. Surgical techniques appear to be no more difficult than in a 1-G environment if a restraint system is used. Minimizing the changes of wound infection from the high particle count spacecraft atmosphere is an additional concern. Additional research is necessary to delineate the clinical significance of these problems and to further develop surgical techniques in microgravity.

  12. Pathogenicity of the enterococcus in surgical infections.

    PubMed Central

    Barie, P S; Christou, N V; Dellinger, E P; Rout, W R; Stone, H H; Waymack, J P

    1990-01-01

    The enterococcus has been relegated to a position of unimportance in the pathogenesis of surgical infections. However the increasing prevalence and virulence of these bacteria prompt reconsideration of this view, particularly because the surgical patient has become increasingly vulnerable to infectious morbidity due to debility, immunosuppression, and therapy with increasingly potent antibiotics. The enterococcus is a versatile opportunistic nosocomial pathogen, causing such diverse infections as wound, intra-abdominal, and urinary tract infections; catheter-associated infection; suppurative thrombophlebitis; endocarditis; and pneumonia. Although surgical drainage remains the cornerstone of therapy for enterococcal infections involving a discrete focus, in the circumstances typified by the compromised surgical patient, specific antibacterial therapy directed against the enterococcus is warranted. Recent evidence indicates that parenteral antibiotic therapy for enterococcal bacteremia is mandatory and that appropriate therapy clearly reduces the number of deaths. PMID:2198000

  13. Surgical Reconstruction of Radiation Injuries

    PubMed Central

    Fujioka, Masaki

    2014-01-01

    Significance: Patients with cancer receive benefits from radiation therapy; however, it may have adverse effects on normal tissue such as causing radiation-induced ulcer and osteoradionecrosis. The most reliable method to treat a radiation ulcer is wide excision of the affected tissue, followed by coverage with well-vascularized tissue. As usual, radiation-induced skin ulcers are due to therapeutic irradiation for residual cancer or lymph nodes; the locations of radiation ulcers are relatively limited, including the head, neck, chest wall, lumbar, groin, and sacral areas. Thus, suitable reconstructive methods vary according to functional and aesthetic conditions. I reviewed the practices and surgical results for radiation ulcers over the past 30 years, and present the recommended surgical methods for these hard-to-heal ulcers. Recent Advances: At a minimum, flaps are required to treat radiation ulcers. Surgeons can recommend earlier debridement, followed by immediate coverage with axial-pattern musculocutaneous and fasciocutaneous flaps. Free flaps are also a useful soft tissue coverage option. The choice of flap varies with the location and size of the wounds. Critical Issues: The most crucial procedure is the complete resection of the radiation-affected area, followed by coverage with well-vascularized tissue. Future Directions: Recent developments in perforator flap techniques, which are defined as flaps with a blood supply from isolated perforating vessels of a stem artery, have allowed the surgeons to successfully resurface these difficult wounds with reduced morbidity. PMID:24761342

  14. Systematic Assessment and Targeted Improvement of Services Following Yearlong Surgical Outcomes Surveys

    ClinicalTrials.gov

    2015-12-23

    Heart Attack; Cardiac Arrest; Congestive Heart Failure; Atrial Fibrillation; Angina; Deep Vein Thrombosis; Pulmonary Embolism; Respiratory Arrest; Respiratory Failure; Pneumonia; Gastrointestinal Bleed; Stomach Ulcer; Delirium; Stroke; Nerve Injury; Surgical Wound Infection

  15. [Application of therapy in negative pressure complex wounds in pediatrics].

    PubMed

    Fernández Sánchez, Rosario; Muñoz-Miguelsanz, María Ángeles

    2016-01-01

    Negative pressure wound therapy (NPWT) has been widely used in the adult patient, contrary to what happens in children, with just a few long series papers. NPWT avoids long and expensive hospital admissions, reducing the hospital costs; it also decreases the family dynamics and allows for an early return to everyday activities. In this article, we present three clinical cases consisting of a toddler, a child and a teenager with complex wounds treated with NPWT in the pediatric surgery department of the Virgen de las Nieves University Hospital in Granada. The results were excellent, with a good adherence to treatment in all cases, achieving a complete closure in two cases; the third case needed a deferred surgical closure after surgical site preparation, and showed a decrease of the wound size after the NPWT. Moreover, successful pain management was achieved during the wound cleansing, which was done under an ambulatory regime. No general anesthesia was needed. From our experience, we propose the NPWT as an alternative therapy to the classic surgical approach for this type of complex lesions in children, which offers the same advantages and results than in adults.

  16. Fibrin sealant combined with fibroblasts and platelet-derived growth factor enhance wound healing in excisional wounds.

    PubMed

    Mogford, Jon E; Tawil, Bill; Jia, Shengxian; Mustoe, Thomas A

    2009-01-01

    We test the hypothesis that the fibrinogen-thrombin formulation of fibrin sealant combined with fibroblasts and PDGF-BB enhance cutaneous wound healing. Four formulations varying in fibrinogen and thrombin concentration were applied to full-thickness biopsy wounds in the rabbit ear cutaneous wound healing model with or without cultured rabbit dermal fibroblasts (RDFs; 3 x 10(5) cells/wound) embedded in the fibrinogen component. At post-wounding day 7, there was no difference in the diluted vs. non-diluted formulations for either the promotion of granulation tissue coverage of the open wounds or total granulation tissue area when tested without embedded cells. Including the RDFs, the highest degree of wound coverage by granulation tissue was observed in the combined dilution formulation (17.3 mg/mL fibrinogen, 167 U/mL thrombin; n=10 wounds) that was 167% (p<0.05) of the nondiluted FS containing cells (50 mg/mL fibrinogen, 250 U/mL thrombin; n=10 wounds). Inclusion of fibroblasts increased granulation tissue area within the wounds vs. FS alone (p<0.05) for each diluted formulation although no differences in this parameter were observed within each group (FS alone or with embedded cells). However, addition of the vulnerary growth factor PDGF-BB (3 mg; n=4) with the embedded RDFs in the combined dilution formulation increased granulation tissue area over two-fold (p<0.01) over FS alone. Additionally, the presence of the RDFs promoted incorporation of the granulation tissue with and epithelial migration over the FS suggesting an active interaction between cells delivered to the wound by FS and the host repair cells. The findings suggest the progress of cutaneous defect repair can be enhanced by ex vivo cell delivery in fibrin sealant.

  17. [Liver gunshot wounds].

    PubMed

    Botoi, G; Blăjan, I; Nemeş, S

    2000-01-01

    The paper presents the 6 cases of liver shot wounds that were in supervision of the general surgery unit, County Hospital of Baia Mare, between the years 1990-1997. The patients were males, most of them being 20 to 30 years old. In 3 situations hunting rifles were involved, all followed by retention of metal foreign body. The wounds were plurivisceral in 5 of the 6 cases, the most frequently wounded was the right liver lobe. All the patients presented serious traumatic shock and haemorrhagic shock. Livertectomy was used in 40% of the cases being imposed by the dilacerant and transfixiant character of the wounds and also by the retention of foreign bodies in parenchime. We registered 2 demises, both in the first postoperatory hours. The paper proposes a few criteria that allow the application of a conservatory treatment:rapid favourable answer at deshocking therapy; hemodynamic stability; minimal hemoperitoneus (echographical and tomographical); absence of associated visceral wounds or, when they exist, of serious physiopathological consequences; access to performant means of imagistics.

  18. Effect of laser-pulse structure and wavelength on wound healing

    NASA Astrophysics Data System (ADS)

    Fortune, D. S.; Huang, Shan; Bryant, G. L.; Garrett, C. Gaelyn; Reinisch, Lou

    1998-07-01

    We have investigated wound healing of incisions in the buccal mucosa of a canine model created with the Vanderbilt Free Electron Laser tuned to 6.1, 6.45 and 6.8 microns. We have also used a carbon dioxide laser, continuous wave and with a short-pulse structure (100 microseconds) to access wavelength and pulse structure components to wound healing from laser incisions. The tissue was evaluated histologically and with tensiometry acutely and at post operative days 3, 7, and 14. The data indicate that shorter laser pulse durations create less lateral thermal injury and wounds with greater tensile strength, resulting in earlier wound healing. Wound healing was only slightly dependent upon the wavelength of the laser. These results demonstrate that surgical carbon dioxide lasers with a short-pulse structure of approximately 100 microseconds or less could offer more prompt wound healing while maintaining the advantages of a 10.6 micron wavelength laser.

  19. Choice of wound care in diabetic foot ulcer: A practical approach

    PubMed Central

    Kavitha, Karakkattu Vijayan; Tiwari, Shalbha; Purandare, Vedavati Bharat; Khedkar, Sudam; Bhosale, Shilpa Sameer; Unnikrishnan, Ambika Gopalakrishnan

    2014-01-01

    Diabetic foot ulcers are the consequence of multiple factors including peripheral neuropathy, decreased blood supply, high plantar pressures, etc., and pose a significant risk for morbidity, limb loss and mortality. The critical aspects of the wound healing mechanism and host physiological status in patients with diabetes necessitate the selection of an appropriate treatment strategy based on the complexity and type of wound. In addition to systemic antibiotics and surgical intervention, wound care is considered to be an important component of diabetic foot ulcer management. This article will focus on the use of different wound care materials in diabetic foot. From a clinical perspective, it is important to decide on the wound care material depending on the type and grade of the ulcer. This article will also provide clinicians with a simple approach to the choice of wound care materials in diabetic foot ulcer. PMID:25126400

  20. [Specific features of wounds with a self-defense traumatic weapon "Osa"].

    PubMed

    Khodov, A M; Zolotov, A S; Filipchenkov, L S

    2012-01-01

    Specific features and outcomes of wounds with a traumatic weapon of self-defense "Osa" were analyzed in 24 patients. Mean age of the wounded was from 21 to76 years. In 20 patients there was a single wound, in 4 patients it was multiple, in 7--blunt, in 12--perforating and 5 patients had gutter wounds. All the patients were treated according to the principles of field military surgery. Five patients had severe wounds: penetrating fracture of the skull (2 of them died), fracture of the shoulder (1 case), injury of the main artery (1 case), of the pleura (1 case). The wounds were closed up by primary intention in 19 patients, by second intention in 4 patients. The authors' experience shows that a traumatic weapon of self-defense "Osa" rather often caused permanent harm to health and can be mortal. Active surgical strategy in treatment of such patients prevents the development of serious infectious complications.

  1. Wound cleaning and wound healing: a concise review.

    PubMed

    Wilkins, Robert G; Unverdorben, Martin

    2013-04-01

    Chronic wounds present a significant societal burden in their cost of care, and they reduce patient quality of life. Key components of wound care include such measures as debridement, irrigation, and wound cleaning. Appropriate care removes necrotic tissue and reduces wound bioburden to enhance wound healing. Physical cleaning with debridement and irrigation is of documented efficacy. Wounds may be washed with water, saline, or Ringer's solution or cleaned with active ingredients, such as hydrogen peroxide, sodium hypochlorite, acetic acid, alcohol, ionized silver preparations, chlorhexidine, polyhexanide/betaine solution, or povidone-iodine--the majority of which are locally toxic and of limited or no proven efficacy in enhancing wound healing. Although the consensus opinion is that these topical cleaning agents should not be routinely used, recent clinical evidence suggests that polyhexanide/betaine may be nontoxic and effective in enhancing wound healing. Further well-designed studies are needed. PMID:23507692

  2. Wound cleaning and wound healing: a concise review.

    PubMed

    Wilkins, Robert G; Unverdorben, Martin

    2013-04-01

    Chronic wounds present a significant societal burden in their cost of care, and they reduce patient quality of life. Key components of wound care include such measures as debridement, irrigation, and wound cleaning. Appropriate care removes necrotic tissue and reduces wound bioburden to enhance wound healing. Physical cleaning with debridement and irrigation is of documented efficacy. Wounds may be washed with water, saline, or Ringer's solution or cleaned with active ingredients, such as hydrogen peroxide, sodium hypochlorite, acetic acid, alcohol, ionized silver preparations, chlorhexidine, polyhexanide/betaine solution, or povidone-iodine--the majority of which are locally toxic and of limited or no proven efficacy in enhancing wound healing. Although the consensus opinion is that these topical cleaning agents should not be routinely used, recent clinical evidence suggests that polyhexanide/betaine may be nontoxic and effective in enhancing wound healing. Further well-designed studies are needed.

  3. [Comparative evolution surgical accesses to temporo-mandibular joint].

    PubMed

    Sysoliatin, P G; Novikov, A I; Sysoliatin, S P; Bobylev, N G; Brega, I N

    2007-01-01

    In experiment on 30 corpses of adult people criteria of an operational wound (depth of a wound, a corner of operational action, an axis of operational action, a corner of an inclination of operational action) were studied at preauricularis, intrauricularis, intrauriculo-temporalis and posterior mandibullaris access to temporo-mandibular joint (TMJ). New surgical intrauriculo-temporalis access to the joint is substantrated. On the basis of the analysis of 289 operations at 268 patients the indications to a choice of surgical access were developed at various diseases and damages of TMJ.

  4. A Dendritic Thioester Hydrogel Based on Thiol-Thioester Exchange as a Dissolvable Sealant System for Wound Closure

    PubMed Central

    Ghobril, Cynthia; Charoen, Kristie; Rodriguez, Edward K.; Nazarian, Ara; Grinstaff, Mark W.

    2014-01-01

    A dissolvable dendritic thioester hydrogel based on thiol-thioester exchange for wound closure is reported. The hydrogel sealant adheres strongly to tissues, closes an ex vivo vein puncture, and withstands high pressures placed on a wound. The hydrogel sealant can be completely washed off upon exposure to thiolates based on thiol-thioester exchange and allow gradual wound re-exposure during definitive surgical care. PMID:24282150

  5. Limb salvage of severely injured extremities after military wounds.

    PubMed

    Brown, K V; Henman, P; Stapley, S; Clasper, J C

    2011-09-01

    Severely wounded extremities following battlefield injuries present a surgical dilemma to military surgeons of whether to attempt salvage or amputate the limb. There are many considerations to be made, including local and systemic patient factors, other wounded personnel and logistical constraints. Attempts have been made previously to form objective scoring criteria so as to remove possible subjectivity in this decision-making process. Furthermore, paediatric patients present their own particular dilemmas. This paper examines these various matters and, with contemporaneous evidence, presents recommendations for management.

  6. Evaluation of a flexible new liquid polymer wound dressing.

    PubMed

    Hsiung, Sherry H; Robins, Perry

    2005-01-01

    Occlusive dressings are the foundation of wound care and have been shown to speed epithelialization and healing of surgical sites. Many different dressings have been introduced over the years including antibacterial ointments with gauze and adhesive, hydrocolloid bandages, and liquid adhesives. All of these have their limitations and advantages. We introduce our experience with a new organic polymer in solvent which when applied to a wound forms a flexible occlusive bandage. The material has been shown to have antimicrobial properties and be well-tolerated by patients.

  7. [THE TREATMENT OF INJURED PERSONS WITH COMPLICATED PENETRATING THORACIC WOUNDINGS ON TERTIARY LEVEL OF THE MEDICAL CARE DELIVERY].

