The effectiveness of traditional Chinese medicine fumigation and washing nursing care after arthroscopic debridement of Knee Osteoarthritis: A protocol for systematic review and meta-analysis.

BACKGROUND: Knee Osteoarthritis (KOA) is a degenerative osteoarthrosis with knee joint pain as the main symptom. In recent years, arthroscopic removal of loose body and repair of meniscus have become common methods for the treatment of KOA. However, postoperative pain, swelling and limited joint movement affect the functional recovery of knee joint and the effect of surgical treatment. Early postoperative control of pain and swelling is of great significance to improve the curative effect of arthroscopic debridement and promote the recovery of knee joint function. In recent years, many clinical studies have reported that the nursing method of fumigation and washing with Chinese medicine after arthroscopic debridement of KOA can relieve pain, promote the recovery of joint function and improve the clinical curative effect, but there is a lack of evidence-based medicine. The purpose of this study is to evaluate the efficacy and safety of fumigation and washing with traditional Chinese medicine after KOA arthroscopy. METHODS: Computer retrieval English database (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese database (China National Knowledge Infrastructure, Wanfang, VIP Database for Chinese Technical Periodicals, China Biology Medicine disc), moreover manual retrieval academic, Google and baidu from building to since December 2020, traditional Chinese medicine fumigation applied to KOA arthroscopy postoperative nursing of randomized controlled clinical research, by two researchers independently evaluated the quality of the included study and extracted the data. Meta-analysis of the included literatures was performed using RevMan5.3 software. RESULTS: The main observation index of this study was the effective rate, and the secondary indexes included Visual Analogue Scale Score, the Western Ontario and McMaster university orthopedic index, Lysholms score and adverse reactions, so as to evaluate the efficacy and safety of traditional Chinese medicine fumigation nursing after KOA arthroscopy. CONCLUSION: This study will provide reliable evidence for the clinical application of Fumigation and washing nursing of traditional Chinese medicine after KOA arthroscopy. ETHICS AND DISSEMINATION: Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/THZP4.

Mid-term results of open debridement and reattachment surgery for insertional Achilles tendinopathy: A retrospective clinical study.

OBJECTIVE: The aim of this study was to determine the effects of age and body mass index (BMI) on the functional outcomes, satisfaction rates, and recovery time after open debridement and reattachment surgery in non-athletic patients with insertional Achilles tendinopathy (IAT). METHODS: In this retrospective study, 33 non-athletic patients (34 ankles) in whom open debridement and reattachment surgery was performed for IAT from 2006 to 2016 were included. Change in pain intensity was assessed using a Visual Analogue Scale (VAS) preoperatively and at the final follow-up. Functional assessment was done by preoperative and postoperative American Orthopaedics Foot and Ankle Score (AOFAS) and final follow-up Victorian Institute of Sport Tendon Study Group-Achilles Tendinopathy score (VISA-A). Patient satisfaction was evaluated by Roles - Maudsley score (RMS). The recovery time was defined as the time interval from the first appearance to postoperative relief of symptoms and recording. In addition, the recurrent Haglund's deformity was determined by postoperative control radiographs. RESULTS: The mean age at the time of the operation was 51.19 years. The mean follow-up was 61.75±8.49 months. According to BMI, 5 patients were determined as morbid obese, 19 as obese, 3 as overweight, and 6 as normal. The mean VAS score significantly decreased from 8.5 preoperatively to 1.3 postoperatively (p<0.001). The mean AOFAS score significantly improved from 55.8 preoperatively to 92 postoperatively (p<0.001). Postoperative VISA-A score was 86% (range=32%-100%). According to RMS, 22 patients reported the result as excellent, 8 as good, 2 as fair, and 1 as poor. The mean recovery time was 11.8 (range=2-60) months, but one patient did not reach a symptom free status and thus was not included in the recovery time analysis. Postoperative control radiographs revealed signs of recurrence deformity in four patients. Recovery time showed a negative correlation with the age of the patients (r=-0.65). Postoperative scores and BMI showed no significant correlations with the recovery time on the basis of Spearman's rho test (p=0.196). CONCLUSION: The results of this study have shown that open debridement and reattachment surgery may be an effective surgical method in relieving pain and improving functional status with high satisfaction rate and acceptable recovery time in the management of non-athletic patients with IAT. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

Arthroscopic debridement and capsular release for the treatment of shoulder osteoarthritis.

