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1.
Br J Nurs ; 29(8): S20-S27, 2020 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-32324453

RESUMO

Vascular access device insertion is a common procedure in healthcare, and complications associated with vascular access can be serious and cause considerable patient harm. The use of care bundles to reduce the risks of these complications is well documented. However, the removal of devices, especially those associated with medical adhesive, can cause significant skin injuries, which often could be avoided if this aspect is included in the care bundle and the risk factors are better understood in healthcare. Appeel Sterile is an effective sterile silicone-based medical adhesive remover that is available in a variety of formats. It is the only sterile medical adhesive remover available, which makes it the safest choice for use with vascular access devices.


Assuntos
Cateterismo Periférico/enfermagem , Silicones/uso terapêutico , Higiene da Pele/enfermagem , Ferimentos e Lesões/prevenção & controle , Humanos , Risco , Pele/lesões , Higiene da Pele/métodos , Adesivos Teciduais/efeitos adversos , Ferimentos e Lesões/etiologia
2.
J Vasc Access ; 21(1): 33-38, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31159638

RESUMO

The Infusional Services Team at a large cancer centre in Belfast, Northern Ireland, performed a cross-sectional analysis of two catheter securement technologies to address an area of frequent, but underestimated concern - peripherally inserted central catheter migration and dislodgement. Healthcare practitioner and patient feedback, along with economic impact, were assessed. The costs associated with catheter replacement during the adhesive device group study period were calculated using an average cost per insertion, based on material costs required for the procedure. Other factors were the replacement cost of the adhesive engineered securement device with each dressing change. In the subcutaneous securement group, the material costs were adjusted for use of the subcutaneous device as it remained in situ for the duration of the catheters' dwell time. This review found that subcutaneous securement offers both patient and facilities a safe, effective and economical alternative for device securement with patients who are unable to tolerate or have successful securement with adhesive securement devices. The use of subcutaneous devices provided for reduced risks for peripherally inserted central catheters in terms of dislodgement, migration or malposition, alleviating the potential risks to develop catheter-related thrombosis and device-related infection.


Assuntos
Cateterismo Venoso Central/instrumentação , Cateterismo Periférico/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Migração de Corpo Estranho/prevenção & controle , Adesivos Teciduais/uso terapêutico , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/economia , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/economia , Cateteres de Demora/economia , Cateteres Venosos Centrais/economia , Pesquisa Comparativa da Efetividade , Análise Custo-Benefício , Estudos Transversais , Desenho de Equipamento , Migração de Corpo Estranho/economia , Migração de Corpo Estranho/etiologia , Custos de Cuidados de Saúde , Humanos , Irlanda do Norte , Fatores de Tempo , Adesivos Teciduais/efeitos adversos , Adesivos Teciduais/economia , Resultado do Tratamento
3.
Plast Reconstr Surg ; 145(1): 32-37, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31881600

RESUMO

Skin adhesives have become standard in wound closure as alternatives to traditional sutures or as sterile occlusive dressings after surgery of all types. The literature is replete with case reports of contact dermatitis following exposure to cyanoacrylate-based adhesives, such as 2-octyl cyanoacrylate. Nonetheless, it has been the impression of the senior author and others that the incidence of allergic and/or contact dermatitis is much higher than commonly considered. The authors prospectively studied 102 consecutive patients who underwent breast surgery performed by the senior author with 2-octyl cyanoacrylate placed over incisions as an occlusive dressing. Two patients with a known glue allergy did not receive cyanoacrylate at surgery but were scratch tested to confirm the diagnosis. All patients were followed postoperatively. Twelve patients went on to develop significant dermatitis postoperatively after glue placement. Cyanoacrylate was confirmed as the cause of all rashes by allergy scratch testing for a total incidence of 14 percent (14 patients). Given the popularity of cyanoacrylate products across emergency rooms, clinics, and operating rooms, awareness of the true incidence of these reactions may caution against their use in the future. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Assuntos
Cianoacrilatos/efeitos adversos , Dermatite de Contato/epidemiologia , Mamoplastia/métodos , Adesivos Teciduais/efeitos adversos , Técnicas de Fechamento de Ferimentos/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Dermatite de Contato/etiologia , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Estudos Prospectivos , Virginia/epidemiologia , Adulto Jovem
5.
Vasc Endovascular Surg ; 54(1): 47-50, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31581906