    PubMed

    Khmehl, V V; Mayetniy, E M; Levshov, Yu A

    2016-01-01

    The results of examination and treatment of 36 injured persons with complicated penetrating thoracic woundings in tertiary centres were analyzed. Own experience of the pulmonary woundings surgical treatment, using application of videothoracoscopic and welding-coagulating equipment, was summarized. PMID:27249928

  8. Wound healing and treating wounds: Differential diagnosis and evaluation of chronic wounds.

    PubMed

    Morton, Laurel M; Phillips, Tania J

    2016-04-01

    Wounds are an excellent example of how the field of dermatology represents a cross-section of many medical disciplines. For instance, wounds may be caused by trauma, vascular insufficiency, and underlying medical conditions, such as diabetes, hypertension, and rheumatologic and inflammatory disease. This continuing medical education article provides an overview of wound healing and the pathophysiology of chronic wounds and reviews the broad differential diagnosis of chronic wounds. It also describes the initial steps necessary in evaluating a chronic wound and determining its underlying etiology.

  9. Investigation on the wound healing activity of oleo-resin from Copaifera langsdorffi in rats.

    PubMed

    Paiva, L A F; de Alencar Cunha, K M; Santos, F A; Gramosa, N V; Silveira, E R; Rao, V S N

    2002-12-01

    The wound healing activity of oleo-resin from Copaifera langsdorffii Desf. (Leguminaceae) bark was evaluated in rats on experimental wounds. The oleo-resin was tested by monitoring wound contraction in excised wounds and by measuring tensile strength in healing incision wounds. The topical application of oleo-resin at a concentration of 4% accelerated wound contraction in open wounds. The mean values of wound contraction in oleo-resin treated rats on day 9 was 84.05% +/- 2.37% as against 51.29% +/- 9.54% seen in controls and the difference was statistically significant (p < 0.05). No significant differences in the rates of wound contraction were observed on days 12, 15, 18 and 21. Also, the tensile strength in healing incised wounds was found to be significantly higher in the group of animals treated with 4% oleo-resin on day 5 but not on days 7 and 12 (controls: 35.95 +/- 7.44 g/cm; oleo-resin: 71.48 +/- 5.77 g/cm; p < 0.05). These results indicate the beneficial effect of C. langsdorffii oleo-resin on wound healing and justify its traditional use for the treatment of wounds.

  10. Post-bariatric abdominoplasty resulting in wound infection and dehiscence—Conservative treatment with medical grade honey: A case report and review of literature

    PubMed Central

    Dina Jarjis, Reem; Thomas Crewe, Bjørn; Henrik Matzen, Steen

    2016-01-01

    Introduction Wound complications in post-bariatric patients undergoing body-contouring surgery after massive weight loss are not uncommon and often, surgical debridement or conservative management is necessary. Honey is one of the most ancient remedies for wound care and it is also considered to possess debriding effects. Current research has demonstrated promising results showing that honey can improve wound granulation and epithelialization, reduce exudate and shorten healing times. Methods This case report has been reported in line with the CARE criteria. Presentation of case A 40 year-old female suffered wound infection and dehiscence after undergoing post-bariatric abdominoplasty. The patient was not interested in surgical revision and split skin grafting. Therefore, conservative wound treatment with topical Manuka honey was instituted resulting in significant clinical improvement and effective healing concurrently with good patient satisfaction. Discussion Surgical wound complications in post-bariatric patients undergoing abdominoplasty are common and often require surgical revision or conservative wound treatment. No previous publication has addressed outpatient treatment of post-bariatric abdominoplasty wound complications with medical grade honey. Conclusion Although more research is needed for definitive conclusions of honey’s efficacy, it is safe and as presented in our case, it may under certain circumstances reduce the need of surgical wound debridement and serve as a remedy for conservative treatment. PMID:26773204

  11. Pre-educational intervention survey of healthcare practitioners' compliance with infection prevention measures in cardiothoracic surgery: low compliance but internationally comparable surgical site infection rate.

    PubMed

    Tartari, E; Mamo, J

    2011-04-01

    Surgical site infections (SSIs) are challenging problems leading to significant postoperative morbidity and mortality and may reflect the level of adherence to infection control policies. We used a structured observational method to collect data about infection control practices among surgeons, anaesthetists, nurses, cardiopulmonary bypass technicians and orderlies practising in the cardiac operating theatre during open heart surgery at Mater Dei Hospital. To prevent bias, we did not disclose the actual procedures observed to the surgical team members, but participants knew they were being observed for infection control practices. We measured the 30-day SSI rate by post-discharge telephonic surveillance among surviving open heart surgery patients who had consented to the survey. We observed practices during 30 randomly chosen operations and found higher levels of inadequate practices related to environmental disinfection, hand hygiene, operating room traffic and surgical attire of non-scrubbed personnel (anaesthesiologists and cardiopulmonary bypass technicians). In all, 140 of 155 patients who underwent open heart surgery were followed up, achieving a response rate of 91.5%. Superficial and deep SSI rates were 16.4% and 4.3% respectively, including both sternal and harvest site infections. We found poor compliance with infection control practices by non-scrubbed personnel involved in cardiac surgery and observed a high surgical site infection rate, the majority being leg wound infections following saphenous vein harvesting. PMID:21334097

  12. Wound Healing Devices Brief Vignettes

    PubMed Central

    Anderson, Caesar A.; Hare, Marc A.; Perdrizet, George A.

    2016-01-01

    Significance: The demand for wound care therapies is increasing. New wound care products and devices are marketed at a dizzying rate. Practitioners must make informed decisions about the use of medical devices for wound healing therapy. This paper provides updated evidence and recommendations based on a review of recent publications. Recent Advances: The published literature on the use of medical devices for wound healing continues to support the use of hyperbaric oxygen therapy, negative pressure wound therapy, and most recently electrical stimulation. Critical Issue: To inform wound healing practitioners of the evidence for or against the use of medical devices for wound healing. This information will aid the practitioner in deciding which technology should be accepted or rejected for clinical use. Future Directions: To produce high quality, randomized controlled trials or acquire outcome-based registry databases to further test and improve the knowledge base as it relates to the use of medical devices in wound care. PMID:27076996

  13. Biofilms in wounds: management strategies.

    PubMed

    Rhoads, D D; Wolcott, R D; Percival, S L

    2008-11-01

    Biofilms probably induce a chronic and/or 'quiet' inflammation in the chronic wound and so delay healing. This paper reviews current strategies that can be used to suppress biofilms in chronic wounds until better options are available.

  14. Synthetic surgical gloves.

    PubMed

    2002-06-01

    Surgical gloves are used by healthcare workers to protect them against bloodborne pathogens and other potential infectants and to prevent wound contamination in patients. In response to the increasing prevalence of allergies to natural rubber latex (NRL) among patients and medical staff, the trend toward purchasing gloves made of synthetic materials is on the rise. However, latex continues to dominate the market, and some people still perceive synthetic gloves as providing less protection and being less comfortable than NRL gloves. For this Update Evaluation, we present our findings for three newly evaluated glove models from three manufacturers and summarize our findings for the seven previously evaluated models that are still on the market. (Our earlier Evaluation was published in the February-March 2000 Health Devices.) As in the previous Evaluation, our ratings are based on the gloves' barrier effectiveness--that is, their resistance to viral penetration and their durability--and comfort. We also compared these characteristics of the synthetic gloves to those of NRL gloves. We found that all the evaluated gloves offer adequate barrier protection but that their level of comfort varies considerably. We rate three models Preferred, five models Acceptable, and two models Not Recommended. PMID:12116503

  15. Negative pressure wound therapy with instillation: past, present, and future.

    PubMed

    Kim, Paul J; Attinger, Christopher E; Steinberg, John S; Evans, Karen K

    2015-05-01

    Negative pressure wound therapy with instillation (NPWTi) is a novel treatment option that provides the combination of negative pressure with intermittent instillation of a solution. Standard Negative Pressure Wound Therapy (NPWT) is an established adjunctive treatment option that offers the ability to promote granulation tissue in wounds. However, there is limited evidence for its utility in the environment of active or senescent infection. Wounds that are acutely infected or that contain deleterious biofilm are a challenging problem, which require an intensive multimodal approach including antibiosis, surgical intervention, and local wound care. Adjunctive application of NPWTi can potentially expedite clearance of infection and wound closure. Although this technology has been commercially available for over a decade, its adoption has been limited. Recently, there has been a resurgence of interest in this therapy with emerging evidence from animal models as well as human clinical studies. There are remaining questions regarding NPWTi including the selection of the optimal instillation solution and device settings. This article discusses the past development, current knowledge, and future direction of NPWTi.

  16. Combat-Related Invasive Fungal Wound Infections

    PubMed Central

    Rodriguez, Carlos J.

    2014-01-01

    Combat-related invasive fungal (mold) wound infections (IFIs) have emerged as an important and morbid complication following explosive blast injuries among military personnel. Similar to trauma-associated IFI cases among civilian populations, as in agricultural accidents and natural disasters, these infections occur in the setting of penetrating wounds contaminated by environmental debris. Specific risk factors for combat-related IFI include dismounted (patrolling on foot) blast injuries occurring mostly in southern Afghanistan, resulting in above knee amputations requiring resuscitation with large-volume blood transfusions. Diagnosis of IFI is based upon early identification of a recurrently necrotic wound following serial debridement and tissue-based histopathology examination with special stains to detect invasive disease. Fungal culture of affected tissue also provides supportive information. Aggressive surgical debridement of affected tissue is the primary therapy. Empiric antifungal therapy should be considered when there is a strong suspicion for IFI. Both liposomal amphotericin B and voriconazole should be considered initially for treatment since many of the cases involve not only Mucorales species but also Aspergillus or Fusarium spp., with narrowing of regimen based upon clinical mycology findings. PMID:25530825

  17. The effects of topical collagen treatment on wound breaking strength and scar cosmesis in rats

    PubMed Central

    Sinno, Hani; Malhotra, Meenakshi; Lutfy, Justyn; Jardin, Barbara; Winocour, Sebastian; Brimo, Fadi; Beckman, Lorne; Watters, Kevin; Philip, Anie; Williams, Bruce; Prakash, Satya

    2012-01-01

    BACKGROUND: Topical application of collagen has been suggested to enhance wound healing; however, its long-term effect on wounds has not been studied in a rat model. HYPOTHESIS: Topical application of collagen type I will not facilitate incision healing or cosmesis in rats up to 28 days postwounding. METHODS: The effects of bovine collagen type I (6 mg/mL) on the rat surgical paired skin incision model were examined. Each rat served as its own control in which topical collagen was applied to one incision while normal saline (0.9%) was applied to the other incision. Rats were euthanized three (n=6), seven (n=6) and 28 (n=5) days after wounding. Tissue harvested from each time point was examined for maximal breaking strength, and for biochemical and histological analysis. RESULTS: There were no statistically significant differences (ie, P<0.05) in maximum wound breaking strength between the collagen- and saline-treated wounds at all time points. Histological analysis revealed a similar infiltration of inflammatory cells and fibroblasts in the wound edges of all incisions when matched with time of wounding. Western blot analysis revealed no differences in fibronectin or collagen I content in all wounds in each rat. CONCLUSIONS: The topical application of collagen did not facilitate wound healing from three to 28 days in the rat wound model. PMID:23997586

  18. Wound Drainage Culture (For Parents)

    MedlinePlus

    ... Things to Know About Zika & Pregnancy Wound Drainage Culture KidsHealth > For Parents > Wound Drainage Culture Print A A A Text Size What's in ... de heridas What It Is A wound drainage culture is a test to detect germs such as ...

  19. The History of Wound Care

    PubMed Central

    Shah, Jayesh B.

    2012-01-01

    The history of wound healing is, in a sense, the history of humankind. This brief history of wound healing has been compiled for the benefit of readers. It is amazing to see that some of the basic principles of wound healing have been known since 2000 bc. PMID:24525756

  20. Surgical adhesives for laser-assisted wound closure

    NASA Astrophysics Data System (ADS)

    Hodges, Diane E.; McNally-Heintzelman, Karen M.; Welch, Ashley J.

    2001-10-01

    Solid protein solder-doped polymer membranes were developed for laser-assisted tissue repair. Biodegradable polymer membranes of controlled porosity were fabricated with poly(L-lactic-co-glycolic acid) (PLGA), poly(ethylene glycol) (PEG), and salt particles, using a solvent-casting and particulate-leaching technique. The membranes provided a porous scaffold that readily absorbed the traditional protein solder composed of serum albumin, indocyanine green dye, and de-ionized water. In vitro investigations were conducted to assess the influence of various processing parameters on the strength of tissue repairs formed using the new membranes. These parameters included PLGA copolymer and PLGA/PEG blend ratios, membrane pore size, initial albumin weight fraction, and laser irradiance used to denature the solder. Altering the PLGA copolymer ratio had little effect on repair strength, however such variations are known to influence the degradation rate of the membranes. The repair strength increased with increased membrane pore size and bovine serum albumin concentration. The addition of PEG during the membrane casting stage increased the flexibility of the membranes but not necessarily the repair strength. Typically, the repair strength increased with increasing irradiance from 12 to 18 W/cm2. The new solder-doped polymer membranes provided all of the benefits associated with solid protein solders including high repair strength and improved edge coaptation. In addition, the flexible, moldable nature of the new membranes offers the capability of tailoring the membranes to a wide range of clinically relevant geometries.

  1. [Atypical agents of wound infection and targeted samples].

    PubMed

    Kucisec-Tepes, Nastja

    2012-10-01

    All open wounds are primarily contaminated and subsequently colonized by microorganisms, predominantly bacteria. Only about 30% of chronic wounds are also infected. Factors which favor the development of infection are the following: large quantity of bacteria, presence of virulence factors, their quantity and number, predominantly the synergy of aerobic and anaerobic bacteria, and formation of biofilm. Common agents of infection of acute and chronic wounds are Staphylococcus aureus, MRSA, Streptococcus beta-haemolyticus, Pseudomonas aeruginosa, Bacteroides spp., and Candida albicans. Difference between acute and chronic wound is in the predominance of individual agents, with an observation that Staphylococcus aureus is predominant in both cases. Atypical agents of chronic wound infection are rare, unusual, not found in the area in which we live, not proven by standard microbiological methods, but molecular methods are needed instead. They are predominantly opportunists, varying in the expression of virulence factors, or they have changed their phenotype characteristics and are not the agents of primary wound infections. They are the agents of secondary infections. Atypical agents of the chronic wound infection are diverse, from the anaerobe group, Peptoniphilus spp., Anaerococcus spp., Bacteroides ureolyticus, Finegoldia magma, the group of gram positive rods of the Corynebacterium genus, the group of bacteria from aquatic environment Mycobacterium fortuitum complex, and Vibrio alginolyticus. The targeted samples are biopsy sample as the "gold standard" and/or aspirate, when a significant quantity of exudate is present. Targeted samples are obligatory when there is a progression and decomposition of the base of the wound, increase in the size or depth of the wound, isolation of multiresistant microbes, or absence of clinical response to empirical antimicrobial therapy. In the diagnosis of opportunistic pathogens or atypical agents of chronic wound infection, it is

  2. A simplified technique for producing an ischemic wound model.

    PubMed

    Chien, Sufan; Wilhelmi, Bradon J

    2012-05-02

    One major obstacle in current diabetic wound research is a lack of an ischemic wound model that can be safely used in diabetic animals. Drugs that work well in non-ischemic wounds may not work in human diabetic wounds because vasculopathy is one major factor that hinders healing of these wounds. We published an article in 2007 describing a rabbit ear ischemic wound model created by a minimally invasive surgical technique. Since then, we have further simplified the procedure for easier operation. On one ear, three small skin incisions were made on the vascular pedicles, 1-2 cm from the ear base. The central artery was ligated and cut along with the nerve. The whole cranial bundle was cut and ligated, leaving only the caudal branch intact. A circumferential subcutaneous tunnel was made through the incisions, to cut subcutaneous tissues, muscles, nerves, and small vessels. The other ear was used as a non-ischemic control. Four wounds were made on the ventral side of each ear. This technique produces 4 ischemic wounds and 4 non-ischemic wounds in one animal for paired comparisons. After surgery, the ischemic ear was cool and cyanotic, and showed reduced movement and a lack of pulse in the ear artery. Skin temperature of the ischemic ear was 1-10 °C lower than that on the normal ear and this difference was maintained for more than one month. Ear tissue high-energy phosphate contents were lower in the ischemic ear than the control ear. Wound healing times were longer in the ischemic ear than in the non-ischemic ear when the same treatment was used. The technique has now been used on more than 80 rabbits in which 23 were diabetic (diabetes time ranging from 2 weeks to 2 years). No single rabbit has developed any surgical complications such as bleeding, infection, or rupture in the skin incisions. The model has many advantages, such as little skin disruption, longer ischemic time, and higher success rate, when compared to many other models. It can be safely used in

  3. Burn Wound Infections

    PubMed Central

    Church, Deirdre; Elsayed, Sameer; Reid, Owen; Winston, Brent; Lindsay, Robert

    2006-01-01

    Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices. PMID:16614255

  4. Spiral wound extraction cartridge

    DOEpatents

    Wisted, E.E.; Lundquist, S.H.

