An Assessment of Wound Dressing by Nursing Personnel at Olabisi Onabanjo University Teaching Hospital (O.O.U.T.H.) Shagamu; Ogun State; Nigeria

Introduction: A variety of effects may result in the occurrence of a wound which may result in immediate loss of all or part of organ functioning; sympathetic stress response; hemorrhage and blood clotting; bacterial contamination and death of cells. Careful asepsis is the most important factor in keeping these effects to a minimum and promoting the successful care of wounds which is dependent on the nurse's knowledge and understanding of normal wound healing physiology; method of closure and the optimal treatment of the wound and with this knowledge; nurses can provide a systematic and holistic patient assessment; and consider any potential wound related complications (Vuolo JC 2006). Aim: This investigation aimed to assess wound dressing performances among nursing personnel in the three surgical wards of Olabisi Onabanjo University Teaching Hospital (O.O.U.T.H.) Shagamu Ogun State Nigeria.Methodology:The investigators utilized the descriptive method of research. A total of sixty nursing personnel in the male; female; and paediatric surgical wards were randomly selected for the investigation. Performance of wound dressing was assessed through an investigators formulated questionnaire and evaluation checklist based on the concept of sterile wound dressing technique.Results: Nurses have a very good performance of wound dressing as they applied the concepts/principles of sterile technique in the performance of the procedure. There was no significant difference between nurses in the performance of wound dressing and their demographic variables such as age; gender; religion; and educational qualification. However; significant difference was found between length of clinical experience and practice of wound dressing.Conclusion: Findings suggests a relationship between length of clinical experience and practice of good wound dressing. Hence regular seminars on wound dressing should be organized to refresh nurses and keep them up to date in nursing practice

Is supplementary fixation necessary in anterior cruciate ligament reconstructions?

BACKGROUND: There has been concern regarding the fixation of anterior cruciate ligament reconstruction, with soft tissue grafts being strong and stiff enough to allow for early accelerated postoperative rehabilitation. Therefore, some have recommended supplementary fixation for soft tissue tibia interference screw fixation with a staple, to improve the strength and stiffness of the fixation. Unfortunately, with staple supplementation, there is a risk for symptomatic hardware, which may require a second surgery to remove the staple. HYPOTHESIS: Supplementary fixation with a bioabsorbable knotless suture anchor will improve the structural properties of soft tissue tibia bioabsorbable interference screw (BIS) fixation and be comparable with supplementary fixation with a staple. STUDY DESIGN: Controlled laboratory study. METHOD: Fifteen porcine tibias and flexor profundus tendons were randomized into 3 fixation study groups: group 1, BIS; group 2, BIS + staple; and group 3, BIS + push-lock screw. The structural properties of the 3 fixation groups were tested under displacement-controlled cyclic loading and load to failure. RESULTS: No significant difference in mean stiffness (N/mm ± SEM) under cyclic loading was found for BIS (335.31 ± 15.43), BIS + staple (344.81 ± 44.97), and BIS + push-lock (353.28 ± 38.93). Under load-to-failure testing, there were no differences found in stiffness, yield load, displacement at yield load, displacement at ultimate load, and energy absorbed among the 3 fixation methods. BIS + push-lock fixation had a significantly higher ultimate load than BIS alone and BIS + staple (917.85 ± 58.30 N vs 479.83 ± 66.04 N, P = .0003 vs 618.89 ± 8.94 N, P = .004). CONCLUSION: Supplementary fixation with staple or push-lock screw did not significantly increase the structural strength and stiffness of the BIS soft tissue graft fixation under cyclic loading, but it did show improvement under load-to-failure testing for ultimate tensile load. CLINICAL RELEVANCE: The indication for supplementary fixation for tibial BIS soft tissue graft fixation depends on the fixation that the BIS achieves at the time of the surgery because the tensile load is transferred to the secondary fixation if and only when there is slippage of graft at the primary fixation. The supplementary fixation may be of value in those cases with poor bone quality, such as revision surgery with tunnel widening and/or graft-tunnel mismatch, or possibly in cases with older patients or patients with disorders affecting bone mineral density.

Porous orbital implants, wraps, and PEG placement in the pediatric population after enucleation.

PURPOSE: To investigate complications of various porous orbital implants and wrapping materials in the pediatric population after enucleation. DESIGN: A retrospective, comparative, nonrandomized study. METHODS: Between November 1992 and November 2006, patients younger than 15 years old were collected for study participation. They underwent enucleation with porous orbital implants primarily or secondarily at National Taiwan University Hospital. The authors used the hydroxyapatite (HA), Medpor, and Bioceramic orbital implant. The HA implant was wrapped with four different materials: donor sclera, Lyodura, porcine sclera, and Vicryl mesh. A part of HA implants and all bioceramic implants were wrapped with Vicryl mesh, added anteriorly with scleral patch grafts. All Medpor implants were unwrapped. RESULTS: Forty-seven cases had more than a two-year follow-up. The exposure rates according to implants and wraps were: donor sclera-wrapped HA (two of nine, 22%), porcine sclera-wrapped HA (three of three, 100%), Vicryl mesh-wrapped HA (one of five, 20%), and unwrapped Medpor (one of four, 25%). No exposure was found in four Lyodura-wrapped HA implants, and 22 Vicryl mesh-wrapped HA and Bioceramic implants with anteriorly scleral coating. The exposure rate was lower in cases with implants wrapped by our method and Lyodura than in those with implants wrapped by other materials (P < .001). Of 47 patients, 20 (42.5%) were fitted with peg-coupled prostheses and all had good prosthetic movements subjectively. CONCLUSIONS: Different types of implants and wraps resulted in various exposure rates in the pediatric population. The modified wrapping technique may prevent porous implants from exposure in children.