RESUMO

OBJECTIVES: Cyanoacrylate glue is injected for incompetent great saphenous vein (GSV) treatment 5 cm distal to the saphenofemoral junction (SFJ). Although a few reports have investigated the postprocedural remnant stump length, none have focused on the factors affecting glue extension length and the consequent remnant stump length. METHODS: Seventy-nine patients undergoing cyanoacrylate closure using the VenaSeal system at our clinic between August 2018 and November 2018 were investigated. The GSV diameter was measured just before treatment in the supine position 3 cm distal to the SFJ. Cyanoacrylate glue was injected 5 cm distal to the SFJ. RESULTS: The mean glue extension length was 1.13 ± 1.12 cm. The GSV diameter and glue extension length exhibited a significant inversely proportional relationship (P < .001). More specifically, patients with a GSV diameter ≥0.7 cm had a longer remnant stump length than those with a smaller GSV diameter (P < .001). CONCLUSIONS: An increased GSV diameter is likely associated with a decreased glue extension length and, consequently, a longer remnant stump.


Assuntos
Cianoacrilatos/administração & dosagem , Veia Safena , Adesivos Teciduais/administração & dosagem , Varizes/terapia , Adulto , Cianoacrilatos/efeitos adversos , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Adesivos Teciduais/efeitos adversos , Resultado do Tratamento , Ultrassonografia de Intervenção , Varizes/diagnóstico por imagem , Varizes/fisiopatologia
6.
Dermatitis ; 30(5): 314-322, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31517667

RESUMO

BACKGROUND: Cyanoacrylates are strong adhesives used for a variety of medical, industrial, and cosmetic applications and have been implicated as a cause of allergic contact dermatitis. OBJECTIVE: The aim of the study was to review our experience in patch testing with cyanoacrylates. METHODS: We reviewed patch test results of 38 patients with a clinical history of contact dermatitis due to a cyanoacrylate-containing adhesive (mostly Dermabond). Testing used cyanoacrylates of >99% purity diluted to 10% to 30% in petrolatum (pet.), undiluted octyl cyanoacrylate, and/or Dermabond Mini or Advanced "as is." Patch tests were also performed with methacrylates, formaldehyde (a cyanoacrylate impurity), benzalkonium chloride, and cyanoacrylate polymerization inhibitors. Three patients were also tested with Dermabond Mini on abraded skin. RESULTS: Commercial cyanoacrylate patch testing material (ethyl cyanoacrylate 10% pet.) detected 29% of Dermabond-allergic patients, whereas patch testing with octyl cyanoacrylate 10% pet. increased detection to 50%. Testing with higher concentrations and/or on abraded skin further increased yield. Thirteen (37%) of our 35 cyanoacrylate-allergic patients were also allergic to methacrylates or acrylates. CONCLUSIONS: Octyl cyanoacrylate is the usual allergenic ingredient in Dermabond. Patch testing with high concentrations is often required. Testing Dermabond on abraded skin further improves diagnostic sensitivity by more closely simulating clinical use.


Assuntos
Cianoacrilatos/efeitos adversos , Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/etiologia , Testes do Emplastro , Adesivos Teciduais/efeitos adversos , Humanos , Metacrilatos/efeitos adversos , Testes do Emplastro/métodos
7.
Br J Nurs ; 28(15): S26-S32, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31393764

RESUMO

The skin is the largest and one of the most important organs of the body and as such it is essential that skin integrity is maintained to preserve normal body functions as much as possible at all times. Health professionals must endeavour to minimise any pain and trauma likely to be encountered by their patients through the use of a variety of medical products and devices that are designed to adhere to the skin, especially as the use of dermatological and wound-management products in particular, that incorporate adhesives to help keep them secure and in place, has grown in line with the increasingly ageing population and changing demographics throughout the UK. This article reviews the literature related to the causes of medical-adhesive-related skin injuries (MARSIs) and the reported patient effects, in particular pain and skin trauma and highlight some 'at-risk' patient groups and potential actions to minimise risk. A sterile silicone medical adhesive remover-Appeel Sterile-is introduced and the clinical benefits highlighted through the discussion of clinical evidence and case studies undertaken on a range of patients with varied aetiologies.