    1999-04-27

    A cartridge device for removing an analyte from a fluid comprises a hollow core, a sheet composite comprising a particulate-loaded porous membrane and optionally at least one reinforcing spacer sheet, the particulate being capable of binding the analyte, the sheet composite being formed into a spiral configuration about the core, wherein the sheet composite is wound around itself and wherein the windings of sheet composite are of sufficient tightness so that adjacent layers are essentially free of spaces therebetween, two end caps which are disposed over the core and the lateral ends of the spirally wound sheet composite, and means for securing the end caps to the core, the end caps also being secured to the lateral ends of the spirally wound sheet composite. A method for removing an analyte from a fluid comprises the steps of providing a spirally wound element of the invention and passing the fluid containing the analyte through the element essentially normal to a surface of the sheet composite so as to bind the analyte to the particulate of the particulate-loaded porous membrane, the method optionally including the step of eluting the bound analyte from the sheet composite. 4 figs.

  5. Gingival Wound Healing

    PubMed Central

    Cáceres, M.; Martínez, C.; Oyarzún, A.; Martínez, J.

    2015-01-01

    Gingival wound healing comprises a series of sequential responses that allow the closure of breaches in the masticatory mucosa. This process is of critical importance to prevent the invasion of microbes or other agents into tissues, avoiding the establishment of a chronic infection. Wound healing may also play an important role during cell and tissue reaction to long-term injury, as it may occur during inflammatory responses and cancer. Recent experimental data have shown that gingival wound healing is severely affected by the aging process. These defects may alter distinct phases of the wound-healing process, including epithelial migration, granulation tissue formation, and tissue remodeling. The cellular and molecular defects that may explain these deficiencies include several biological responses such as an increased inflammatory response, altered integrin signaling, reduced growth factor activity, decreased cell proliferation, diminished angiogenesis, reduced collagen synthesis, augmented collagen remodeling, and deterioration of the proliferative and differentiation potential of stem cells. In this review, we explore the cellular and molecular basis of these defects and their possible clinical implications. PMID:25527254

  6. Wound care centers

    MedlinePlus

    ... at a time as it heals. Negative pressure therapy -- pulling the air out of a closed dressing, creating a vacuum. The negative pressure improves blood flow and pulls out excess fluid. Growth factor therapy -- materials produced by the body that helps wound- ...

  7. Spiral wound extraction cartridge

    DOEpatents

    Wisted, Eric E.; Lundquist, Susan H.

    1999-01-01

    A cartridge device for removing an analyte from a fluid comprises a hollow core, a sheet composite comprising a particulate-loaded porous membrane and optionally at least one reinforcing spacer sheet, the particulate being capable of binding the analyte, the sheet composite being formed into a spiral configuration about the core, wherein the sheet composite is wound around itself and wherein the windings of sheet composite are of sufficient tightness so that adjacent layers are essentially free of spaces therebetween, two end caps which are disposed over the core and the lateral ends of the spirally wound sheet composite, and means for securing the end caps to the core, the end caps also being secured to the lateral ends of the spirally wound sheet composite. A method for removing an analyte from a fluid comprises the steps of providing a spirally wound element of the invention and passing the fluid containing the analyte through the element essentially normal to a surface of the sheet composite so as to bind the analyte to the particulate of the particulate-loaded porous membrane, the method optionally including the step of eluting the bound analyte from the sheet composite.

  8. Healing Invisible Wounds

    ERIC Educational Resources Information Center

    Adams, Erica J.

    2010-01-01

    As many as 9 in 10 justice-involved youth are affected by traumatic childhood experiences. According to "Healing Invisible Wounds: Why Investing in Trauma-Informed Care for Children Makes Sense," between 75 and 93 percent of youth currently incarcerated in the justice system have had at least one traumatic experience, including sexual abuse, war,…

  9. The Wounded Spirit.

    ERIC Educational Resources Information Center

    Peretti, Frank

    2001-01-01

    This article offers a glimpse into the life of Frank Peretti, who as a child suffered abuse because of his physical disfigurement. He was bullied and physically assaulted by peers and sometimes adults. Now well known for his novels, Peretti suggests that people who cause others to suffer also suffer from a wounded spirit. (Author)

  10. Diabetic Wound Care

    MedlinePlus

    ... Feet Footwear & Products Products by Company Products by Type Foot Health Awareness Diabetes Awareness What is a Podiatrist? Today's Podiatrist Print Share RSS Home » Learn About Feet » Foot Health Information Diabetic Wound Care What is a Diabetic Foot Ulcer? ...

  11. Choosing a Wound Dressing Based on Common Wound Characteristics

    PubMed Central

    Dabiri, Ganary; Damstetter, Elizabeth; Phillips, Tania

    2016-01-01

    Significance: Chronic wounds are a major healthcare burden.The practitioner should have an appropriate understanding of both the etiology of the wound as well as the optimal type of dressings to use. Fundamental wound characteristics may be used to guide the practitioner's choice of dressings. The identification of optimal dressings to use for a particular wound type is an important element in facilitating wound healing. Recent Advances: Researchers have sought to design wound dressings that aim to optimize each stage in the healing process. In addition, dressings have been designed to target and kill infection-causing bacteria, with the incorporation of antimicrobial agents. Critical Issues: Chronic wounds are frequently dynamic in presentation, and the numerous wound dressings available make dressing selection challenging for the practitioner. Choosing the correct dressing decreases time to healing, provides cost-effective care, and improves patient quality of life. Future Directions: Research into the mechanisms of wound healing has enhanced our ability to heal chronic wounds at a faster rate through the use of moisture-retentive dressings. Newer dressings are incorporating the use of nanotechnology by incorporating miniature electrical sensors into the dressing. These dressings are engineered to detect changes in a wound environment and alert the patient or practitioner by altering the color of the dressing or sending a message to a smartphone. Additional investigations are underway that incorporate biologic material such as stem cells into dressings. PMID:26858913

  12. Using multimodal imaging techniques to monitor limb ischemia: a rapid noninvasive method for assessing extremity wounds

    NASA Astrophysics Data System (ADS)

    Luthra, Rajiv; Caruso, Joseph D.; Radowsky, Jason S.; Rodriguez, Maricela; Forsberg, Jonathan; Elster, Eric A.; Crane, Nicole J.

    2013-03-01

    Over 70% of military casualties resulting from the current conflicts sustain major extremity injuries. Of these the majority are caused by blasts from improvised explosive devices. The resulting injuries include traumatic amputations, open fractures, crush injuries, and acute vascular disruption. Critical tissue ischemia—the point at which ischemic tissues lose the capacity to recover—is therefore a major concern, as lack of blood flow to tissues rapidly leads to tissue deoxygenation and necrosis. If left undetected or unaddressed, a potentially salvageable limb may require more extensive debridement or, more commonly, amputation. Predicting wound outcome during the initial management of blast wounds remains a significant challenge, as wounds continue to "evolve" during the debridement process and our ability to assess wound viability remains subjectively based. Better means of identifying critical ischemia are needed. We developed a swine limb ischemia model in which two imaging modalities were combined to produce an objective and quantitative assessment of wound perfusion and tissue viability. By using 3 Charge-Coupled Device (3CCD) and Infrared (IR) cameras, both surface tissue oxygenation as well as overall limb perfusion could be depicted. We observed a change in mean 3CCD and IR values at peak ischemia and during reperfusion correlate well with clinically observed indicators for limb function and vitality. After correcting for baseline mean R-B values, the 3CCD values correlate with surface tissue oxygenation and the IR values with changes in perfusion. This study aims to not only increase fundamental understanding of the processes involved with limb ischemia and reperfusion, but also to develop tools to monitor overall limb perfusion and tissue oxygenation in a clinical setting. A rapid and objective diagnostic for extent of ischemic damage and overall limb viability could provide surgeons with a more accurate indication of tissue viability. This may

  13. [Physiology and pathophysiology of wound healing of wound defects].

    PubMed

    Mutschler, W

    2012-09-01

    Understanding wound healing involves more than simply stating that there are the three phases of inflammation, proliferation and maturation. Wound healing is a complex series of actions, reactions and interactions among cells and mediators in a sequential and simultaneously ongoing temporal process within a spatial frame. At first this article will attempt to provide a concise summary of the events, cellular components and main influential mediators of wound healing over time. Secondly, the pathophysiology of chronic non-healing wounds is described where an imbalance of stimulating and inhibiting factors causes failure of healing. The most relevant extrinsic and intrinsic determinants are described and related to the cellular and molecular level of disturbed wound healing. A basic understanding of wound healing is a prerequisite for any prophylactic or therapeutic maneuver to maintain or re-establish wound equilibrium to give a satisfactory healing trajectory.

  14. Surgical procedures in pinniped and cetacean species.

    PubMed

    Higgins, Jennifer L; Hendrickson, Dean A

    2013-12-01

    Significant advances in veterinary diagnostic and surgical techniques have been made over the past several decades. Many of these advances, however, have not reached the field of marine mammal medicine. A number of limitations exist: risks of anesthesia, anatomical challenges, difficulties with wound closure, environmental constraints, equipment limitations, and perceived risks. Despite these limitations, surgical treatments have been successfully utilized in marine mammals. While surgery is performed in pinnipeds more frequently than in cetaceans, studies conducted in the 1960s and 1970s on dolphin sleep and hearing demonstrated that general anesthesia can be successfully induced in cetaceans. Since this pioneering work, a small number of successful surgeries have been performed in dolphins under both general anesthesia and heavy sedation. While these surgical procedures in pinnipeds and cetaceans have typically been limited to wound management, dentistry, ophthalmic procedures, fracture repair, and superficial biopsy, a number of abdominal surgeries have also been performed. Recently there have been pioneering successes in the application of minimally invasive surgery in marine mammals. Many of the anatomical challenges that almost prohibit traditional laparotomies in cetacean species and present challenges in pinnipeds can be overcome through the use of laparoscopic techniques. Due to the limited number of pinnipeds and cetaceans in captivity and, thus, the limited case load for veterinarians serving marine mammal species, it is vital for knowledge of surgical procedures to be shared among those in the field. This paper reviews case reports of surgical procedures, both traditional and laparoscopic, in pinnipeds and cetaceans. Limitations to performing surgical procedures in marine mammals are discussed and surgical case reports analyzed in an effort to determine challenges that must be overcome in order to make surgery a more feasible diagnostic and treatment

  15. Inflammatory inert poly(ethylene glycol)--protein wound dressing improves healing responses in partial- and full-thickness wounds.

    PubMed

    Shingel, Kirill I; Di Stabile, Liliana; Marty, Jean-Paul; Faure, Marie-Pierre

    2006-12-01

    In this study, a novel soft hydrogel system based on the poly(ethylene glycol)-protein conjugates was evaluated as an occlusive wound dressing material. The hydrogel material, referred by the name of BioAquacare, contains up to 96% of the liquid and is formulated with phosphate-buffered saline and safe preservative to control bacterial load in the open wounds. Performance of the BioAquacare as a wound dressing material was assessed in partial- and full-thickness wounds in pigs. Wound analysis comprised macroscopic determination of the wound size, histological examination of the healing tissues and biochemical characterisation of wound exudates. The wounds treated with BioAquacare healed without any signs of inflammation, skin irritation, oedema or erythema. Cellular composition of the reepithelialised wounds was very similar to that of the normal skin, with a well-developed stratum corneum and epithelial layer. It was observed that BioAquacare plays the role of a liquid compartment, which provides pronounced hydration effect and helps maintain a natural moist environment of the healing tissues. BioAquacare showed relatively low protein-absorbing activity, absorbing predominantly low-molecular-weight molecules, including interleukin (IL)-1beta, IL-6, transforming growth factor-beta1 and products of haemoglobin degradation. It is concluded that application of the moist BioAquacare dressing promotes fast reepithelialisation by creating favourable environment for keratinocytes proliferation and it also reduces scarring. The results show that BioAquacare can be considered as a safe, biocompatible and inflammatory inert wound dressing material.

  16. Inflammatory inert poly(ethylene glycol)--protein wound dressing improves healing responses in partial- and full-thickness wounds.

    PubMed

    Shingel, Kirill I; Di Stabile, Liliana; Marty, Jean-Paul; Faure, Marie-Pierre

    2006-12-01

    In this study, a novel soft hydrogel system based on the poly(ethylene glycol)-protein conjugates was evaluated as an occlusive wound dressing material. The hydrogel material, referred by the name of BioAquacare, contains up to 96% of the liquid and is formulated with phosphate-buffered saline and safe preservative to control bacterial load in the open wounds. Performance of the BioAquacare as a wound dressing material was assessed in partial- and full-thickness wounds in pigs. Wound analysis comprised macroscopic determination of the wound size, histological examination of the healing tissues and biochemical characterisation of wound exudates. The wounds treated with BioAquacare healed without any signs of inflammation, skin irritation, oedema or erythema. Cellular composition of the reepithelialised wounds was very similar to that of the normal skin, with a well-developed stratum corneum and epithelial layer. It was observed that BioAquacare plays the role of a liquid compartment, which provides pronounced hydration effect and helps maintain a natural moist environment of the healing tissues. BioAquacare showed relatively low protein-absorbing activity, absorbing predominantly low-molecular-weight molecules, including interleukin (IL)-1beta, IL-6, transforming growth factor-beta1 and products of haemoglobin degradation. It is concluded that application of the moist BioAquacare dressing promotes fast reepithelialisation by creating favourable environment for keratinocytes proliferation and it also reduces scarring. The results show that BioAquacare can be considered as a safe, biocompatible and inflammatory inert wound dressing material. PMID:17199768

  17. An overview of factors maximizing successful split-thickness skin grafting in diabetic wounds

    PubMed Central

    Donegan, Ryan J.; Schmidt, Brian M.; Blume, Peter A.

    2014-01-01

    Open wounds, from ulcerations or slow healing, are one of the comorbidities in diabetic patients that can lead to amputation. Therefore, an optimal way to close and heal wounds quickly in diabetic patients is required. Split-thickness skin grafts (STSG) offer a quick method of wound closure for diabetic patients. This article review will look at causes of failure in STSG, and ways to optimize success.

  18. Vibrio alginolyticus-associated wound infection acquired in British waters, Guernsey, July 2011.

    PubMed

    Reilly, G D; Reilly, C A; Smith, E G; Baker-Austin, C

    2011-10-20

    In July 2011, a Vibrio alginolyticus infection was diagnosed in a woman from Guernsey in the Channel Islands, British Isles after sea bathing and application of a natural seaweed dressing to a pre-existing leg wound. Microbiological investigation confirmed Vibrio in the wound and the species of seaweed used for the dressing. The washing of open wounds in seawater and use of unsterilised seaweed dressings should be discouraged, particularly in individuals with underlying risk conditions.