PURPOSE: The purpose of this study was to evaluate patients who underwent isolated arthroscopic debridement and capsular release without any other procedures for primary glenohumeral osteoarthritis to determine clinical and functional outcomes and time until conversion to shoulder arthroplasty. METHODS: We performed a retrospective review of 33 patients who underwent arthroscopic debridement and capsular release for shoulder osteoarthritis at our institution between 2006 and 2011. All procedures were performed by a single surgeon (K.Y.). Patients were evaluated for intraoperative arthritis grade, preoperative and postoperative range or motion, American Shoulder and Elbow Surgeons (ASES) score, pain score self-assessments, radiographic evaluation, and conversion to total shoulder arthroplasty. Clinical follow-up was on average 40.3 weeks postoperatively and telephone interview follow-up was performed at a minimum of 2 years postoperatively in all patients. RESULTS: There was an initial improvement in range of motion and pain scores; however, patients in our study returned to preoperative levels approximately 3.8 months after debridement and capsular release. Twenty patients (60.6%) reported that they were not satisfied with the outcome of the procedure. Total shoulder arthroplasty was undertaken in 14 (42.4%) patients an average of 8.8 months after arthroscopy. Among the 19 (57.6%) patients who did not go on to have total shoulder arthroplasty, ASES scores (42.2 to 50.8; P = .41) and visual analog scale pain scores (7.8 to 7.4; P = .59) were similar preoperatively and at final telephone follow-up. CONCLUSIONS: Isolated arthroscopic debridement and capsular release without any other procedures were associated with only temporary pain relief and improvement in motion. Although there are limited nonarthroplasty surgical options available for glenohumeral arthritis, isolated arthroscopic debridement and capsular release may not provide substantial benefit to justify its use in most patients. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Retalho de grande dorsal para reconstrução de perda de substância por queimadura elétrica em membro superior / Latissimus dorsi flap for reconstruction of loss of substance caused by electric burn on upper limb

As queimaduras elétricas podem causar lesões graves e o músculo grande dorsal é uma opção para reconstrução dessas lesões. Paciente vítima de queimadura elétrica com lesão grave em membro superior esquerdo foi submetido à reconstrução com retalho pediculado do músculo grande dorsal. O paciente evoluiu bem, com resultado satisfatório. O retalho do músculo grande dorsal pediculado se mostrou seguro para cobrir exposição óssea em queimaduras elétricas em membro superior esquerdo.

Electrical burns can cause serious injuries and the latissimus dorsi reconstruction is an option for these lesions. Victim of electrical burn patient with severe lesions in the left upper limb underwent reconstruction with pedicled latissimus dorsi muscle. The patient progressed well, with satisfactory results. The flap of the large dorsal muscle pedicle proved insurance to cover exposed bone in electrical burns in the left upper limb.

Rehabilitation and return-to-sports activity after debridement and bone marrow stimulation of osteochondral talar defects.

An osteochondral defect (OD) is a lesion involving the articular cartilage and the underlying subchondral bone. ODs of the talus can severely impact on the quality of life of patients, who are usually young and athletic. The primary treatment for ODs that are too small for fixation, consists of arthroscopic debridement and bone marrow stimulation. This article delineates levels of activity, determines times for return to activity and reviews the factors that affect rehabilitation after arthroscopic debridement and bone marrow stimulation of a talar OD. Articles for review were obtained from a search of the MEDLINE database up to January 2012 using the search headings 'osteochondral defects', 'bone marrow stimulation', 'sports/activity', 'rehabilitation', various other related factors and 'talus'. English-, Dutch- and German-language studies were evaluated.The review revealed that there is no consensus in the existing literature about rehabilitation times or return-to-sports activity times, after treatment with bone marrow stimulation of ODs in the talus. Furthermore, scant research has been conducted on these issues. The literature also showed that potential factors that aid rehabilitation could include youth, lower body mass index, smaller OD size, mobilization and treatment with growth factors, platelet-rich plasma, biphosphonates, hyaluronic acid and pulse electromagnetic fields. However, most studies have been conducted in vitro or on animals. We propose a scheme, whereby return-to-sports activity is divided into four phases of increasing intensity: walking, jogging, return to non-contact sports (running without swerving) and return to contact sports (running with swerving and collision). We also recommend that research, conducted on actual sportsmen, of recovery times after treatment of talar ODs is warranted.