Assuntos
Dor/prevenção & controle , Higiene da Pele/enfermagem , Adesivos Teciduais/efeitos adversos , Ferimentos e Lesões/prevenção & controle , Humanos , Dor/etiologia , Pele/lesões , Populações Vulneráveis , Ferimentos e Lesões/etiologia
8.
Ann Vasc Surg ; 60: 463-467, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31200058

RESUMO

Surgical site infections (SSIs) are a common source of morbidity with vascular surgery incisions, especially in the groin. Single institution case series have widely varying, but high incidences of groin wound infection after open lower extremity revascularization. Optimally, a dressing that did not require changes, had low cost, and was water resistant would be optimal in these patients. We developed and validate a new dressing utilizing Dermabond (Ethibond™) and Tegaderm™ for vascular surgery incisions that could simplify and reduce postoperative SSIs. In this initial experience, we reviewed 94 patients. Of the 94 patients, 0 had signs of infection superficial or deep, dehiscence, or evidence of nonhealing. Gluing a Tegaderm to an incision using Dermabond is a novel and easy way to perform dressing that reduces wound infection, increases patient comfort, avoids dressing changes, and allows visualization of the wound.


Assuntos
Bandagens , Cianoacrilatos/uso terapêutico , Infecção da Ferida Cirúrgica/prevenção & controle , Adesivos Teciduais/uso terapêutico , Procedimentos Cirúrgicos Vasculares , Cicatrização , Adulto , Idoso , Idoso de 80 Anos ou mais , Bandagens/efeitos adversos , Cianoacrilatos/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adesivos Teciduais/efeitos adversos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos
9.
Ann Ital Chir ; 90: 100-105, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31182696

RESUMO

INTRODUCTION: The routinely use of drains in thyroid surgery is a traditional and well-defined method, even if there is no clear evidence of significant improvement in patients outcomes. Aim of our study is to define the feasibility, safety and cost- effectiveness of fibrin sealant in total thyroidectomy in order to overcome the use of drains. MATERIALS AND METHODS: We enrolled 262 patients (45 men and 217 women, mean age 54.7 yrs) undergone total thyroidectomy in University Hospital of Palermo (Italy), between July 2015 and October 2017. We randomized patients into group A (drain) and group B (no drain, fibrin sealant application). RESULTS: We registered statistical difference between the two groups in mean operative time, visual analogue scale of pain, post-operative stay, incidence of seromas and/or deep and superficial hematomas, re-operation and wound infection (reduced in the fibrin sealant group). No significant difference have been found in intraoperative blood loss, postoperative cough, post-operative use of analgesic and in incidence of hypoparathyroidism or recurrent palsy. CONCLUSIONS: Our study demonstrates that there is no evidence that the use of suction drains improves patients outcome and that routinely use of fibrin sealant can be advocated in thyroid surgery as an adjunct to a good surgical procedure. KEY WORDS: Complication, Drainage, Fibrin Sealant, Thyroidectomy.


Assuntos
Drenagem , Adesivo Tecidual de Fibrina , Tireoidectomia/métodos , Adesivos Teciduais , Análise Custo-Benefício , Estudos de Viabilidade , Feminino , Adesivo Tecidual de Fibrina/efeitos adversos , Adesivo Tecidual de Fibrina/economia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Adesivos Teciduais/efeitos adversos , Adesivos Teciduais/economia , Resultado do Tratamento
10.
J Cardiovasc Surg (Torino) ; 60(5): 599-611, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31089086