  19. Distinction of infected and non-infected post-surgical incisions with In-111-WBC scintigraphy

    SciTech Connect

    Abdel-Nabi, H.; Hinkle, G.H.; Olsen, J.O.

    1985-05-01

    To determine if In-111-WBCs scintigraphy can distinguish between healing and infection in post-surgical wounds, a prospective study was performed in patients with 3-14 day old surgical incisions. Eighteen patients (11 males and 7 females) were scanned 24 hrs after injection of 0.5 mCi of In-111 labeled autologous leukocytes. The scan findings were correlated with blood and/wound cultures results and diagnosis at time of discharge. Incisional uptake of In-111-WBCs was noted in 9 patients with infected surgical wounds and was absent in those 9 patients with non-infected surgical wounds. The results of the authors' study show that In-111-WBCs do not accumulate in non-infected surgical incisions. This confirms their previous findings in rats. The high specificity of In-111 leukocytes imaging makes it a valuable study in the evaluation of post-operative patients with suspected surgical wound infections. In-111 WBCs scintigraphy can distinguish between normal healing and infection at the site of recent (3-14 days) surgical incisions.

  20. Use of negative pressure wound therapy in the management of infected abdominal wounds containing mesh: an analysis of outcomes.

    PubMed

    Baharestani, Mona Mylene; Gabriel, Allen

    2011-04-01

    The purpose of this study was to examine the clinical outcomes of negative pressure wound therapy (NPWT) using reticulated open-cell foam (ROCF) in the adjunctive management of abdominal wounds with exposed and known infected synthetic mesh. A non randomised, retrospective review of medical records for 21 consecutive patients with infected abdominal wounds treated with NPWT was conducted. All abdominal wounds contained exposed synthetic mesh [composite, polypropylene (PP), or knitted polyglactin 910 (PG) mesh]. Demographic and bacteriological data, wound history, pre-NPWT and comparative post-NPWT, operative procedures and complications, hospital length of stay (LOS) and wound healing outcomes were all analysed. Primary endpoints measured were (1) hospital LOS prior to initiation of NPWT, (2) total time on NPWT, (3) hospital LOS from NPWT initiation to discharge and (4) wound closure status at discharge. A total of 21 patients with abdominal wounds with exposed, infected mesh were treated with NPWT. Aetiology of the wounds was ventral hernia repair (n = 11) and acute abdominal wall defect (n = 10). Prior to NPWT initiation, the mean hospital LOS for the composite, PP and PG meshes were 76 days (range: 21-171 days), 51 days (range: 32-62 days) and 19 days (range: 12-39 days), respectively. The mean hospital LOS following initiation of NPWT for wounds with exposed composite, PP and PG mesh were 28, 31 and 32 days, respectively. Eighteen of the 21 wounds (86%) reached full closure after a mean time of 26 days of NPWT and a mean hospital LOS of 30 days postinitiation of NPWT. Three wounds, all with composite mesh left in situ, did not reach full closure, although all exhibited decreased wound dimensions, granulating beds and decreased surface area exposure of mesh. During NPWT/ROCF, one hypoalbuminemic patient with exposed PP mesh developed an enterocutaneous fistula over a prior enterotomy site. This patient subsequently underwent total mesh extraction, takedown of

  1. Advances in wound debridement techniques.

    PubMed

    Nazarko, Linda

    2015-06-01

    Dead and devitalised tissue interferes with the process of wound healing. Debridement is a natural process that occurs in all wounds and is crucial to healing; it reduces the bacterial burden in a wound and promotes effective inflammatory responses that encourage the formation of healthy granulation tissue (Wolcott et al, 2009). Wound care should be part of holistic patient care. Recent advances in debridement techniques include: biosurgery, hydrosurgery, mechanical debridement, and ultrasound. Biosurgery and mechanical debridement can be practiced by nonspecialist nurses and can be provided in a patient's home, thus increasing the patient's access to debridement therapy and accelerating wound healing.

  2. Effect of reactive skin decontamination lotion on skin wound healing in laboratory rats.

    PubMed

    Walters, Thomas J; Kauvar, David S; Reeder, Joanna; Baer, David G

    2007-03-01

    Reactive skin decontamination lotion (RSDL) is a proposed replacement for the existing skin and equipment decontamination kit. Because RSDL may need to be used to decontaminate wounded personnel, we conducted an assessment of the effect of this agent on wound healing. A skin incision model using male Sprague Dawley rats (n = 19 rats/group) was used. A 7.0-cm incision was made through the skin, and RSDL was (experimental group) or was not (control group) applied to the open wound; the wound edges were then approximated with sutures. Seven days later, animals were euthanized and wound samples were taken. Healing was assessed by measuring mechanical strength, collagen content, and histological appearance. RSDL-treated wounds had 23% lower tensile strength (p < 0.05) and 11% lower collagen content (p < 0.05) than did the untreated control wounds. Histological assessments did not differ significantly between groups. The results of this investigation demonstrate that the application of RSDL directly to an open wound impairs wound strength and decreases collagen content in the early phases of wound healing. This may have clinical implications for the treatment and outcomes of chemical casualty combat trauma.

  3. Effect of reactive skin decontamination lotion on skin wound healing in laboratory rats.

    PubMed

    Walters, Thomas J; Kauvar, David S; Reeder, Joanna; Baer, David G

    2007-03-01

    Reactive skin decontamination lotion (RSDL) is a proposed replacement for the existing skin and equipment decontamination kit. Because RSDL may need to be used to decontaminate wounded personnel, we conducted an assessment of the effect of this agent on wound healing. A skin incision model using male Sprague Dawley rats (n = 19 rats/group) was used. A 7.0-cm incision was made through the skin, and RSDL was (experimental group) or was not (control group) applied to the open wound; the wound edges were then approximated with sutures. Seven days later, animals were euthanized and wound samples were taken. Healing was assessed by measuring mechanical strength, collagen content, and histological appearance. RSDL-treated wounds had 23% lower tensile strength (p < 0.05) and 11% lower collagen content (p < 0.05) than did the untreated control wounds. Histological assessments did not differ significantly between groups. The results of this investigation demonstrate that the application of RSDL directly to an open wound impairs wound strength and decreases collagen content in the early phases of wound healing. This may have clinical implications for the treatment and outcomes of chemical casualty combat trauma. PMID:17436779

  4. Office management of minor wounds.

    PubMed Central

    Gouin, S.; Patel, H.

    2001-01-01

    OBJECTIVE: To review office interventions for minor wounds not requiring sutures, such as abrasions, bites, and lacerations. QUALITY OF EVIDENCE: Most information on minor wound management comes from descriptive studies. Few comparative studies examine the effectiveness of topical antisepsis for minor wounds. Several clinical trials have demonstrated that tissue adhesives produce short- and long-term cosmetic results equivalent to those achieved with suture materials. MAIN MESSAGE: Sterile saline is the least toxic solution for wound irrigation. Chlorhexidine (2%) and povidone iodine (10%) have been the most investigated antiseptic solutions. Systemic antibiotics are unnecessary for wounds unlikely to be infected. All bite wounds require special attention. Primary closure of bite wounds is indicated in certain circumstances: less than 12-hour-old nonpuncture wounds, uninfected wounds, and low-risk lesions (such as on the face). In spite of their many advantages, skin tapes should be used for low-tension wounds only. The popularity of tissue adhesives has greatly increased. Since the advent of newer products (with increased bonding strength and flexibility), adhesives are used to manage most lacerations except those in areas of high tension (e.g., joints) and on mucosal surfaces. CONCLUSION: Minor wounds not requiring sutures can be managed easily in the office. PMID:11340758

  5. Common questions about wound care.

    PubMed

    Worster, Brooke; Zawora, Michelle Q; Hsieh, Christine

    2015-01-15

    Lacerations, abrasions, burns, and puncture wounds are common in the outpatient setting. Because wounds can quickly become infected, the most important aspect of treating a minor wound is irrigation and cleaning. There is no evidence that antiseptic irrigation is superior to sterile saline or tap water. Occlusion of the wound is key to preventing contamination. Suturing, if required, can be completed up to 24 hours after the trauma occurs, depending on the wound site. Tissue adhesives are equally effective for low-tension wounds with linear edges that can be evenly approximated. Although patients are often instructed to keep their wounds covered and dry after suturing, they can get wet within the first 24 to 48 hours without increasing the risk of infection. There is no evidence that prophylactic antibiotics improve outcomes for most simple wounds. Tetanus toxoid should be administered as soon as possible to patients who have not received a booster in the past 10 years. Superficial mild wound infections can be treated with topical agents, whereas deeper mild and moderate infections should be treated with oral antibiotics. Most severe infections, and moderate infections in high-risk patients, require initial parenteral antibiotics. Severe burns and wounds that cover large areas of the body or involve the face, joints, bone, tendons, or nerves should generally be referred to wound care specialists.

  6. [Robot-assisted radical prostatectomy: surgical techniques].

    PubMed

    Kojima, Yoshiyuki; Sato, Yuichi; Ogawa, Soichiro; Haga, Nobuhiro; Yanagida, Tomohiko

    2016-01-01

    Robot-assisted radical prostatectomy (RARP) for the patients with localized prostate cancer is increasingly being adopted around the world. The da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA, USA) provides the advantages of simplification and precision of exposure and suturing because of allowing movements of the robotic arm in real time with increased degree of freedom and magnified 3-dimensional view. Therefore, RARP has been expected to provide superior therapeutic benefit to patients in terms of surgical outcome to open or laparoscopic radical prostatectomy. In this review, we provide our technical aspects and tips and tricks of RARP to improve surgical outcome and postoperative quality of life. PMID:26793888

  7. Filament wound structure and method

    DOEpatents

    Dritt, William S.; Gerth, Howard L.; Knight, Jr., Charles E.; Pardue, Robert M.

    1977-01-01

    The present invention relates to a filament wound spherical structure comprising a plurality of filament band sets disposed about the surface of a mandrel with each band of each set formed of a continuous filament circumferentially wound about the mandrel a selected number of circuits and with each circuit of filament being wound parallel to and contiguous with an immediate previously wound circuit. Each filament band in each band set is wound at the same helix angle from the axis of revolution of the mandrel and all of the bands of each set are uniformly distributed about the mandrel circumference. The pole-to-equator wall thickness taper associated with each band set, as several contiguous band sets are wound about the mandrel starting at the poles, is accumulative as the band sets are nested to provide a complete filament wound sphere of essentially uniform thickness.

  8. Reconstructive challenges in war wounds

    PubMed Central

    Bhandari, Prem Singh; Maurya, Sanjay; Mukherjee, Mrinal Kanti

    2012-01-01

    War wounds are devastating with extensive soft tissue and osseous destruction and heavy contamination. War casualties generally reach the reconstructive surgery centre after a delayed period due to additional injuries to the vital organs. This delay in their transfer to a tertiary care centre is responsible for progressive deterioration in wound conditions. In the prevailing circumstances, a majority of war wounds undergo delayed reconstruction, after a series of debridements. In the recent military conflicts, hydrosurgery jet debridement and negative pressure wound therapy have been successfully used in the preparation of war wounds. In war injuries, due to a heavy casualty load, a faster and reliable method of reconstruction is aimed at. Pedicle flaps in extremities provide rapid and reliable cover in extremity wounds. Large complex defects can be reconstructed using microvascular free flaps in a single stage. This article highlights the peculiarities and the challenges encountered in the reconstruction of these ghastly wounds. PMID:23162233

  9. Normoxic wound fluid contains high levels of vascular endothelial growth factor.

    PubMed Central

    Howdieshell, T R; Riegner, C; Gupta, V; Callaway, D; Grembowicz, K; Sathyanarayana; McNeil, P L

    1998-01-01

    OBJECTIVE: To examine the temporal integration of vascular endothelial growth factor (VEGF), which has been shown to be present in wound fluid, with the putatively related processes of wound fluid oxygen content, wound angiogenesis, and granulation tissue formation. SUMMARY BACKGROUND DATA: During cutaneous wound repair, new tissue formation starts with reepithelialization and is followed by granulation tissue formation, including neutrophil and macrophage accumulation, fibroblast ingrowth, matrix deposition, and angiogenesis. Because angiogenesis and increased vascular permeability are characteristic features of wound healing, VEGF may play an important role in tissue repair. METHODS: A ventral hernia, surgically created in the abdominal wall of female swine, was repaired using silicone sheeting and skin closure. Over time, a fluid-filled wound compartment formed, bounded by subcutaneous tissue and omentum. Ultrasonography was performed serially to examine the anatomy and dimensions of the subcutaneous tissue and wound compartment. Serial wound fluid samples, obtained by percutaneous aspiration, were analyzed for PO2, PCO2, pH, and growth factor concentrations. RESULTS: Three independent assays demonstrate that VEGF protein is present at substantially elevated levels in a wound fluid associated with the formation of abdominal granulation tissue. However, the wound fluid is not hypoxic at any time. Serial sampling reveals that transforming growth factor beta-1 protein appears in the wound fluid before VEGF. CONCLUSIONS: The results suggest that VEGF is a prominent regulator of wound angiogenesis and vessel permeability. A factor other than hypoxia, perhaps the earlier appearance of another growth factor, transforming growth factor beta-1, may positively regulate VEGF appearance in the wound fluid. Images Figure 1. Figure 2. Figure 3. Figure 5. Figure 7. PMID:9833810

  10. Identifying wound prevalence using the Mobile Wound Care program.

    PubMed

    Walker, Judi; Cullen, Marianne; Chambers, Helen; Mitchell, Eleanor; Steers, Nicole; Khalil, Hanan

    2014-06-01

    Measuring the prevalence of wounds within health care systems is a challenging and complex undertaking. This is often compounded by the clinicians' training, the availability of the required data to collect, incomplete documentation and lack of reporting of this type of data across the various health care settings. To date, there is little published data on wound prevalence across regions or states. This study aims to identify the number and types of wounds treated in the Gippsland area using the Mobile Wound Care (MWC™) program. The MWC program has enabled clinicians in Gippsland to collect data on wounds managed by district nurses from four health services. The main outcomes measured were patient characteristics, wound characteristics and treatment characteristics of wounds in Gippsland. These data create several clinical and research opportunities. The identification of predominant wound aetiologies in Gippsland provides a basis on which to determine a regional wound prospective and the impact of the regional epidemiology. Training that incorporates best practice guidelines can be tailored to the most prevalent wound types. Clinical pathways that encompass the Australian and New Zealand clinical practice guidelines for the management of venous leg ulcers can be introduced and the clinical and economical outcomes can be quantitatively measured. The MWC allows healing times (days) to be benchmarked both regionally and against established literature, for example, venous leg ulcers.

  11. Wound Microbiology and Associated Approaches to Wound Management

    PubMed Central

    Bowler, P. G.; Duerden, B. I.; Armstrong, D. G.

