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1.
Medicine (Baltimore) ; 100(22): e26235, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087908

RESUMO

RATIONALE: Degloving foot injuries are challenging to treat and associated with life-long sequelae for patients. An appropriate debridement of ischemic soft tissues with maximal preservation of glabrous skin is key during the reconstruction of these injuries. Indocyanine green (ICG) fluorescence angiography is an established technique for the intraoperative evaluation of tissue perfusion. PATIENT CONCERNS: Two patients sustained complex foot injuries in traffic accidents, including multiple fracture dislocations and extensive degloving of the plantar skin. DIAGNOSIS: Clinical inspection revealed significant degloving of the glabrous skin in both patients. INTERVENTIONS: After fracture fixation, ICG fluorescence angiography-assisted debridement with immediate latissimus dorsi free flap reconstruction was performed. OUTCOMES: In both cases, this technique allowed a precise debridement with maximal preservation of the glabrous skin. The healing of the remaining glabrous skin was uneventful and the 6-month follow-up was characterized by stable soft tissues and satisfying ambulation. LESSONS: ICG fluorescence angiography is a safe, user-friendly, and quick procedure with minimal risks, expanding the armamentarium of the reconstructive surgeon. It is highly useful for the debridement of extensive plantar degloving injuries and may also help to minimize the number of procedures and the risk of infection.


Assuntos
Desbridamento/métodos , Angiofluoresceinografia/métodos , Traumatismos do Pé/cirurgia , Pé/diagnóstico por imagem , Adulto , Assistência ao Convalescente , Criança , Desenluvamentos Cutâneos/cirurgia , Feminino , Pé/irrigação sanguínea , Pé/patologia , Traumatismos do Pé/complicações , Fraturas Múltiplas/cirurgia , Humanos , Verde de Indocianina/administração & dosagem , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos/cirurgia , Resultado do Tratamento
2.
Medicine (Baltimore) ; 100(22): e26247, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087913

RESUMO

RATIONALE: Open total dislocation of ankle joint is rare and often caused by high-energy injury. The present study describes a patient with open total lateral dislocation of ankle joint without fractures and obtained a satisfactory clinical result following early debridement and irrigation, one-stage repairment of ligaments, and plaster external fixation. PATIENT CONCERNS: The patient, a 45-year-old male, complained of right foot pain with bleeding and limited motion. Physical examination showed a 15-cm open wound at the medial ankle region, with soft tissues impaired and ankle bones exposed. The 3 dimensional reconstruction computed tomography (CT) examination showed an open total dislocation of ankle joint without concomitant fractures. DIAGNOSES: open total lateral dislocation of ankle joint without fractures. INTERVENTIONS: Early modern wound care including thorough debridement and irrigation on the wound was performed to remove contaminated soft tissues. Subsequently, the dislocated ankle joint was reduced by hand and the medial and lateral collateral ligaments were repaired using wire anchors. OUTCOMES: The medial wound healed at 2 weeks after surgery, and several common complications such as infection and skin necrosis did not occur. The last follow-up showed a good range of metatarsal flexion and extension of the injured foot, and obvious signs of traumatic arthritis were not observed. According to Kaikkonen ankle function score, the patient was assessed with 90 points. LESSONS: For open total dislocation of ankle joint, early treatment should focus on debridement and irrigation, reduction and fixation of the dislocated ankle, protection of the weak soft tissues, and stable external fixation to promote wound healing and reduce the incidence of related complications.


Assuntos
Articulação do Tornozelo/patologia , Desbridamento/métodos , Luxações Articulares/cirurgia , Irrigação Terapêutica/métodos , Assistência ao Convalescente , Articulação do Tornozelo/diagnóstico por imagem , Humanos , Imageamento Tridimensional/instrumentação , Luxações Articulares/diagnóstico , Ligamentos Laterais do Tornozelo/lesões , Ligamentos Laterais do Tornozelo/cirurgia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Lesões dos Tecidos Moles/patologia , Lesões dos Tecidos Moles/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ferimentos e Lesões/patologia , Ferimentos e Lesões/cirurgia
4.
Acta Med Indones ; 53(1): 105-107, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33818413