Pautas para el uso de terapia de vacío en el Servicio de Cirugía Plástica delHospital La Fe en Valencia (España) / Use of vacuum therapy in the Plastic Surgery Department hospital La Fe, Valencia (Spain)

El tratamiento de heridas complejas, con pérdida de sustancia importante o exposición de estructuras nobles, constituye una práctica diaria en la mayoría de los Servicios de Cirugía Plástica de referencia. A pesar de que el desbridamiento quirúrgico continúa siendo la terapia de elección para el tratamiento de heridas infectadas o con abundantes restos necróticos, el advenimiento de la terapia de vacío y las mejoras tecnológicas experimentadas por dicha terapia en la última década, hacen de su utilización una herramienta coadyuvante para el control del lecho quirúrgico, de los exudados de la herida y de la colonización bacteriana. Presentamos 9 casos clínicos de uso de terapia V AC® en el tratamiento de diversas patologías, tales como: dehiscencia esternal, grandes quemados, traumatismos de extremidades, etc. En todos ellos, esta terapia constituyó un pilar fundamental en el tratamiento de los pacientes facilitando el control del exudado de las heridas, la protección de estructuras nobles y mejorando la calidad de vida y el confort de los pacientes durante su estancia hospitalaria (AU)

Treatment of complex wounds that imply loss of substance or important anatomic structures exposure has a great relevance in Plastic Surgery Departments nowadays. Even though surgical debridement keep son being the principal choice treatment in infected ornecrotic wounds, VAC® therapy use and its new technology advances in the last decade, has allowed an option to control bacterial colonization, exudates and surgical wounds. We present 9 cases of vacuum therapy use for treatment of different pathologies such as sternum dehiscence, burned patients, extremities trauma, etc. In all these cases vacuum therapy has been essential in the management of exudates, protection of anatomic vital structures as well as to improve patient’s quality of life during hospital stay (AU)

Rehabilitation following microfracture for chondral injury in the knee.

Full-thickness chondral defects in the knee are common, and these articular cartilage lesions may present in various clinical settings and at different ages. Articular cartilage defects that extend full thickness to subchondral bone rarely - by providing a suitable environment for new tissue formation and takes advantage of the body's own healing potential. Proper surgical technique and rehabilitation improve the success rate of the microfracture procedure. The goals are to alleviate the pain and disability that can result from chondral lesions and restore joint conformity, thereby preventing late degenerative changes in the joint.

Results of 268 pressure sores in 158 patients managed jointly by plastic surgery and rehabilitation medicine.

Despite improvements in surgical repair of pressure sores, recurrence rates greater than 80 percent are reported, thus indicating that this difficult problem is not yet solved. Recurrence results in additional hospitalizations and increased medical expenses. Because associated general clinical and social issues are numerous for these patients, our physical medicine and rehabilitation colleagues are active participants in their perioperative medical care. In addition, the Department of Physical Medicine and Rehabilitation also directs a complete postreconstruction rehabilitation and education program for them. The results of surgically repaired pressure sores for patients managed in this collaborative fashion have not been previously reported. Pressure sore patients at the Harborview and University of Washington Medical Centers are evaluated by plastic surgery colleagues together with the Department of Physical Medicine and Rehabilitation. Patients believed to be candidates for complete postoperative rehabilitation are offered surgical repair and constitute this study cohort. Individuals who cannot cooperate with our protocol are treated nonoperatively and are not included in this study. A retrospective analysis of all 158 patients (mean age 34.5 years) operated on for 268 grade III and IV pressure sores between October of 1977 and December of 1989 was performed. Following surgical debridement and reconstruction, patients receive their principal medical care from the Department of Physical Medicine and Rehabilitation service while the Plastic Surgery Department manages the surgical wounds. Graduated patient mobilization is initiated in accord with a mutually agreed upon standardized protocol. New or primary sores numbered 174 (65 percent), and recurrent or secondary sores numbered 94 (35 percent). Mean patient follow-up was 3.7 years. The overall pressure sore recurrence rate (recurrence at the same site) was 19 percent, and the overall patient recurrence rate (previous patient developing a new sore) was 25 percent. Recurrence rates of 22 and 15 percent were noted for primary and secondary pressure sores, respectively. On most recent examination, 131 patients (83 percent) had intact pelvic and perineal skin. These results support a collaborative approach to the management of high-grade pressure sore patients. Our protocol of mutual patient evaluation followed by surgical reconstruction and postoperative rehabilitation yields notably low recurrence rates of both primary and secondary sores. In addition, the high percentage of patients who manifest long-term maintenance of skin integrity demonstrates the excellent education in personal skin and self-care that this approach provides. Not only do patients enjoy successful and durable reconstructive results, but additional hospitalizations and health care expenses implicit to pressure sore recurrence are consequently diminished. This collaborative clinical effort remains our standard of care.