    2001-01-01

    The majority of dermal wounds are colonized with aerobic and anaerobic microorganisms that originate predominantly from mucosal surfaces such as those of the oral cavity and gut. The role and significance of microorganisms in wound healing has been debated for many years. While some experts consider the microbial density to be critical in predicting wound healing and infection, others consider the types of microorganisms to be of greater importance. However, these and other factors such as microbial synergy, the host immune response, and the quality of tissue must be considered collectively in assessing the probability of infection. Debate also exists regarding the value of wound sampling, the types of wounds that should be sampled, and the sampling technique required to generate the most meaningful data. In the laboratory, consideration must be given to the relevance of culturing polymicrobial specimens, the value in identifying one or more microorganisms, and the microorganisms that should be assayed for antibiotic susceptibility. Although appropriate systemic antibiotics are essential for the treatment of deteriorating, clinically infected wounds, debate exists regarding the relevance and use of antibiotics (systemic or topical) and antiseptics (topical) in the treatment of nonhealing wounds that have no clinical signs of infection. In providing a detailed analysis of wound microbiology, together with current opinion and controversies regarding wound assessment and treatment, this review has attempted to capture and address microbiological aspects that are critical to the successful management of microorganisms in wounds. PMID:11292638

  12. Optic chiasm compression from mass effect and thrombus formation following unsuccessful treatment of a giant supraclinoid ICA aneurysm with the Pipeline device: open surgical bailout with STA-MCA bypass and parent vessel occlusion.

    PubMed

    Abla, Adib A; Zaidi, Hasan A; Crowley, R Webster; Britz, Gavin W; McDougall, Cameron G; Albuquerque, Felipe C; Spetzler, Robert F

    2014-07-01

    Pipeline Embolization Devices (PEDs) have been shown to be effective for intracranial internal carotid artery (ICA) aneurysms, and are now approved by the FDA specifically for this use. Potential pitfalls, however, have not yet been described in the pediatric neurosurgical literature. The authors report on a 10-year-old boy who presented to the Barrow Neurological Institute after progressive visual decline. He had undergone placement of a total of 7 telescoping PEDs at another facility for a large ICA aneurysm. Residual filling of the aneurysm and significant expansion of intraaneurysmal thrombus with chiasmal compression on admission images were causes for concern. The patient underwent a surgical bailout with a superficial temporal artery-middle cerebral artery bypass, with parent artery occlusion. Postoperative vascular imaging was notable for successful occlusion of the parent vessel, with no evidence of filling of the aneurysm. Reports on the pitfalls of PEDs in the neurosurgical literature are scarce. To the authors' knowledge this represents the first paper describing a successful open surgical bailout for residual aneurysmal filling and expansion of thrombus after placement of a PED.

  13. The Haiti earthquake: the provision of wound care for mass casualties utilizing negative-pressure wound therapy.

    PubMed

    Gabriel, Allen; Gialich, Shelby; Kirk, Julie; Edwards, Sheriden; Beck, Brooke; Sorocéanu, Alexandra; Nelson, Scott; Gabriel, Cassie; Gupta, Subhas

    2011-10-01

    Many months after the devastating earthquake in January 2010, wounds remain a major disease burden in Haiti. Since January 2010, through the efforts of corporations, nonprofit charitable organizations, and medical professionals, advanced wound care techniques, including negative-pressure wound therapy (NPWT), have been introduced into the wound care regimens of various hospitals in Haiti. In June 2010, the authors completed their second volunteer trip at a Haitian hospital specializing in orthopedic wounds. The medical team was composed of a plastic surgeon, orthopedic surgeon, anesthesiologist, medical assistant, scrub technician, and registered nurse (specializing in plastic surgery and orthopedics). The authors' team supplied NPWT devices, reticulated open-cell foam dressings, and canisters donated by Kinetic Concepts, Inc, San Antonio, Texas, for use at the hospital. This report describes the medical challenges in postearthquake Haiti (including limb salvage and infection), benefits of adjunctive use of NPWT/reticulated open-cell foam, and current wound care status in a Haitian orthopedic hospital. The future role of NPWT in Haiti and during mass catastrophe in a least-developed country is also discussed. PMID:21926673

  14. The Haiti earthquake: the provision of wound care for mass casualties utilizing negative-pressure wound therapy.

    PubMed

    Gabriel, Allen; Gialich, Shelby; Kirk, Julie; Edwards, Sheriden; Beck, Brooke; Sorocéanu, Alexandra; Nelson, Scott; Gabriel, Cassie; Gupta, Subhas

    2011-10-01

    Many months after the devastating earthquake in January 2010, wounds remain a major disease burden in Haiti. Since January 2010, through the efforts of corporations, nonprofit charitable organizations, and medical professionals, advanced wound care techniques, including negative-pressure wound therapy (NPWT), have been introduced into the wound care regimens of various hospitals in Haiti. In June 2010, the authors completed their second volunteer trip at a Haitian hospital specializing in orthopedic wounds. The medical team was composed of a plastic surgeon, orthopedic surgeon, anesthesiologist, medical assistant, scrub technician, and registered nurse (specializing in plastic surgery and orthopedics). The authors' team supplied NPWT devices, reticulated open-cell foam dressings, and canisters donated by Kinetic Concepts, Inc, San Antonio, Texas, for use at the hospital. This report describes the medical challenges in postearthquake Haiti (including limb salvage and infection), benefits of adjunctive use of NPWT/reticulated open-cell foam, and current wound care status in a Haitian orthopedic hospital. The future role of NPWT in Haiti and during mass catastrophe in a least-developed country is also discussed.

  15. Androgen actions in mouse wound healing: Minimal in vivo effects of local antiandrogen delivery.

    PubMed

    Wang, Yiwei; Simanainen, Ulla; Cheer, Kenny; Suarez, Francia G; Gao, Yan Ru; Li, Zhe; Handelsman, David; Maitz, Peter

    2016-05-01

    The aims of this work were to define the role of androgens in female wound healing and to develop and characterize a novel wound dressing with antiandrogens. Androgens retard wound healing in males, but their role in female wound healing has not been established. To understand androgen receptor (AR)-mediated androgen actions in male and female wound healing, we utilized the global AR knockout (ARKO) mouse model, with a mutated AR deleting the second zinc finger to disrupt DNA binding and transcriptional activation. AR inactivation enhanced wound healing rate in males by increasing re-epithelialization and collagen deposition even when wound contraction was eliminated. Cell proliferation and migration in ARKO male fibroblasts was significantly increased compared with wild-type (WT) fibroblasts. However, ARKO females showed a similar healing rate compared to WT females. To exploit local antiandrogen effects in wound healing, while minimizing off-target systemic effects, we developed a novel electrospun polycaprolactone (PCL) scaffold wound dressing material for sustained local antiandrogen delivery. Using the antiandrogen hydroxyl flutamide (HF) at 1, 5, and 10 mg/mL in PCL scaffolds, controlled HF delivery over 21 days significantly enhanced in vitro cell proliferation of human dermal fibroblasts and human keratinocytes. HF-PCL scaffolds also promoted in vivo wound healing in mice compared with open wounds but not to PCL scaffolds. PMID:26873751

  16. Efficacy of Annona squamosa on wound healing in streptozotocin-induced diabetic rats.

    PubMed

    Ponrasu, Thangavel; Suguna, Lonchin

    2012-12-01

    Annona squamosa L. (Annonaceae), commonly known as custard apple, mainly used for its edible fruit, is also recognised with numerous medicinal properties. As there is no report on the efficacy of this plant for wound healing, we examined the efficacy of ethanolic extract of A. squamosa leaves on wound repair in streptozotocin-nicotinamide-induced diabetic rats. Open excision wounds were made on the back of rats. The drug at a dosage of 100 mg/kg body wt was reconstituted in 200 µl of phosphate buffered saline and applied topically once daily for the treated wounds. The control wounds were left untreated. Wound tissues formed on days 4, 8, 12 and 16 (post-wound) were used to estimate DNA, total protein, total collagen, hexosamine and uronic acid. Levels of lipid peroxides were also evaluated along with tensile strength and period of epithelialisation. A. squamosa L. increased cellular proliferation and collagen synthesis at the wound site as evidenced by increase in DNA, protein and total collagen. The treated wounds were observed to heal much faster as proved by enhanced rates of epithelialisation and wound contraction, which was also confirmed by histopathological examinations. The results strongly substantiate the beneficial effects of the topical application of A. squamosa L. in the acceleration of normal and diabetic wound healing. PMID:22233431

  17. Effect of discarded keratin-based biocomposite hydrogels on the wound healing process in vivo.

    PubMed

    Park, Mira; Shin, Hye Kyoung; Kim, Byoung-Suhk; Kim, Myung Jin; Kim, In-Shik; Park, Byung-Yong; Kim, Hak-Yong

    2015-10-01

    Biocompatible keratin-based hydrogels prepared by electron beam irradiation (EBI) were examined in wound healing. As the EBI dose increased to 60 kGy, the tensile strength of the hydrogels increased, while the percentage of elongation of the hydrogels decreased. After 7 days, the dehydrated wool-based hydrogels show the highest mechanical properties (the % elongation of 1341 and the tensile strength of 6030 g/cm(2) at an EBI dose of 30 kGy). Excision wound models were used to evaluate the effects of human hair-based hydrogels and wool-based hydrogels on various phases of healing. On post-wounding days 7 and 14, wounds treated with either human hair-based or wool-based hydrogels were greatly reduced in size compared to wounds that received other treatments, although the hydrocolloid wound dressing-treated wound also showed a pronounced reduction in size compared to an open wound as measured by a histological assay. On the 14th postoperative day, the cellular appearances were similar in the hydrocolloid wound dressing and wool-based hydrogel-treated wounds, and collagen fibers were substituted with fibroblasts and mixed with fibroblasts in the dermis. Furthermore, the wound treated with a human hair-based hydrogel showed almost complete epithelial regeneration, with the maturation of immature connective tissue and hair follicles and formation of a sebaceous gland.

  18. Efficacy of Annona squamosa on wound healing in streptozotocin-induced diabetic rats.

    PubMed

    Ponrasu, Thangavel; Suguna, Lonchin

    2012-12-01

    Annona squamosa L. (Annonaceae), commonly known as custard apple, mainly used for its edible fruit, is also recognised with numerous medicinal properties. As there is no report on the efficacy of this plant for wound healing, we examined the efficacy of ethanolic extract of A. squamosa leaves on wound repair in streptozotocin-nicotinamide-induced diabetic rats. Open excision wounds were made on the back of rats. The drug at a dosage of 100 mg/kg body wt was reconstituted in 200 µl of phosphate buffered saline and applied topically once daily for the treated wounds. The control wounds were left untreated. Wound tissues formed on days 4, 8, 12 and 16 (post-wound) were used to estimate DNA, total protein, total collagen, hexosamine and uronic acid. Levels of lipid peroxides were also evaluated along with tensile strength and period of epithelialisation. A. squamosa L. increased cellular proliferation and collagen synthesis at the wound site as evidenced by increase in DNA, protein and total collagen. The treated wounds were observed to heal much faster as proved by enhanced rates of epithelialisation and wound contraction, which was also confirmed by histopathological examinations. The results strongly substantiate the beneficial effects of the topical application of A. squamosa L. in the acceleration of normal and diabetic wound healing.

  19. Thiolated Carboxymethyl-Hyaluronic-Acid-Based Biomaterials Enhance Wound Healing in Rats, Dogs, and Horses

    PubMed Central

    Yang, Guanghui; Prestwich, Glenn D.; Mann, Brenda K.

    2011-01-01

    The progression of wound healing is a complicated but well-known process involving many factors, yet there are few products on the market that enhance and accelerate wound healing. This is particularly problematic in veterinary medicine where multiple species must be treated and large animals heal slower, oftentimes with complicating factors such as the development of exuberant granulation tissue. In this study a crosslinked-hyaluronic-acid (HA-) based biomaterial was used to treat wounds on multiple species: rats, dogs, and horses. The base molecule, thiolated carboxymethyl HA, was first found to increase keratinocyte proliferation in vitro. Crosslinked gels and films were then both found to enhance the rate of wound healing in rats and resulted in thicker epidermis than untreated controls. Crosslinked films were used to treat wounds on forelimbs of dogs and horses. Although wounds healed slower compared to rats, the films again enhanced wound healing compared to untreated controls, both in terms of wound closure and quality of tissue. This study indicates that these crosslinked HA-based biomaterials enhance wound healing across multiple species and therefore may prove particularly useful in veterinary medicine. Reduced wound closure times and better quality of healed tissue would decrease risk of infection and pain associated with open wounds. PMID:23738117

  20. A Novel Surgical Pre-suturing Technique for the Management of Ankyloglossia

    PubMed Central

    Khairnar, Mayur; Pawar, Babita; Khairnar, Darshana

    2014-01-01

    Ankyloglossia or “tongue-tie” is a congenital anomaly caused by tight lingual frenulum that abnormally connects the tongue base to the floor of the mouth. Ankyloglossia can results in difficulty during speech and deglutition. This case series presents a novel surgical technique in the management of ankyloglossia in using presuturing technique in which different sets of sutures are given on lingual frenum before severing it. This results in reduced opening of the wound, minimal bleeding, pain and discomfort. Two male patients with severe ankyloglossia had been managed with this technique and after 2 years of follow-up of these cases showed satisfactory protrusive and lateral movement of the tongue with minimal scarring and discomfort. PMID:25598942

  1. Gunshot wounds to the thigh. Evaluation of vascular and subclinical vascular injuries.

    PubMed

    Payne, W K; Gabriel, R A; Massoud, R P

    1995-01-01

    A retrospective review of 173 patient charts, angiograms, surgical reports, and plain radiographs were performed for all patients admitted with gunshot wounds to the thigh from May 1988 to January 1991 at Martin Luther King, Jr. Hospital. A zonal classification of gunshot wounds to the thigh was created and defined to determine if a zonal classification was predictive of a positive angiogram. Associations and relationships of patients with vascular injury are presented.

  2. Bedside placement of polyglycolic acid mesh: a novel treatment of uncomplicated abdominal wound dehiscence.

    PubMed

    Chendrasekhar, A

    1996-01-01

    Uncomplicated abdominal wound dehiscence is a common problem in critically ill patients undergoing general surgical procedures. In the past, a majority of these patients have been subjected to an emergency return to the operating room for wound closure to prevent evisceration. In this article, we present two successful cases of a novel bedside approach using local anesthesia and polyglycolic acid mesh in uncomplicated abdominal dehiscence to prevent evisceration.

  3. Monitoring combat wound healing by IR hyperspectral imaging

    NASA Astrophysics Data System (ADS)

    Howle, Chris R.; Spear, Abigail M.; Gazi, Ehsan; Crane, Nicole J.

    2016-03-01

    In recent conflicts, battlefield injuries consist largely of extensive soft injuries from blasts and high energy projectiles, including gunshot wounds. Repair of these large, traumatic wounds requires aggressive surgical treatment, including multiple surgical debridements to remove devitalised tissue and to reduce bacterial load. Identifying those patients with wound complications, such as infection and impaired healing, could greatly assist health care teams in providing the most appropriate and personalised care for combat casualties. Candidate technologies to enable this benefit include the fusion of imaging and optical spectroscopy to enable rapid identification of key markers. Hence, a novel system based on IR negative contrast imaging (NCI) is presented that employs an optical parametric oscillator (OPO) source comprising a periodically-poled LiNbO3 (PPLN) crystal. The crystal operates in the shortwave and midwave IR spectral regions (ca. 1.5 - 1.9 μm and 2.4 - 3.8 μm, respectively). Wavelength tuning is achieved by translating the crystal within the pump beam. System size and complexity are minimised by the use of single element detectors and the intracavity OPO design. Images are composed by raster scanning the monochromatic beam over the scene of interest; the reflection and/or absorption of the incident radiation by target materials and their surrounding environment provide a method for spatial location. Initial results using the NCI system to characterise wound biopsies are presented here.

  4. Wound healing: part II. Clinical applications.

    PubMed

    Janis, Jeffrey; Harrison, Bridget

    2014-03-01

    Treatment of all wounds requires adequate wound bed preparation, beginning with irrigation and débridement. Complicated or chronic wounds may also require treatment adjuncts or specialized wound healing products. An extensive body of research and development has introduced novel wound healing therapies and scar management options. In this second of a two-part continuing medical education series on wound healing, the reader is offered an update on current wound healing technologies and recommendations for obtaining optimal outcomes.