RESUMO

Acute bacterial skin and skin-structure infections (ABSSSI) is defined in 2013 by the US Food and Drug Administration as a bacterial cellulitis/erysipelas, major skin abscesses, and wound infections. The Infectious Diseases Society of America (IDSA) in 2014 classifies skin and soft-tissue infection (SSTI) as either non-purulent (which includes cellulitis, erysipelas, and necrotizing infection) or purulent (including furuncle, carbuncle, and abscess). Among hospitalized patients with SSTI, healthcare-associated infections account for 73.5% of all cases. Notably, skin and skin-structure infections caused by Pseudomonas aeruginosa, a common hospital pathogen, was reported to cause higher total cost and longer hospital length of stay compared to non-P. aeruginosa cases, despite causing only approximately 5.7% of all healthcare-associated SSTIs. Infection with P. aeruginosa should always be considered in non-healing skin infections in patients with prolonged hospitalization and antibiotic exposure. Tissue culture, preferably taken by surgical debridement, should be promptly performed; and when hospital-infection is suspected, appropriate antibiotics should be started along with removal of all devitalized tissue and to promote skin and soft tissue healing. Expedited discharge should be considered when possible, with adequate antibiotic treatment and follow up for definitive wound treatment.


Assuntos
COVID-19/complicações , Desbridamento/métodos , Doença Iatrogênica , Linezolida/administração & dosagem , Dermatopatias Infecciosas , Antibacterianos/administração & dosagem , COVID-19/diagnóstico , COVID-19/fisiopatologia , Feminino , Hospitalização , Humanos , Pessoa de Meia-Idade , SARS-CoV-2/isolamento & purificação , Pele/microbiologia , Pele/patologia , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/etiologia , Dermatopatias Infecciosas/fisiopatologia , Dermatopatias Infecciosas/terapia , Resultado do Tratamento
5.
Medicine (Baltimore) ; 100(12): e24330, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761633

RESUMO

ABSTRACT: This study aimed to investigate the therapeutic effects of osteotomy combined with lateral ligament reconstruction on the osteochondral lesion of patients with talar injuries and varus ankles.Seventy five patients with talar injuries and varus ankles who received osteotomy combined with lateral ligament reconstruction for the osteochondral lesions from June 2008 to December 2014 were retrospectively reviewed. Patients were followed up for 32.4 ±â€Š15.3 months after surgeries, and the AOFAS-AH score, VAS score and SF36 score were determined preoperatively and postoperatively. The iconographic data were compared preoperatively and postoperatively, including tibial anterior surface angle (TAS), TTS, TT, and tibial lateral surface angle (TLS) angles.After surgeries, the AOFAS-AF score increased from 43.2 ±â€Š8.1 to 82.1 ±â€Š5.6, the VAS score decreased from 6.9 ±â€Š2.3 to 1.8 ±â€Š1.5, and the SF36 score increased from 48.7 ±â€Š9.4 to 83.5 ±â€Š6.2. TAS increased from 83.3 ±â€Š5.1 to 90.3 ±â€Š6.1, TTS increased from 70.3 ±â€Š6.1 to 82.5 ±â€Š5.4, TT decreased from 12.9 ±â€Š6.1 to 6.9 ±â€Š5.7, and TLS increased from 76.5 ±â€Š4.1 to 81.2 ±â€Š3.3 (P < .05).Osteotomy combined with lateral ligament reconstruction is effective for the treatment of talar osteochondral lesion with varus ankle, which could relieve the arthritic symptoms induced by cartilage lesions. By correcting the force line on lower limbs and metapedes with osteotomy completely, the treatments on talar osteochondral lesion and lateral ligament reconstruction are the critical factors with better results.