RESUMO

BACKGROUND: Synthetic vascular material use, particularly polytetrafluoroethylene- (PTFE) -based, can be associated with bleeding, which may increase operative time and blood loss. None of the commercially available sealants designed to ensure hemostasis combine bioresorption, high viscosity, hydrophobicity, and compliance with the underlying tissue and on-demand activation. METHODS: A study was designed to assess the biocompatibility and in-vivo performance and bioresorption of a new synthetic on-demand light-activated poly(glycerol-sebacate) acrylate- (PGSA) -based SETALIUM™ Vascular Sealant (TISSIUM, Paris, France) in three large animal studies of open vascular carotid and aortic surgery. The pre-clinical results were then translated into a clinical setting in a prospective, single-arm multicenter study in patients requiring carotid endarterectomy using an ePTFE patch. RESULTS: The biocompatibility testing showed that the PGSA-based SETALIUM™ Vascular Sealant did not induce any significant toxic reaction at a standard clinical dose nor at doses up to 40 times the equivalent intended clinical dose. The PGSA-based sealant was shown to be non-pyrogenic, non-sensitizing, non-irritant, non-clastogenic, and non-mutagenic. The animal studies showed excellent performance and safety results, with clinically significant hemostasis achieved in 100% of the animals in both carotid and aorta studies and excellent local tolerance. Histopathology and morphometric analyses showed surface-based gradual and sustained bioresorption of the PGSA-based sealant up to 86% at 12 months. In the clinical study, the application of the PGSA-based sealant resulted in good performance and safety, with immediate hemostasis achieved in 84% of the cases and no adverse event related to the sealant reported through the one-year follow-up. CONCLUSIONS: The new synthetic on-demand light activated PGSA-based SETALIUM™ Vascular Sealant investigated in our studies demonstrated good biocompatibility, sustained and gradual surface based bioresorption, and acceptable safety profile in animal studies. In addition, the first in-human use showed that the sealant is a safe and effective alternative to achieve fast and controlled hemostasis in vascular carotid reconstructions. A larger randomized controlled study will allow further validation of these encouraging preliminary results.


Assuntos
Acrilatos/administração & dosagem , Angioplastia/efeitos adversos , Aorta Torácica/cirurgia , Artérias Carótidas/cirurgia , Decanoatos/administração & dosagem , Endarterectomia das Carótidas/efeitos adversos , Glicerol/análogos & derivados , Hemorragia/prevenção & controle , Técnicas Hemostáticas , Polímeros/administração & dosagem , Adesivos Teciduais/administração & dosagem , Acrilatos/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Angioplastia/instrumentação , Animais , Decanoatos/efeitos adversos , Endarterectomia das Carótidas/instrumentação , Feminino , Glicerol/administração & dosagem , Glicerol/efeitos adversos , Técnicas Hemostáticas/efeitos adversos , Humanos , Masculino , Teste de Materiais , Pessoa de Meia-Idade , Modelos Animais , Polímeros/efeitos adversos , Estudos Prospectivos , Carneiro Doméstico , Fatores de Tempo , Adesivos Teciduais/efeitos adversos , Resultado do Tratamento
12.
Adv Skin Wound Care ; 32(4): 176-182, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30845071

RESUMO

OBJECTIVE: To investigate the prevalence of medical adhesive-related skin injuries (MARSIs) and associated risk factors in a pediatric ICU (PICU). METHODS: A cross-sectional design was adopted in the PICU of a university-based children's hospital in eastern China. A total of 232 patients were enrolled, and 611 person-days were analyzed. MAIN OUTCOME MEASURES: Researchers assessed all patients daily for 2 weeks. The use of adhesives and prevalence of MARSIs were recorded. The patients' clinical data were also collected. The prevalence of MARSIs was calculated daily, and the risk factors were examined statistically. MAIN RESULTS: The MARSI prevalence ranged from 23.53% to 54.17% (mean, 37.15%). Multivariate analysis identified being female, age 2 years or younger, hospital stays longer than 5 days, infection, edema, and surgery as independent risk factors. Prevalence by product ranged from 19 to 53 per 1,000 product-days with a mean of 34 MARSIs per 1,000 product-days. The major MARSI types were epidermal stripping and skin tear. The face was the most common MARSI site, and tracheal intubation was the most common inciting condition. Implicated products were acrylate tapes with elastic cloth backings. CONCLUSIONS: Researchers concluded that MARSI is common in the PICU. Skin stripping and skin tear were the most common types, and the face was the most vulnerable site for MARSI, typically attributable to the cloth tape used to affix tracheal intubation. Careful attention should be paid to children with identified risk factors (females, age 2 years or younger, longer hospital stays, edema, infection, or surgery).