  5. A Cross-sectional, Descriptive, Quality Improvement Project to Assess Undergraduate Nursing Students' Clinical Exposure to Patients With Wounds in an Introductory Nursing Course.

    PubMed

    Pieper, Barbara; Keves-Foster, Mary Kathryn; Ashare, JoAnn; Zugcic, Mary; Albdour, Maha; Albdour, Dalia

    2016-04-01

    Because nurses frequently participate in decisions related to wound care, learning about wounds and their care during undergraduate education is critical. A cross-sectional, descriptive, quality improvement project was conducted in an introductory baccalaureate nursing course to identify: 1) the types of patients with wounds assigned to beginning students, 2) patient wound care procedures and dressings, and 3) student level of participation in wound care. Data were collected from the weekly notes recorded about students' (N = 49) patient care experiences in 3 acute care hospitals for 9 clinical days during 1 semester. Data were recorded on a paper-and-pencil form by instructors at the end of the clinical day and included type of wound, wound irrigation, dressing, technique of care, and student's participation. Descriptive statistics were used to examine the frequency and distribution of the wound characteristics and care assessed. Of the 284 patients assigned to students, 75 (26.4%) had a wound. The most common wound was a surgical incision (49, 65%) and was closed (36, 73.5%). Twenty-six (26) patients had a pressure ulcer, most commonly Stage II. The most common dressing was dry gauze (29). Damp gauze was used on 18 wounds. Wound irrigation was recorded for 24 wound protocols and performed with a bulb syringe or by pouring the solution from a container. Generally, nonsterile wound care was performed. Twenty-five (25) students performed wound care with the instructor, 16 watched the care performed by another clinician, and 10 participated with another nurse in the wound care. For 22 patients, the wound care was neither observed nor performed because either it was not time for the dressing to be changed or it was only to be changed by a medical team. From these data, it was concluded beginning nursing students had some, but limited, clinical experience with patients with wounds. Students' wound care experiences need further examination, especially across multiple

  6. Removal of adhesive wound dressing and its effects on the stratum corneum of the skin: comparison of eight different adhesive wound dressings.

    PubMed

    Matsumura, Hajime; Imai, Ryutaro; Ahmatjan, Niyaz; Ida, Yukiko; Gondo, Masahide; Shibata, Dai; Wanatabe, Katsueki

    2014-02-01

    In recent years, adhesive wound dressings have been increasingly applied postoperatively because of their ease of use as they can be kept in place without having to cut and apply surgical tapes and they can cover a wound securely. However, if a wound dressing strongly adheres to the wound, a large amount of stratum corneum is removed from the newly formed epithelium or healthy periwound skin. Various types of adhesives are used on adhesive wound dressings and the extent of skin damage depends on how much an adhesive sticks to the wound or skin surface. We quantitatively determined and compared the amount of stratum corneum removed by eight different wound dressings including polyurethane foam using acrylic adhesive, silicone-based adhesive dressing, composite hydrocolloid and self-adhesive polyurethane foam in healthy volunteers. The results showed that wound dressings with silicone adhesive and self-adhesive polyurethane foam removed less stratum corneum, whereas composite hydrocolloid and polyurethane foam using acrylic adhesive removed more stratum corneum.

  7. Clinical challenges of chronic wounds: searching for an optimal animal model to recapitulate their complexity

    PubMed Central

    Nunan, Robert; Harding, Keith G.; Martin, Paul

    2014-01-01

    The efficient healing of a skin wound is something that most of us take for granted but is essential for surviving day-to-day knocks and cuts, and is absolutely relied on clinically whenever a patient receives surgical intervention. However, the management of a chronic wound – defined as a barrier defect that has not healed in 3 months – has become a major therapeutic challenge throughout the Western world, and it is a problem that will only escalate with the increasing incidence of conditions that impede wound healing, such as diabetes, obesity and vascular disorders. Despite being clinically and molecularly heterogeneous, all chronic wounds are generally assigned to one of three major clinical categories: leg ulcers, diabetic foot ulcers or pressure ulcers. Although we have gleaned much knowledge about the fundamental cellular and molecular mechanisms that underpin healthy, acute wound healing from various animal models, we have learned much less about chronic wound repair pathology from these models. This might largely be because the animal models being used in this field of research have failed to recapitulate the clinical features of chronic wounds. In this Clinical Puzzle article, we discuss the clinical complexity of chronic wounds and describe the best currently available models for investigating chronic wound pathology. We also assess how such models could be optimised to become more useful tools for uncovering pathological mechanisms and potential therapeutic treatments. PMID:25359790

  8. [Traumatic wound botulism].

    PubMed

    Moreno, Emilia; Pannocchia, Cecilia; Carricondo, Concepción

    2014-04-01

    Botulism is a rare illness caused by a potent neurotoxin produced by the bacterium of the Clostridium family. Clostridium botulinum is the most frequent one, but Clostridium baratti and Clostridium butyricum are also neurotoxins producers. There are seven neurotoxins types, A to G; A, B, E, F and G cause human botulism. Every neurotoxin type blocks cholinergic transmission at the myoneural junction. The least frequent syndrome results from Clostridium botulinum colonization of a wound and it is clinically similar to the other botulism syndromes, but with fever due to an infected wound. Disease should be suspected in lucid patient with a symmetric descending, flaccid paralysis. This syndrome appears within the first twenty days, but it could be present for weeks or months before the disease is diagnosed. This disease is poorly known, so to be diagnosed it requires a high index of suspicion. The treatment is a supportive one; administration of the specific antitoxin must be early in order to neutralize the toxin before the debridement and cleaning of the infected wound.

  9. The Burn Wound Microenvironment

    PubMed Central

    Rose, Lloyd F.; Chan, Rodney K.

    2016-01-01

    Significance: While the survival rate of the severely burned patient has improved significantly, relatively little progress has been made in treatment or prevention of burn-induced long-term sequelae, such as contraction and fibrosis. Recent Advances: Our knowledge of the molecular pathways involved in burn wounds has increased dramatically, and technological advances now allow large-scale genomic studies, providing a global view of wound healing processes. Critical Issues: Translating findings from a large number of in vitro and preclinical animal studies into clinical practice represents a gap in our understanding, and the failures of a number of clinical trials suggest that targeting single pathways or cytokines may not be the best approach. Significant opportunities for improvement exist. Future Directions: Study of the underlying molecular influences of burn wound healing progression will undoubtedly continue as an active research focus. Increasing our knowledge of these processes will identify additional therapeutic targets, supporting informed clinical studies that translate into clinical relevance and practice. PMID:26989577

  10. Clinician perceptions of wound biofilm.

    PubMed

    Metcalf, Daniel G; Bowler, Philip G

    2016-10-01

    In wound care today, biofilm is a subject area of great interest and debate. There is an increasing awareness that biofilm exists in the majority of non-healing wounds, and that it is implicated in both recalcitrance and infection. Together with the presence of devitalised host tissue, biofilm is recognised as a component of the wound environment that requires removal to enable wound progression. However, uncertainty exists among wound care practitioners regarding confirmation of the presence of biofilm, and how best to remove biofilm from a non-healing wound. While recent efforts have been taken to assist practitioners in signs and symptoms of wound biofilm, continuing research is required to characterise and confirm wound biofilm. This research was conducted as part of a market research process to better understand the knowledge levels, experiences, clinical awareness and impact of biofilm in wound care, which was undertaken across the USA and Europe. While knowledge levels and experiences vary from country to country, certain wound characteristics were consistently associated with the presence of biofilm.

  11. Polypragmasia in the therapy of infected wounds - conclusions drawn from the perspectives of low temperature plasma technology for plasma wound therapy.

    PubMed

    Kramer, Axel; Hübner, Nils-Olaf; Weltmann, Klaus-Dieter; Lademann, Jürgen; Ekkernkamp, Axel; Hinz, Peter; Assadian, Ojan

    2008-11-03

    As long as a wound is infected, the healing process cannot begin. The indication for wound antiseptic is dependent on the interaction between the wound, the causative micro-organisms, and the host immune system. An uncritical colonisation is a condition whereby micro-organisms on a wound will proliferate, yet the immune system will not react excessively. Wound antiseptic is most often not necessary unless for epidemiologic reasons like colonisation with multi-resistant organisms. In most instances of a microbial contamination of the wound and colonisation, thorough cleaning will be sufficient.Bacterial counts above 10(5) to 10(6) cfu per gram tissue (critical colonisation) might decrease wound healing due to release of toxins, particularly in chronic wounds. Traumatic and heavily contaminated wounds therefore will require anti-infective measures, in particular wound antiseptic. In such situations, even a single application of an antiseptic compound will significantly reduce the number of pathogens, and hence, the risk of infection. If a wound infection is clinically manifest, local antiseptics and systemic antibiotics are therapeutically indicated.The prophylactic and therapeutic techniques for treatment of acute and chronic wounds (chemical antiseptics using xenobiotics or antibiotics, biological antiseptic applying maggots, medical honey or chitosan, physical antiseptic using water-filtered infrared A, UV, or electric current) mostly have been empirically developed without establishing a fundamental working hypothesis for their effectiveness.The most important aspect in controlling a wound infection and achieving healing of a wound is meticulous debridement of necrotic material. This is achieved by surgical, enzymatic or biological means e.g. using maggots. However, none of these methods (with some exception for maggots) is totally gentle to vital tissue and particularly chemical methods possess cytotoxicity effects.DERIVED FROM THE GENERAL PRINCIPLES OF

  12. Methicillin-resistant Staphylococcus aureus infection in vascular surgical patients.

    PubMed Central

    Murphy, G. J.; Pararajasingam, R.; Nasim, A.; Dennis, M. J.; Sayers, R. D.

    2001-01-01

    BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infection is emerging as a major problem in vascular surgical practice. The aim of this study was to review the management of patients with MRSA infection complicating vascular surgical operations. METHODS: Data were obtained from the vascular audit, case notes, intensive therapy unit (ITU) notes, high dependency unit (HDU) notes and microbiological records of patients who underwent either arterial reconstruction (n = 464) or limb amputation (n = 110) between April 1994 and October 1998. RESULTS: Forty-nine vascular surgical patients developed clinical MRSA infection (9%). Clinical MRSA infection in patients who had undergone aorto-iliac reconstruction (n = 18) was associated with a 56% mortality (n = 10) and the most common infections were bacteraemia (55%) and pneumonia (50%). MRSA infection occurred in 17 patients who had undergone infra-inguinal bypass and was associated with a 29% mortality (n = 5). The most common site of MRSA infection was the groin wound (76%) leading to anastomotic dehiscence and death in one patient (11%) and necessitating wound debridement in 4 patients (22%). MRSA infection of the groin wound in the presence of a prosthetic graft (n = 3) led to anastomotic dehiscence in 2 patients, and graft excision in 2 patients. Similar complications were not observed in the presence of an underlying autogeneous long saphenous vein graft (n = 16). MRSA infection following major lower limb amputation (n = 14) was associated with death in 5 patients (36%). Wound infection in 10 amputees (71%) led to revision of the amputation to a higher level in 2 (14%) and wound debridement in 2 (14%). CONCLUSIONS: MRSA infection has a high mortality in vascular surgical patients in general, and following aorto-iliac reconstruction in particular. Autogeneous vein may confer some protection against local complications following groin wound infection. Strategies aimed at reducing the incidence of infection

  13. Methods of Advanced Wound Management for Care of Combined Traumatic and Chemical Warfare Injuries

    PubMed Central

    Graham, John S.; Gerlach, Travis W.; Logan, Thomas P.; Bonar, James P.; Fugo, Richard J.; Lee, Robyn B.; Coatsworth, Matthew A.

    2008-01-01

    Objective: Chemical warfare agents are potential threats to military personnel and civilians. The potential for associated traumatic injuries is significant. Damage control surgery could expose medical personnel to agents contaminating the wounds. The objectives of this study were to demonstrate efficacy of surgical decontamination and assess exposure risk to attending personnel. Methods: Weanling pigs were randomly assigned to 2 of 4 debridement tools (scalpel, Bovie® knife, Fugo Blade®, and Versajet™ Hydrosurgery System). Penetrating traumatic wounds were created over the shoulder and thigh and then exposed to liquid sulfur mustard (HD) for 60 minutes. Excisional debridement of the injuries was performed while vapors over each site were collected. Gas chromatography was used to measure HD in samples of collected vapors. Unbound HD was quantified in presurgical wound swabs, excised tissues, and peripheral tissue biopsies following solvent extraction. Results: Excisional debridement produced agent-free wound beds (surgical decontamination). A significant amount of HD vapor was detected above the surgical fields with each tool. Apart from the Versajet™ producing significantly lower levels of HD detected over thigh wounds compared with those treated using the scalpel, there were no differences in the amount of agent detected among the tools. All measured levels significantly exceeded established safety limits. Vesicating levels of unbound HD were extracted from excised tissue. There was no measured lateral spreading of HD beyond the surgical margins. Conclusions: There is significant occupational exposure risk to HD during surgical procedures designed to stabilize agent-contaminated wounds. If appropriate protective measures are taken, surgical decontamination is both effective and safe. PMID:18716652

  14. Postoperative continuous wound infusion of ropivacaine has comparable analgesic effects and fewer complications as compared to traditional patient-controlled analgesia with sufentanil in patients undergoing non-cardiac thoracotomy

    PubMed Central

    Liu, Fang-Fang; Liu, Xiao-Ming; Liu, Xiao-Yu; Tang, Jun; Jin, Li; Li, Wei-Yan; Zhang, Li-Dong

    2015-01-01

    Objective: To compare the postoperative analgesic effects of continuous wound infusion of ropivacaine with traditional patient-controlled analgesia (PCA) with sufentanil after non-cardiac thoracotomy. Methods: One hundred and twenty adult patients undergoing open thoracotomy were recruited into this assessor-blinded, randomized study. Patients were randomly assigned to receive analgesia through a wound catheter placed below the fascia and connected to a 2 ml/h ropivacaine 0.5% (RWI group) or sufentanil PCA (SPCA group). Analgesia continued for 48 h. Visual analogue scores (VAS) at rest and movement, Ramsay scores and adverse effects were recorded at 2, 8, 12, 24, 36 and 48 h after surgery. Three months after discharge, patient’s satisfaction, residual pain and surgical wound complications were assessed. Results: General characteristics of patients were comparable between two groups. There were no statistical differences in the VAS scores and postoperative pethidine consumption between two groups (P > 0.05). However, when compared with SPCA group, the incidences of drowsiness, dizziness and respiratory depression, ICU stay and hospital expenditure reduced significantly in RWI group (P < 0.05). Patients’ satisfaction with pain management was also improved markedly in RWI group (P < 0.05). Conclusion: Continuous wound infusion with ropivacaine is effective for postoperative analgesia and has comparable effects to traditional PCA with sufentanil. Furthermore, this therapy may also reduce the incidences of drowsiness, dizziness, respiratory depression and decrease the ICU stay and hospital expenditure. PMID:26131121

  15. Micronutrients, Arginine, and Glutamine: Does Supplementation Provide an Efficient Tool for Prevention and Treatment of Different Kinds of Wounds?