Heridas por mordedura de perro: tratamiento de 40 pacientes / Dog bite wounds in children. Management of 40 patients

Las mordeduras de perro son las agresiones más frecuentes de los animales al ser humano. Aproximadamente dos terceras partes de todos los agredidos son menores de quince años; el sitio anatómico más frecuentes es la cara. La Norma Oficial Mexicana para la Prevención y Control de la Rabia señala "La sutura de la herida debe dejarse para más adelante"; "Sin embargo, si es necesario suturar inmediatamente, se procederá primero a la aplicación del suero antirrábico". Existe pues la controversia sobre si se debe o no suturar invariablemente una herida por mordedura de perro. En este estudio se presenta el resultado del tratamiento de cuarenta pacientes mordidos por perros en diversas partes del cuerpo, a quienes se les realizó lavado y desbridación de la herida seguido de sutura; se administró un antimicrobiano del tipo de amoxicilina y clavulanato. Unicamente dos pacientes presentaron infección de la zona agredida. Los resultados cosméticos se catalogaron como buenos y aceptables en todos los pacientes. Concluimos que toda herida por mordedura de perro debe ser suturada de inmediato previo aseo y desbridación de la zona y que se deben emplear antibióticos por vía sistémica

Surgical transfer of the sartorius muscle to the groin after lymphadenectomy or debridement: CT findings.

OBJECTIVE: We describe the CT findings of medial transfer of a sartorius muscle flap, which is done to protect the femoral blood vessels after radical inguinal lymphadenectomy for cancer or surgical debridement of infected femoral vascular grafts. MATERIALS AND METHODS: We reviewed the appearances and initial interpretations of 33 CT studies in 17 patients who underwent medial sartorius flap transfer after either (1) inguinal lymphadenectomy for melanoma or penile cancer or (2) debridement of infected groin wounds complicating vascular reconstruction of the femoral arteries. Muscle flap transfer was defined by the surgical record as either complete or incomplete. In complete sartorius muscle transfer, the proximal end of the muscle is dissected from the anterior superior iliac spine, rotated along its long axis, and sutured medially to the inguinal ligament. In incomplete transfer, the muscle it mobilized and stretched medially, and its medial border is fixed to the inguinal ligament and deep tissues. Clinical correlation and follow-up examinations were done for all patients, and CT reevaluation at intervals was done in nine patients. RESULTS: Complete sartorius flap transfer resulted in a mass anterolateral or anterior to the femoral vessels on postoperative CT scans in 20 studies; five of these masses were misinterpreted initially as possible recurrent metastatic lymphadenopathy, infection, or hematoma. Incomplete sartorius flap transfer resulted in bandlike stretching of the muscle over the femoral vessels in 13 studies. CONCLUSION: Medial transfer of the sartorius muscle causes a variable appearance of the groin on CT scans. The findings on CT scans after complete sartorius flap transfer should be distinguished from recurrent lymphadenopathy and from postoperative phlegmon or hematoma.

Novas consideraçöes sobre o uso tópico de açúcar e mel em feridas / New insights about topical sugar and honey treatment of wounds

Os autores fazem revisäo dos artigos publicados entre 1986 e 1993, referentes ao uso tópico do açúcar puro ou associado a outros agentes. Esta publicaçäo consta de resultados clínicos e laboratoriais, mecanismos de açäo mais aceitos, espectro de açäo, relatos de vantagens, desvantagens e indicaçöes de seu uso. É ainda relatado, a título de ilustraçäo, um caso de fasceite necrotizante acometendo todo o membro inferior esquerdo, onde foi feito curativo de açúcar por 1 (um) mês, sendo notada significativa melhora no quadro geral e local que, ao final deste período, se apresentava propício à enxertia.