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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.
Asunto(s)
Enfermedad Crónica/terapia , Terapia de Presión Negativa para Heridas/métodos , Úlcera por Presión/diagnóstico , Úlcera por Presión/terapia , Cicatrización de Heridas/fisiología , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Management of major limb injuries is a daunting challenge, especially as many of these patients have severe associated injuries. In trying to save life, often the limb is sacrificed. The existing guidelines on managing such trauma are often confusing. There is scope to lay down such protocols along with the need for urgent transfer of such patients to a multispecialty center equipped to salvage life and limb for maximizing outcome. This review article comprehensively deals with the issue of managing such major injuries.
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Extremidades/lesiones , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/terapia , Amputación Quirúrgica , Desbridamiento , Toma de Decisiones , Extremidades/patología , Humanos , Terapia Recuperativa , Índices de Gravedad del TraumaRESUMEN
INTRODUCTION: Enzymatic debridement is a method by which burn wounds can be prepared for coverage by skin grafts in patients presenting late. Many agents have been used in the past but none of them have been thoroughly evaluated. The present study was undertaken to assess the efficacy of Debridace, a commonly available debriding agent with papain and urea as its constituents. MATERIAL AND METHODS: A prospective descriptive study design was used to evaluate our experience. Almost symmetrical areas of the burnt surface were assessed and used for comparison. On one half of the wound, Debridace was applied while on the other silver sulphadiazine was used. The primary end point of this study was the extent of the achieved debridement at the end of the study period. Secondary outcomes were the presence of adverse effects such as pain and fever. All patients with sepsis were excluded from the study. RESULTS: The age of the subjects ranged from 9 to 80 years with an SD of 16. Large areas ranging from 5% to 20% body surface area with an SD of 4.27 were debrided by Debridace. Only two patients (3.33%) could complete the study. The rest of the recruited patients either had high fever (63.33%), excruciating pain (13.33%) or both (16.66%), which brought an end to enzymatic debridement. CONCLUSION: Debridace, a papain-urea product, cannot be considered safe as an enzymatic debriding agent in its present form for use in major burn patients who present late with deep burn wounds that are large in size.
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Consenso , Diabetes Mellitus Tipo 2/complicaciones , Pie Diabético/terapia , Atención Primaria de Salud/normas , Amputación Quirúrgica/estadística & datos numéricos , Antibacterianos/uso terapéutico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/epidemiología , Pie Diabético/diagnóstico , Pie Diabético/epidemiología , Pie Diabético/etiología , Estilo de Vida Saludable , Humanos , Hipoglucemiantes/uso terapéutico , Incidencia , India/epidemiología , Atención Primaria de Salud/métodosAsunto(s)
Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Enfermedades Cutáneas Vasculares , Úlcera Cutánea , Diagnóstico Diferencial , Femenino , Humanos , Mutación Puntual , Enfermedades Cutáneas Vasculares/diagnóstico , Enfermedades Cutáneas Vasculares/etiología , Enfermedades Cutáneas Vasculares/genética , Úlcera Cutánea/diagnóstico , Úlcera Cutánea/etiología , Úlcera Cutánea/genética , Vasculitis/diagnóstico , Vasculitis/etiología , Vasculitis/genética , Adulto JovenRESUMEN
Intraneural lipoma is a hamartoma that may involve various nerves, although its association with the superficial peroneal nerve is extremely rare. In this article, we describe the case of a young female with an intraneural lipoma localized to the superficial peroneal nerve. Also highlighted is the importance of meticulous clinical examination in order to accurately diagnose the entity so as to avoid expensive diagnostic imaging investigations.
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Lipoma/diagnóstico , Neoplasias del Sistema Nervioso Periférico/diagnóstico , Nervio Peroneo/patología , Neuropatías Peroneas/diagnóstico , Adulto , Femenino , Hamartoma/diagnóstico , Humanos , Lipoma/patología , Lipoma/cirugía , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/patología , Síndromes de Compresión Nerviosa/cirugía , Neoplasias del Sistema Nervioso Periférico/patología , Neoplasias del Sistema Nervioso Periférico/cirugía , Nervio Peroneo/cirugía , Neuropatías Peroneas/etiología , Neuropatías Peroneas/cirugíaRESUMEN
BACKGROUND: In patients with life-threatening injuries, simple wounds requiring split-thickness skin grafts (SSG) often get neglected. These then need SSG once they are covered with granulation tissue through wound bed preparation. Traditionally, this is done by daily moist dressings. Recombinant human platelet-derived growth factor (rhPDGF) has been shown to improve healing in chronic wounds. AIM: The present study was undertaken to compare the efficacy of rhPDGF in wound bed preparation with the current practice of daily saline dressings. SETTING AND DESIGN: A prospective randomised, single-blinded study was carried out for evaluation in traumatic wounds. MATERIALS AND METHODS: The patients were randomised and divided into a control group that was subjected to saline dressings and a test group that was treated with rhPDGF gel. Both the groups were then compared. The statistical analysis was carried out using SPSS 16.0 and the quantitative variables were analysed using unpaired "t" test, while the pre- and post-intervention effects were assessed using paired "t" test. The 95% CI values were also included. RESULTS: Of the 155 wounds studied, time taken for appearance of granulation tissue (in days) in the test group had a mean of 13.81 ± 2.68, while that in the control group was 13.36 ± 3.81 (P = 0.401). Complete re-epithelialisation without discharge occurred in the control group with a mean value of 28.9 ± 3.67 days, while that in the test group had a mean of 31.17 ± 4.82 days. CONCLUSION: There was no difference in wound healing between the patients treated with rhPDGF compared to those treated by conventional moist dressings.
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Peripartum cardiomyopathy (PPCM) is a rare entity, and anesthetic management for cesarean section of a patient with this condition can be challenging. We hereby present the anesthetic management of a patient with PPCM complicated with preeclampsia scheduled for cesarean section, along with a mini review of literature. A 24 year-old primigravida with twin gestation was admitted to our hospital with severe PPCM and preeclampsia for peripartum care, which finally required a cesarean section. Preoperative optimization was done according to the goal of managing left ventricular failure. Combined spinal epidural (CSE) anaesthesia with bupivacaine and sufentanil was used for cesarean section under optimal monitoring. The surgery was completed without event or complication. Postoperative pain relief was adequate and patient required only one epidural top up with sufentanil 6 hours after operation. To the best of our knowledge there is no report in literature of the use of sufentanil as a neuraxial opioid in the anesthetic management of cesarean section in a patient with PPCM. CSE with sufentanil may be a safer and more effective alternative in such cases.
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Anestesia Epidural/métodos , Anestesia Raquidea/métodos , Cardiomiopatías/complicaciones , Preeclampsia/cirugía , Sufentanilo/uso terapéutico , Femenino , Humanos , Periodo Periparto , EmbarazoRESUMEN
Obesity is a global disease with epidemic proportions. Bariatric surgery or modified lifestyles go a long way in mitigating the vast weight gain. Patients following these interventions usually undergo massive weight loss. This results in redundant tissues in various parts of the body. Loose skin causes increased morbidity and psychological trauma. This demands various body contouring procedures that are usually excisional. These procedures are complex and part of a painstaking process that needs a committed patient and an industrious plastic surgeon. As complications in these patients can be quite frequent, both the patient and the surgeon need to be aware and willing to deal with them.