    PubMed Central

    Ellinger, Sabine

    2014-01-01

    Significance: Wound-healing complications are a clinical problem with a considerable socioeconomic burden. Since several nutrients play a physiological role in wound healing, supplementation of these nutrients may improve wound healing. Recent Advances: Oral nutritional supplements and enteral formulas providing arginine, glutamine, and micronutrients such as ascorbic acid and zinc should improve the healing of pressure ulcers (PU) and the healing of surgical, traumatic, and burned wounds. Is their efficacy proved from clinical intervention trials? Critical Issues: Formulas that are rich in energy, protein, arginine, vitamin C, and zinc can improve PU healing, whereas their efficacy for PU prevention is less clear. High-dose supplementation of vitamin C, zinc, and pantothenic acid may improve the healing of surgical wounds in healthy subjects. Arginine lowers the risk of fistulas in patients undergoing elective surgery due to gastrointestinal cancer. However, formulations also enriched with n-3–fatty acids and ribonucleic acids lower the risk of several wound complications, thus being more effective than isolated arginine. Glutamine and antioxidant micronutrients (vitamin C and E, zinc, selenium, and copper) can improve the healing of surgical, traumatic, and burned wounds. Future Directions: Considerable evidence suggests that formulations, indicated especially for critically ill patients, support the healing of PU and the healing of surgical and burned wounds. However, their optimal composition with regard to the dose of individual components has to be determined in future studies. Further well-designed trials should investigate the impact of certain nutrients for the prevention of PU and for the healing of surgical wounds in healthy subjects. PMID:25371852

  16. [Wounded patients transportation during peace enforcement operation in Georgia (August 2008)].

    PubMed

    Kotenko, P K; Pak, R V; Golovinova, V Iu

    2014-09-01

    The article highlights the analysis of wounded movement during peace enforcement operation in Georgia (August 2008). 72% of incoming patients were walking wounded; 97,5% male patients, 2,5% female patients; per cent of combat surgery pathology - 90,2% including combat surgical trauma 83,2%, general surgical diseases - 7%, combat therapeutic pathology - 9,8%; leading gunshot traumas in walking wounded are lower extremities injuries - 33,6%, upper extremities injuries - 27,9% (in total 61,5%), head injuries - 25,4%. Within combat therapeutic pathology walking wounded suffered from the following classes of diseases/sicknesses - I class - 35,7%, XII class - 14,3%, V class - 10,7%. 236 military hospitals (In Vladikavkaz) had admitted 71,2% of walking wounded (of incoming traffic), 1458 military hospitals (in Mozdok) had admitted 91,7% of walking wounded from front traffic, flank traffic was 100%. 49, 7% of patients finished the treatment in military hospitals of zone level, 47,9% of patients - in hospitals of district level, 2,4% of patients - in central hospitals. The,average duration of the treatment of walking wounded in hospitals of zone level consisted 16,9±0,7 days, no lethal outcomes were registered. PMID:25546962

  17. Ward nurses' use of wound dressings before and after a bespoke education programme.

    PubMed

    Smith, G; Greenwood, M; Searle, R

    2010-09-01

    A survey of ward nurses in medical, surgical, orthopaedic and rehabilitation specialties in relation to their care of wounds and their choice and use of wound dressings was carried out in May and August 2009 at St Mary's Hospital. Isle of Wight, UK. The objectives were to find out the distribution of wound types, and their characteristics, that were treated by ward nurses in the hospital, and to assess clinical practice in the use of wound dressings, before and after a bespoke programme of education and training. A visual framework to aid the ward nurses in the choice of dressings and frequency of change was introduced after the May 2009 survey. Following the nurses' education and training programme a repeat survey, using the same methodology, was conducted in August 2009. In the initial survey, 172 wounds were included (mean number of wounds per patient 1.64) and in the repeat one, 159 (mean number of wounds per patient 1.54). In both phases of the survey, the most common wound type was pressure ulcers, followed by surgical wounds; over 60% of the wounds were pressure ulcers, of which around half were category 1, and one-third were category 2. No category 4 ulcers were recorded. About one-third of the wounds had a duration of more than 21 days. On average, wound dressings were left in place for between two and three days, with 35% of dressings being changed on a daily basis. The mean cost of dressings per wound per week was observed to be lower in the repeat survey than in the initial one (£9.02 and £11.23 respectively). The number of undesirable reasons for changing the dressing was lower in the second phase than the first. The methodology of the surveys provided meaningful and valuable results over a short timescale, and increased understanding of wound types, their characteristics, and clinical practice. The surveys showed that data that can be collected in a short period using a simple tool can yield complex and revealing data trends. They also showed that

  18. Attempts to accelerate wound healing.

    PubMed

    Kasuya, Akira; Tokura, Yoshiki

    2014-12-01

    Wound healing is a well-orchestrated process, where numerous factors are activated or inhibited in a sequence of steps. Immediately after the infliction of damage, the repair of wound stars. The initial step is an inflammatory change with activation of innate immunity, which is followed by proliferation phase, including fibroplasia, angiogenesis and re-epithelialization. Pathological impairment of wound healing process may lead to persistent ulceration as seen in diabetic patients. Various signaling pathways are involved in wound healing. TGFβ/Smad pathway is a representative and well known to participate in fibroplasia, however, its comprehensive effect on wound healing is controversial. Experimental and clinical remedies have been being tried to promote wound healing. Advancement of cell engineering allows us to use stem cells and living skin equivalents.

  19. Xenogenic (porcine) acellular dermal matrix promotes growth of granulation tissues in the wound healing of Fournier gangrene.

    PubMed

    Zhang, Zhaoxin; Lv, Lei; Mamat, Masut; Chen, Zhao; Zhou, Zhitao; Liu, Lihua; Wang, Zhizhong

    2015-01-01

    This article investigates the application values of Xenogenic (porcine) acellular dermal matrix (XADM) in preparation of a Fournier gangrene wound bed. Thirty-six consecutive cases of patients with Fournier gangrene between 2002 and 2012 were enrolled in our department of our hospital. The patients were divided into two groups according to different methods of wound bed preparation after surgical débridement, including the experimental group (17 cases) and the control group (19 cases). The wounds in the experimental group were covered with XADM after surgical wound débridement, whereas the wounds were cleaned with hydrogen peroxide and sodium hypochlorite solution (one time/day) in the control group. The wound bed preparation time and hospital stay were then compared in the two groups. The wound preparation time was 13.64 ± 1.46 days and hospitalization period was 26.06 ± 0.83 days in the experimental XADM group. In the control group, the wound bed preparation time and hospitalization period were 22.37 ± 1.38 and 38.11 ± 5.60 days, respectively. The results showed statistical differences between these two groups. When used in wound débridement after Fournier gangrene, XADM protects interecological organizations, promotes the growth of granulation tissues, and maximally retains function and morphology of the perineum and penis. PMID:25569072

  20. How to make a hospital-based wound center financially viable: the Georgetown University Hospital model.

    PubMed

    Attinger, Christopher E; Hoang, Han; Steinberg, John; Couch, Kara; Hubley, Katherine; Winger, Linda; Kugler, Margaret

    2008-11-01

    As the medical need and expenditure for chronic wound care have increased markedly over the past decade, wound centers have grown exponentially throughout the country. They can be community-based or hospital-based, and in either case, can be run by the facility or by a national chain. The wound center's viability is dependent on generated revenue, and its clinical effectiveness is based on a multidisciplinary approach to wound care. By incorporating the wound center into an existing hospital system, one can take advantage of the hospital's resources to effectively treat the more complex patients. Additionally, by focusing on limb salvage, the hospital attracts the critical limb ischemia and other complex patients that often require inpatient admission. We examined the Georgetown University Hospital Center for Wound Healing performance over the first 6 years of operation. Since opening the wound center in 1999, the number of outpatient visits has doubled, the wound care inpatient census has doubled, and the operative cases have increased 3-fold. Because the outpatient segment of the wound center can at best cover its direct cost, it cannot financially justify its existence. Hyperbaric oxygen (HBO) can increase the revenue to the point where the indirect costs are covered as well and the wound center can be revenue neutral. Due to the medical complexity of limb salvage patients, the inpatient collections are much higher than those of the outpatient wound center and therefore can serve as justification for the latter's financial viability. More importantly, with the wound center in place, the hospital can provide the local/regional community with a comprehensive service that can effectively treat the most challenging wounds. The success is built on a multidisciplinary team approach, use of evidence-based treatment protocols, efficient clinical structure, and a supportive hospital system. The beneficiaries include the patient with a healed wound, the physician with a

  1. Radiation combined injury models to study the effects of interventions and wound biomechanics.

    PubMed

    Zawaski, Janice A; Yates, Charles R; Miller, Duane D; Kaffes, Caterina C; Sabek, Omaima M; Afshar, Solmaz F; Young, Daniel A; Yang, Yunzhi; Gaber, M Waleed

    2014-12-01

    In the event of a nuclear detonation, a considerable number of projected casualties will suffer from combined radiation exposure and burn and/or wound injury. Countermeasure assessment in the setting of radiation exposure combined with dermal injury is hampered by a lack of animal models in which the effects of interventions have been characterized. To address this need, we used two separate models to characterize wound closure. The first was an open wound model in mice to study the effect of wound size in combination with whole-body 6 Gy irradiation on the rate of wound closure, animal weight and survival (morbidity). In this model the addition of interventions, wound closure, subcutaneous vehicle injection, topical antiseptic and topical antibiotics were studied to measure their effect on healing and survival. The second was a rat closed wound model to study the biomechanical properties of a healed wound at 10 days postirradiation (irradiated with 6 or 7.5 Gy). In addition, complete blood counts were performed and wound pathology by staining with hematoxylin and eosin, trichrome, CD68 and Ki67. In the mouse open wound model, we found that wound size and morbidity were positively correlated, while wound size and survival were negatively correlated. Regardless of the wound size, the addition of radiation exposure delayed the healing of the wound by approximately 5-6 days. The addition of interventions caused, at a minimum, a 30% increase in survival and improved mean survival by ∼9 days. In the rat closed wound model we found that radiation exposure significantly decreased all wound biomechanical measurements as well as white blood cell, platelet and red blood cell counts at 10 days post wounding. Also, pathological changes showed a loss of dermal structure, thickening of dermis, loss of collagen/epithelial hyperplasia and an increased density of macrophages. In conclusion, we have characterized the effect of a changing wound size in combination with radiation

  2. Robotic, laparoscopic and open surgery for gastric cancer compared on surgical, clinical and oncological outcomes: a multi-institutional chart review. A study protocol of the International study group on Minimally Invasive surgery for GASTRIc Cancer—IMIGASTRIC

    PubMed Central

    Desiderio, Jacopo; Jiang, Zhi-Wei; Nguyen, Ninh T; Zhang, Shu; Reim, Daniel; Alimoglu, Orhan; Azagra, Juan-Santiago; Yu, Pei-Wu; Coburn, Natalie G; Qi, Feng; Jackson, Patrick G; Zang, Lu; Brower, Steven T; Kurokawa, Yukinori; Facy, Olivier; Tsujimoto, Hironori; Coratti, Andrea; Annecchiarico, Mario; Bazzocchi, Francesca; Avanzolini, Andrea; Gagniere, Johan; Pezet, Denis; Cianchi, Fabio; Badii, Benedetta; Novotny, Alexander; Eren, Tunc; Leblebici, Metin; Goergen, Martine; Zhang, Ben; Zhao, Yong-Liang; Liu, Tong; Al-Refaie, Waddah; Ma, Junjun; Takiguchi, Shuji; Lequeu, Jean-Baptiste; Trastulli, Stefano; Parisi, Amilcare

    2015-01-01

    Introduction Gastric cancer represents a great challenge for healthcare providers and requires a multidisciplinary treatment approach in which surgery plays a major role. Minimally invasive surgery has been progressively developed, first with the advent of laparoscopy and recently with the spread of robotic surgery, but a number of issues are currently being debated, including the limitations in performing an effective extended lymph node dissection, the real advantages of robotic systems, the role of laparoscopy for Advanced Gastric Cancer, the reproducibility of a total intracorporeal technique and the oncological results achievable during long-term follow-up. Methods and analysis A multi-institutional international database will be established to evaluate the role of robotic, laparoscopic and open approaches in gastric cancer, comprising of information regarding surgical, clinical and oncological features. A chart review will be conducted to enter data of participants with gastric cancer, previously treated at the participating institutions. The database is the first of its kind, through an international electronic submission system and a HIPPA protected real time data repository from high volume gastric cancer centres. Ethics and dissemination This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevant laws/regulations. A multicentre study with a large number of patients will permit further investigation of the safety and efficacy as well as the long-term outcomes of robotic, laparoscopic and open approaches for the management of gastric cancer. Trial registration number NCT02325453; Pre-results. PMID:26482769

  3. Management of burn wounds.

    PubMed

    Schiestl, Clemens; Meuli, Martin; Trop, Marija; Neuhaus, Kathrin

    2013-10-01

    Small and moderate scalds in toddlers are still the most frequent thermal injuries the pediatric surgeons have to face today. Over the last years, surgical treatment of these patients has changed in many aspects. Due to new dressing materials and new surgical treatment strategies that are particularly suitable for children, today, far better functional and aesthetic long-term results are possible. While small and moderate thermal injuries can be treated in most European pediatric surgical departments, the severely burned child must be transferred to a specialized, ideally pediatric, burn center, where a well-trained multidisciplinary team under the leadership of a (ideally pediatric) burn surgeon cares for these highly demanding patients. In future, tissue engineered full thickness skin analogues will most likely play an important role, in pediatric burn as well as postburn reconstructive surgery.

  4. Honey: A Biologic Wound Dressing.

    PubMed

    Molan, Peter; Rhodes, Tanya

    2015-06-01

    Honey has been used as a wound dressing for thousands of years, but only in more recent times has a scientific explanation become available for its effectiveness. It is now realized that honey is a biologic wound dressing with multiple bioactivities that work in concert to expedite the healing process. The physical properties of honey also expedite the healing process: its acidity increases the release of oxygen from hemoglobin thereby making the wound environment less favorable for the activity of destructive proteases, and the high osmolarity of honey draws fluid out of the wound bed to create an outflow of lymph as occurs with negative pressure wound therapy. Honey has a broad-spectrum antibacterial activity, but there is much variation in potency between different honeys. There are 2 types of antibacterial activity. In most honeys the activity is due to hydrogen peroxide, but much of this is inactivated by the enzyme catalase that is present in blood, serum, and wound tissues. In manuka honey, the activity is due to methylglyoxal which is not inactivated. The manuka honey used in wound-care products can withstand dilution with substantial amounts of wound exudate and still maintain enough activity to inhibit the growth of bacteria. There is good evidence for honey also having bioactivities that stimulate the immune response (thus promoting the growth of tissues for wound repair), suppress inflammation, and bring about rapid autolytic debridement. There is clinical evidence for these actions, and research is providing scientific explanations for them. PMID:26061489

  5. Accurate documentation and wound measurement.

    PubMed

    Hampton, Sylvie

    This article, part 4 in a series on wound management, addresses the sometimes routine yet crucial task of documentation. Clear and accurate records of a wound enable its progress to be determined so the appropriate treatment can be applied. Thorough records mean any practitioner picking up a patient's notes will know when the wound was last checked, how it looked and what dressing and/or treatment was applied, ensuring continuity of care. Documenting every assessment also has legal implications, demonstrating due consideration and care of the patient and the rationale for any treatment carried out. Part 5 in the series discusses wound dressing characteristics and selection.

  6. [Negative pressure wound therapy dressings].

    PubMed

    Téot, Luc

    2016-01-01

    There are many different forms of negative pressure wound therapy dressings and it is important to distinguish clearly between each type. They enable the treatment to be adapted to the shape and depth of the wound, its degree of exudation and the persistence of the fibrinous areas on the surface. The machine's traction capacity, measured in mm of mercury (Hg), must be controlled to establish the healing profile: the more powerful the machine and the more contact there is between the foam and the wound, the faster the formation of the granulation tissue. There are many different solutions which are implemented in accordance with the clinical assessment of the wound.