Assuntos
Unidades de Terapia Intensiva Pediátrica , Dermatopatias/etiologia , Pele/lesões , Adesivos Teciduais/efeitos adversos , Fatores Etários , Criança , Pré-Escolar , China , Cuidados Críticos/métodos , Estudos Transversais , Feminino , Hospitais Universitários , Humanos , Lactente , Recém-Nascido , Masculino , Determinação de Necessidades de Cuidados de Saúde , Prevalência , Medição de Risco , Dermatopatias/epidemiologia , Dermatopatias/fisiopatologia
13.
Toxicol Pathol ; 47(4): 483-493, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30898059

RESUMO

Self-adhesive meshes are being developed to avoid complications due to traumatic fixation methods. LifeMesh™ is a novel self-adhesive mesh with a biodegradable gelatin adhesive layer developed for hernia repair. The aim of this study was to assess the safety and biodegradability of LifeMesh in Sprague-Dawley (SD) rats for 6 weeks, in comparison to a bare polypropylene (BPP) mesh fixed with sutures. LifeMesh was tolerated well and its implantation did not result in any adverse local reaction, and its adhesive layer was substantially degraded after 4 weeks. Histopathological examination revealed that the presence of the adhesive contributed to a uniform thickness of the granulation tissue surrounding the mesh, in contrast to a nonuniform granulation tissue with BPP. Nonuniform granulation tissue suggests that there will be poorer integration of the mesh to the abdominal wall. The use of LifeMesh also resulted in less adhesions of internal organs with a smaller surface area of involvement. These findings lend support to the potential benefit of LifeMesh for hernia repair in humans and expand the available information on the typical histopathological findings expected with biodegradable implants in the peritoneal cavity of SD rats.


Assuntos
Implantes Absorvíveis , Telas Cirúrgicas/efeitos adversos , Adesivos Teciduais/efeitos adversos , Parede Abdominal/patologia , Parede Abdominal/cirurgia , Animais , Masculino , Polipropilenos/efeitos adversos , Ratos Sprague-Dawley , Suturas , Aderências Teciduais/etiologia
14.
Turk Neurosurg ; 29(3): 377-385, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30907976

RESUMO

AIM: To investigate comparative efficacy of a novel absorbable adhesive membrane (TissuePatchDuralTM "TPD") and a fibrin glue (Tisseel "T") in reducing cerebrospinal fluid (CSF) leaks after posterior fossa and spinal procedures, and also to identify potential risk factors for CSF leakage. MATERIAL AND METHODS: This is a single-center, retrospective cohort study of 123 consecutive posterior fossa (n=77) and spinal (n=46) surgeries. Patients were grouped based on dural sealants used 2-group comparison: TPD (n=56) vs. no-TPD (n=67) and 3-group comparison: T only (n=43), TPD only (n=32) vs TPD+T (n=35). RESULTS: Mean age was 38.9 ± 22.2 years (62 males, 61 females). Baseline characteristics were similar between groups. Neither 2-group (TPD: 10.4% vs no-TPD: 8.9%; p=0.778) nor 3-group (T: 9.3% vs TPD: 6.3% vs TPD+T: 14.3%; p=0.539) comparisons revealed a significant difference in postoperative CSF leakage rates. Multivariate analysis showed that diagnosis (non-tumoral vs. tumor) (OR: 5.487; 95% CI: 1.118-26.937; p=0.036); previous surgery (OR: 9.268; 95% CI: 1.911-44.958; p=0.006), postoperative hydrocephalus (OR: 5.456; 95% CI: 1.250-23.821; p=0.024) were independent predictors of postoperative CSF leakage. CONCLUSION: TissuePatchDural < sup > TM < /sup > is a novel dural sealant patch which can be safely used to reinforce dural closure in posterior fossa and spinal surgeries, and its efficacy is comparable to widely used fibrin glue (Tisseel). Non-tumoral pathologies, previous surgery, and postoperative hydrocephalus appear to be independent risk factors for postoperative CSF leakage.


Assuntos
Vazamento de Líquido Cefalorraquidiano/diagnóstico , Dura-Máter/cirurgia , Adesivo Tecidual de Fibrina/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Coluna Vertebral/cirurgia , Adesivos Teciduais/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Vazamento de Líquido Cefalorraquidiano/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Dura-Máter/patologia , Feminino , Adesivo Tecidual de Fibrina/administração & dosagem , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/tendências , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Coluna Vertebral/patologia , Adesivos Teciduais/administração & dosagem , Adulto Jovem
15.
J Pediatr Surg ; 54(8): 1668-1670, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30268489

RESUMO

BACKGROUND / PURPOSE: Sacrococcygeal pilonidal sinus disease (PSD) has an incidence of 1.2-2.5/1000 in children. Onset is around puberty. Symptoms of recurrent abscess and chronic suppuration may interfere with education and social integration. Treatments should cause minimal disruption while having good cure and recurrence rates. Curettage and Fibrin glue obliteration (FGO) show promising results in adults. We present our experience of its use in children. METHODS: Review of all pediatric patients receiving FGO of pilonidal sinus performed by a single surgeon from September 2014 to February 2018. RESULTS: Eighteen patients were identified. Median age was 16 (range 15-17), 55.6% were male. All procedures were completed as day cases. Median operative duration was 14 .1 (6-29) min. Twelve patients required only 1 procedure, 4 required 2 procedures, 1 required 5 procedures and 1 elected for formal excision after 2 FGO treatments. Median return to normal activities was 3 days, with 1 day school absence. Two patients developed minor surgical site infections. Median follow-up was 52 weeks (17-102), during which time there was 1 recurrence (5.6%). CONCLUSION: This study demonstrates FGO is a safe, effective procedure for pediatric PNS, with results comparable to off-midline flap techniques and without the need for extensive tissue excision and the associated morbidity. LEVEL OF EVIDENCE: IV.


Assuntos
Adesivo Tecidual de Fibrina/uso terapêutico , Seio Pilonidal/cirurgia , Adesivos Teciduais/uso terapêutico , Adolescente , Feminino , Adesivo Tecidual de Fibrina/efeitos adversos , Humanos , Masculino , Duração da Cirurgia , Recidiva , Reoperação , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia , Adesivos Teciduais/efeitos adversos
17.
Ann Vasc Surg ; 55: 239-245, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30217712

RESUMO

BACKGROUND: Cyanoacrylate closure for the treatment of incompetent saphenous veins does not cause thermal damage and demonstrates satisfactory outcomes with rapid recovery. However, the characteristics of phlebitis-like abnormal reaction (PLAR), the most common adverse event after cyanoacrylate closure, have not been clarified. Moreover, it differs from typical phlebitis after thermal ablation. The objective of our study is to investigate the clinical features of PLAR after cyanoacrylate closure and to report its management. METHODS: A total of 160 patients with 271 incompetent saphenous veins (great saphenous veins, 201; small saphenous veins, 70) underwent cyanoacrylate closure with the VenaSeal™ system. We defined PLAR as any unusual skin condition that develops suddenly, such as erythema, itching, swelling, and pain/tenderness, over the treated veins several days after cyanoacrylate closure. Oral antihistamines and intravenous dexamethasone were administered to manage PLAR. RESULTS: Of the 271 treated veins, 69 experienced PLAR (25.4%). The mean time of occurrence was 13.6 ± 4.6 days after treatment. The rate of occurrence of erythema, itching, swelling, and pain/tenderness were 92.2%, 91.2%, 66.2%, and 48.5%, respectively. The occurrence of PLAR was significantly higher for great saphenous veins than for small saphenous veins (P < 0.001). Occurrences were more frequent in cases with a suprafascial great saphenous vein of length >10 cm than in cases with a subfascial great saphenous vein (P = 0.001). The proportion of patients who reported swelling decreased by more than half after the administration of oral antihistamine. The pain score on the 10th day also decreased significantly after the administration of antihistamine (P = 0.006). CONCLUSIONS: PLAR must be distinguished from classic phlebitis. We believe that PLAR is a type IV hypersensitivity reaction due to a foreign body, and in our experience, antihistamines or steroids are effective for the prevention and management of PLAR.