  7. Healing in the irradiated wound

    SciTech Connect

    Miller, S.H.; Rudolph, R. )

    1990-07-01

    Poor or nonhealing of irradiated wounds has been attributed to progressive obliterative endarteritis. Permanently damaged fibroblasts may also play an important part in poor healing. Regardless of the cause, the key to management of irradiated skin is careful attention to prevent its breakdown and conservative, but adequate, treatment when wounds are minor. When wounds become larger and are painful, complete excision of the wound or ulcer is called for and coverage should be provided by a well-vascularized nonparasitic distant flap.16 references.

  8. Honey: A Biologic Wound Dressing.

    PubMed

    Molan, Peter; Rhodes, Tanya

    2015-06-01

    Honey has been used as a wound dressing for thousands of years, but only in more recent times has a scientific explanation become available for its effectiveness. It is now realized that honey is a biologic wound dressing with multiple bioactivities that work in concert to expedite the healing process. The physical properties of honey also expedite the healing process: its acidity increases the release of oxygen from hemoglobin thereby making the wound environment less favorable for the activity of destructive proteases, and the high osmolarity of honey draws fluid out of the wound bed to create an outflow of lymph as occurs with negative pressure wound therapy. Honey has a broad-spectrum antibacterial activity, but there is much variation in potency between different honeys. There are 2 types of antibacterial activity. In most honeys the activity is due to hydrogen peroxide, but much of this is inactivated by the enzyme catalase that is present in blood, serum, and wound tissues. In manuka honey, the activity is due to methylglyoxal which is not inactivated. The manuka honey used in wound-care products can withstand dilution with substantial amounts of wound exudate and still maintain enough activity to inhibit the growth of bacteria. There is good evidence for honey also having bioactivities that stimulate the immune response (thus promoting the growth of tissues for wound repair), suppress inflammation, and bring about rapid autolytic debridement. There is clinical evidence for these actions, and research is providing scientific explanations for them.

  9. Electrospun PCL membranes incorporated with biosynthesized silver nanoparticles as antibacterial wound dressings

    NASA Astrophysics Data System (ADS)

    Augustine, Robin; Kalarikkal, Nandakumar; Thomas, Sabu

    2016-03-01

    An open wound is highly prone to bacterial colonization and infection. Bacterial barrier property is an important factor that determines the success of a wound coverage material. Apart from the bacterial barrier property, presence of antibacterial agents can successfully eliminate the invasion and colonization of pathogen in the wound. Silver nanoparticles are well-known antimicrobial agents against a wide range of microorganisms. Biosynthesized silver nanoparticles are more acceptable for medical applications due to superior biocompatibility than chemically synthesized ones. Presence of biomolecules on biosynthesized silver nanoparticles enhances its therapeutic efficiency. Polycaprolactone (PCL) is a well-known material for biomedical applications including wound dressings. Electrospinning is an excellent technique for the fabrication of thin membranes for wound coverage applications with barrier property against microbes. In this paper, we report the fabrication and characterization of electrospun PCL membranes incorporated with biosynthesized silver nanoparticles for wound dressing applications.

  10. Simulation in Surgical Education

    PubMed Central

    de Montbrun, Sandra L.; MacRae, Helen

    2012-01-01

    The pedagogical approach to surgical training has changed significantly over the past few decades. No longer are surgical skills solely acquired through a traditional apprenticeship model of training. The acquisition of many technical and nontechnical skills is moving from the operating room to the surgical skills laboratory through the use of simulation. Many platforms exist for the learning and assessment of surgical skills. In this article, the authors provide a broad overview of some of the currently available surgical simulation modalities including bench-top models, laparoscopic simulators, simulation for new surgical technologies, and simulation for nontechnical surgical skills. PMID:23997671

  11. Psychoanalytic Ethnography and the Transformation of Racially Wounded Communities

    ERIC Educational Resources Information Center

    Stanfield, John H., II

    2006-01-01

    This paper first defines race and related dehumanizing experiences and then explores the history of the study of Blacks in ethnography and in psychoanalysis before addressing the primary focus: psychoanalytical ethnography. Psychoanalytical ethnography is valuable for transforming racially wounded communities into vibrant open communities through…

  12. Distribution assessment comparing continuous and periodic wound instillation in conjunction with negative pressure wound therapy using an agar-based model.

    PubMed

    Rycerz, Anthony M; Slack, Paul; McNulty, Amy K

    2013-04-01

    Negative pressure wound therapy (NPWT) is a widely accepted and effective treatment for various wound types, including complex wounds. Negative pressure with instillation was initially used as a gravity-fed system whereby reticulated, open-cell foam in the wound bed was periodically exposed to cycles of soaking with instillation solution followed by NPWT. Recent publications have alluded to positive outcomes with continuous instillation, where fluid is delivered simultaneously with negative pressure. To evaluate the distribution of instillation solutions to wound beds in conjunction with negative pressure, agar-based models were developed and exposed to coloured instillation solutions to identify exposure intensity via agar staining. This model allowed comparison of continuous- versus periodic-instillation therapy with negative pressure. Continuous instillation at a rate of 30 cc/hour with negative pressure showed isolated exposure of instillation fluid to wound beds in agar wound models with and without undermining and tunnelling. In contrast, periodic instillation illustrated uniform exposure of the additive to the entire wound bed including undermined and tunnel areas, with increased staining with each instillation cycle. These findings suggest that periodic instillation facilitates more uniform exposure throughout the wound, including tunnels and undermining, to instillation solutions, thereby providing therapy consistent with the clinician-ordered treatment.

  13. Mobilised bone marrow-derived cells accelerate wound healing.

    PubMed

    Wang, Yu; Sun, Yu; Yang, Xiao-Yan; Ji, Shi-Zhao; Han, Shu; Xia, Zhao-Fan

    2013-08-01

    Massive skin defects caused by severe burn and trauma are a clinical challenge to surgeons. Timely and effective wound closure is often hindered by the lack of skin donor site. Bone marrow-derived cells (BMDCs) have been shown to 'differentiate' into multiple tissue cells. In this study we focused on the direct manipulation of endogenous BMDCs, avoiding the immunocompatibility issues and complicated cell isolation, purification, identification and amplification procedures in vitro on wound repair. We found that mobilisation of the BMDCs into the circulation significantly increased the amount of BMDCs at the injury site which in turn accelerated healing of large open wound. We used a chimeric green fluorescent protein (GFP) mouse model to track BMDCs and to investigate their role in full-thickness skin excisional wounds. We have shown that bone marrow mobilisation by granulocyte colony stimulating factor (G-CSF) exerted multiple beneficial effects on skin repair, both by increasing the engraftment of BMDCs into the skin to differentiate into multiple skin cell types and by upregulating essential cytokine mRNAs critical to wound repair. The potential trophic effects of G-CSF on bone marrow stem cells to accelerate wound healing could have a significant clinical impact.

  14. Penetrating chest wound: a case report.

    PubMed

    Rourke, L L; McKenzie, F N; Heimbecker, R O

    1977-04-23

    An unusual penetrating chest injury was caused by a ball-point pen. Because of apparent penetration of the heart, preparations were made for an emergency open-heart procedure before emergency thoracotomy was undertaken, with the pen still in situ. The pen had bruised the epicardium but had not penetrated the pericardial sac. After removal of the pen, the wound was closed and a chest tube left in place. Recovery, apart from minor degrees of basal atelectasis, pleural effusion and wound infection, was uneventful. The outcome was consistent with that associated with current aggressive management of penetrating chest injuries. Management is based on three approaches. The primary one is intercostal thoracostomy tube drainage and fluid and blood replacement. In cases of massive hemorrhage or air leak, thoracotomy is necessary. The third approach is to prevent post-traumatic pulmonary insufficiency by using fine, high-efficiency filters during blood transfusion, avoiding excessive administration of intravenous fluids, performing tracheostomy after prolonged endotracheal intubation, and using a volume respirator with positive end-expiratory pressure. The average mortality for penetrating wounds of the heart is 25%.

  15. Wound tube heat exchanger

    DOEpatents

    Ecker, Amir L.

    1983-01-01

    What is disclosed is a wound tube heat exchanger in which a plurality of tubes having flattened areas are held contiguous adjacent flattened areas of tubes by a plurality of windings to give a double walled heat exchanger. The plurality of windings serve as a plurality of effective force vectors holding the conduits contiguous heat conducting walls of another conduit and result in highly efficient heat transfer. The resulting heat exchange bundle is economical and can be coiled into the desired shape. Also disclosed are specific embodiments such as the one in which the tubes are expanded against their windings after being coiled to insure highly efficient heat transfer.

  16. Efficacy of Antibiotics Sprayed into Surgical Site for Prevention of the Contamination in the Spinal Surgery

    PubMed Central

    Suh, Bo-Kyung; Moon, Seong-Hwan; Kim, Tae-Hwan; Oh, Jae Keun; Kwon, Yong Shin; Park, Jung-Seob

    2015-01-01

    Study Design Retrospective study. Purpose To evaluate the effect of intraoperative wound application of vancomycin on preventing surgical wound contamination during instrumented lumbar spinal surgery. Overview of Literature Postoperative infection is the one of the most devastating complications of lumbar surgery. There are a few reports showing the benefits of intraoperative wound application of vancomycin during spinal surgery. However, there is no report about the effectiveness of local vancomycin instillation in prevention of surgical wound contamination. Methods Eighty-six patients underwent instrumented lumbar spinal surgery. Mean patient age was 65.19 years (range, 23-83 years). There were 67 females and 19 males. During surgery, vancomycin powder was applied into the surgical site before closure in 43 patients (antibiotic group) and vancomycin powder was not applied into the surgical site before closure in 43 patients (control group). The tip of the surgical drain was cultured to evaluate surgical wound contamination. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured on the first, third, seventh, and fourteenth day after the operation. Results We found two patients with a positive culture from the tip of surgical drains in the antibiotic group, and one patient with a positive culture from the tip of the surgical drain in the control group. Postoperative ESR and CRP levels did not show significant differences between the two groups. On the third postoperative day, ESR in patients of the antibiotic group was more significantly decreased than that in patients of the control group, while CRP level did not show a significant difference between the two groups. Conclusions There was no evidence to suggest that intraoperative vancomycin application is effective in decreasing the risk of postoperative wound infection after instrumented posterior lumbar fusion surgery. PMID:26240708

  17. Surgical innovation as sui generis surgical research.

    PubMed

    Lotz, Mianna

    2013-12-01

    Successful innovative 'leaps' in surgical technique have the potential to contribute exponentially to surgical advancement, and thereby to improved health outcomes for patients. Such innovative leaps often occur relatively spontaneously, without substantial forethought, planning, or preparation. This feature of surgical innovation raises special challenges for ensuring sufficient evaluation and regulatory oversight of new interventions that have not been the subject of controlled investigatory exploration and review. It is this feature in particular that makes early-stage surgical innovation especially resistant to classification as 'research', with all of the attendant methodological and ethical obligations--of planning, regulation, monitoring, reporting, and publication--associated with such a classification. This paper proposes conceptual and ethical grounds for a restricted definition according to which innovation in surgical technique is classified as a form of sui generis surgical 'research', where the explicit goal of adopting such a definition is to bring about needed improvements in knowledge transfer and thereby benefit current and future patients.

  18. Notes from the field: rapidly growing nontuberculous Mycobacterium wound infections among medical tourists undergoing cosmetic surgeries in the Dominican Republic--multiple states, March 2013-February 2014.

    PubMed

    Schnabel, David; Gaines, Joanna; Nguyen, Duc B; Esposito, Douglas H; Ridpath, Alison; Yacisin, Kari; Poy, Joe A; Mullins, Jocelyn; Burns, Rachel; Lijewski, Virginia; McElroy, Nora P; Ahmad, Nina; Harrison, Cassandra; Parinelli, Ellen J; Beaudoin, Amanda L; Posivak-Khouly, Leah; Pritchard, Scott; Jensen, Bette J; Toney, Nadege C; Moulton-Meissner, Heather A; Nyangoma, Edith N; Barry, Anita M; Feldman, Katherine A; Blythe, David; Perz, Joseph F; Morgan, Oliver W; Kozarsky, Phyllis; Brunette, Gary W; Sotir, Mark

    2014-03-01

    In August 2013, the Maryland Department of Health and Mental Hygiene (MDHMH) was notified of two persons with rapidly growing nontuberculous mycobacterial (RG-NTM) surgical-site infections. Both patients had undergone surgical procedures as medical tourists at the same private surgical clinic (clinic A) in the Dominican Republic the previous month. Within 7 days of returning to the United States, both sought care for symptoms that included surgical wound abscesses, clear fluid drainage, pain, and fever. Initial antibiotic therapy was ineffective. Material collected from both patients' wounds grew Mycobacterium abscessus exhibiting a high degree of antibiotic resistance characteristic of this organism.

  19. Unusual Open Surgical Repair of a Type IB Endoleak and a Giant Symptomatic Aortic Aneurysm following Stent Grafting for Type B Aortic Dissection.

    PubMed

    Mihály, Zsuzsanna; Csobay-Novák, Csaba; Entz, László; Szeberin, Zoltán

    2016-01-01

    Treatment of type IB endoleak after thoracic endovascular aortic repair (TEVAR) for post-dissection aortic aneurysm usually includes attempts of endovascular interventions using coils or plugs to occlude the false lumen or placement of a distal fenestrated endograft. Open conversion usually requires deep hypothermia and circulatory arrest with the associated increased mortality and complications. We present a case of a young patient with a 90 mm descending thoracic aneurysm caused by a chronic type B aortic dissection. A type II endoleak after TEVAR was successfully treated with left subclavian artery transposition. The patient had a rapidly increasing aortic aneurysm with a persistent type IB endoleak in spite of placement of an Amplatzer plug into the false lumen of the dissection. He developed progressive acute compression of the main stem bronchi by the aneurysm sac and his dyspnea worsened by an acute pulmonary embolism treated with anticoagulation. Adequate oxygenation could only be achieved with mechanical ventilation using a double-lumen endobronchial tube. A left thoracotomy was performed and the type IB endoleak was treated with bending of the distal aorta around the stent graft with a Dacron graft sleeve. Aortic clamping and circulatory support devices were avoided. The sac of the aneurysm was opened, a giant hematoma was evacuated, and aneurysmorrhaphy was performed to cover the stent graft. There was no residual endoleak and the bronchi were decompressed. The patient recovered after prolonged hospitalization and he was discharged home in good condition 24 days after admission. He returned to his normal activities and is asymptomatic 5 months later. Computed tomographic angiography showed decreased aneurysm sac, no evidence of endoleak, no residual pulmonary embolus, and no bronchial compression. PMID:26520424

  20. Civilian gunshot wounds--outpatient management.

    PubMed

    Ordog, G J; Wasserberger, J; Balasubramanium, S; Shoemaker, W

    1994-01-01

    Cost containment is important in this time of inner-city economic and health-care crisis. Of 28,150 patients treated for gunshot wounds (GSWs) from 1977 through 1991, 16,892 (60%) were treated as outpatients after emergency department evaluation and treatment. The complication rate was 1.8% (mostly infections), and nine patients were later found to have vascular injuries requiring surgical treatment. These were identified later at outpatient follow-up and treated with no long-term morbidity or mortality. A conservative estimate of the cost savings from this study was more than $37 million. With a more liberal use of angiography to eliminate rare missed vascular injuries, many GSW victims can be safely treated as outpatients, eliminating the need for expensive in-hospital observation.