Assuntos
Cianoacrilatos/efeitos adversos , Reação a Corpo Estranho/induzido quimicamente , Hipersensibilidade Tardia/induzido quimicamente , Flebite/induzido quimicamente , Veia Safena , Adesivos Teciduais/efeitos adversos , Insuficiência Venosa/terapia , Administração Intravenosa , Administração Oral , Adulto , Idoso , Dexametasona/administração & dosagem , Feminino , Reação a Corpo Estranho/diagnóstico por imagem , Reação a Corpo Estranho/tratamento farmacológico , Reação a Corpo Estranho/fisiopatologia , Glucocorticoides/administração & dosagem , Antagonistas dos Receptores Histamínicos/administração & dosagem , Humanos , Hipersensibilidade Tardia/diagnóstico por imagem , Hipersensibilidade Tardia/tratamento farmacológico , Hipersensibilidade Tardia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Flebite/diagnóstico por imagem , Flebite/tratamento farmacológico , Flebite/fisiopatologia , Estudos Prospectivos , Fatores de Risco , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia , Adulto Jovem
18.
World J Surg ; 43(2): 447-456, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30251208

RESUMO

The most troublesome complications of inguinal hernia repair are recurrent herniation and chronic pain. A multitude of technological products dedicated to abdominal wall surgery, such as self-gripping mesh (SGM) and glue fixation (GF), were introduced in alternative to suture fixation (SF) in the attempt to lower the postoperative complication rates. We conducted an electronic systematic search using MEDLINE databases that compared postoperative pain and short- and long-term surgical complications after SGM or GF and SF in open inguinal hernia repair. Twenty-eight randomized controlled trials totaling 5495 patients met the inclusion criteria and were included in this network meta-analysis. SGM and GF did not show better outcomes in either short- or long-term complications compared to SF. Patients in the SGM group showed significantly more pain at day 1 compared to those in the GF group (VAS score pain mean difference: - 5.2 Crl - 11.0; - 1.2). The relative risk (RR) of developing a surgical site infection (RR 0.83; Crl 0.50-1.32), hematoma (RR 1.9; Crl 0.35-11.2), and seroma (RR 1.81; Crl 0.54-6.53) was similar in SGM and GF groups. Both the SGM and GF had a significantly shorter operative time mean difference (1.70; Crl - 1.80; 5.3) compared to SF. Chronic pain and hernia recurrence did not statistically differ at 1 year (RR 0.63; Crl 0.36-1.12; RR 1.5; Crl 0.52-4.71, respectively) between SGM and GF. Methods of inguinal hernia repair are evolving, but there remains no superiority in terms of mesh fixation. Ultimately, patient's preference and surgeon's expertise should still lead the choice about the fixation method.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Dor Crônica/etiologia , Humanos , Metanálise em Rede , Dor Pós-Operatória/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Telas Cirúrgicas/efeitos adversos , Técnicas de Sutura/efeitos adversos , Suturas/efeitos adversos , Adesivos Teciduais/efeitos adversos
19.
Pediatr Emerg Care ; 35(1): 75-77, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27977531

RESUMO

OBJECTIVES: Nail bed injuries are common in children, with nail bed damage accounting for 15% to 24% of fingertip injuries. Our objective was to see whether medical adhesives, the cyanoacrylates including Histoacryl and Dermabond, could be used to fix nail bed lacerations as opposed to doing a primary repair with sutures, thus potentially being a quicker method for repair in the emergency department for these injuries. METHODS: We conducted a literature review using the search engines MEDLINE, PubMed, Web of Science, and Google Scholar, and the references within these articles were also integrated. All articles in English were searched. Search terms included "nail bed repair," "nail bed laceration repair," and "cyanoacrylate." RESULTS: A total of 6 articles were found using the previously mentioned search terms. Four articles using 2-octyl cyanoacrylate or Dermabond for the repair of nail bed injuries were found, with 2 additional articles describing the use of Histoacryl-n-butyl-2-cyanoacrylate-for nail injury repairs. CONCLUSIONS: The 6 articles discussed in this article include approximately 118 patients' worth of data including a mix of adult and pediatric patients. Despite the small numbers and variety of types of study, it is encouraging that there are so many positive results. Cryoacrylates such as Dermabond or Histoacryl maybe useful to assist with nail injuries in children. Therefore, we feel that using a medical adhesive is as effective as suturing nail bed injuries in children.


Assuntos
Cianoacrilatos/administração & dosagem , Doenças da Unha/terapia , Unhas/lesões , Suturas/efeitos adversos , Adesivos Teciduais/uso terapêutico , Adulto , Criança , Cianoacrilatos/efeitos adversos , Serviço Hospitalar de Emergência , Humanos , Lacerações/terapia , Adesivos Teciduais/efeitos adversos
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