Assuntos
Articulação do Tornozelo/anormalidades , Ligamentos Colaterais/cirurgia , Osteotomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tálus/lesões , Articulação do Tornozelo/cirurgia , Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Desbridamento/efeitos adversos , Desbridamento/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos Retrospectivos , Tálus/cirurgia , Resultado do Tratamento
6.
Medicine (Baltimore) ; 100(11): e24752, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725941

RESUMO

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.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Fumigação/métodos , Medicina Tradicional Chinesa/métodos , Osteoartrite do Joelho/reabilitação , Cuidados Pós-Operatórios/enfermagem , Artroscopia/métodos , Artroscopia/reabilitação , Desbridamento/métodos , Desbridamento/reabilitação , Humanos , Metanálise como Assunto , Osteoartrite do Joelho/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
7.
Medicine (Baltimore) ; 100(10): e24965, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725860

RESUMO

BACKGROUND: There have been no published randomized clinical trial to assess the clinical outcomes between the articular-sided and bursal-sided tears. Therefore, a comparative analysis of evaluating and comparing the functional outcomes following arthroscopic repair of bursal-sided versus articular-sided partial-thickness rotator cuff tearsis essential. METHODS: This study is a present randomized controlled trial which is conducted in our hospital. Consecutive patients with symptomatic articular-sided or bursal-sided partial-thickness rotator cuff tears underwent arthroscopic repair between June 2020 and January 2022. The institutional review board approved the study proposal (with number 10012030), and informed consent was obtained from all patients. Inclusion criteria were existence of an articular- or bursal-sided tear involving <50% of the tendon thickness-confirmed intraoperatively and treated with arthroscopic debridement with or without other decompression surgery (acromioplasty/distal clavicle resection)-and a minimum follow-up of 2 years. All patients followed the same postoperative rehabilitation program. The patients were assessed at baseline preoperatively, and at 1 year and 2 years postoperatively. Outcome parameters were measured at each respective follow-up, which included active range of motion in forward flexion and abduction of the affected shoulder, pain score as measured on the Numeric Pain Rating Scale, as well as outcome scores in terms of the Constant-Murley Score, and Oxford Shoulder Score. RESULTS: Table 1 and Table 2 describe the data indicators that this article wants to evaluate and collect. CONCLUSIONS: We hypothesize that both groups of patients will show improvement in range of motion, functional outcome scores, and pain at 2 years, and that results would be similar between the two groups. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry6496).


Assuntos
Artralgia/cirurgia , Artroscopia , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Articulação do Ombro/fisiopatologia , Artralgia/diagnóstico , Artralgia/etiologia , Artralgia/fisiopatologia , Braquetes , Desbridamento/métodos , Descompressão Cirúrgica/métodos , Feminino , Seguimentos , Humanos , Masculino , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/reabilitação , Articulação do Ombro/cirurgia , Resultado do Tratamento
8.
Pan Afr Med J ; 38: 23, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33777291

RESUMO

Fournier's gangrene (FG) is a rapidly progressive necrotizing bacterial dermo-hypodermitis of the perineum and external genitalia. It represents a real medical and surgical emergency requiring multidisciplinary care. Our study was based on the retrospective analysis of 18 cases of FG, collected in the Department of General and Visceral Surgery of Fattouma Bourguiba University Hospital in Monastir over an 18-year period extending from January 2000 to December 2018. Our series included 18 cases of FG collected over an 18-year period, an annual incidence of one case per year. The average age of our patients was 58 years (36 to 77). The male prevalence was clear. Diabetes and old age were found to be the major risk factors. The treatment was based on an aggressive surgical debridement remains to be the cornerstone of therapy and is commonly preceded by patient preparation for the surgical act by perioperative resuscitation and broad-spectrum antibiotic therapy, possibly accompanied by hyperbaric oxygen therapy (HBOT). The vaccum assisted closure (VAC) therapy is also used, which is a non-invasive system that promotes open wound healing. Healing techniques can be once the septic risk is controlled. Dressings topical treatments, such as fatty substances or calcium alginate, in addition to skin grafts, musculo-neurotic or musculo-cutaneous cover flaps can be used. During the follow-up period, no reccurrence occurred in 14 out of the 18 cases (2 patients were lost to follow-up and 2 patients died). A colostomy was closed in 10 out of 11 cases with simple follow-ups. Restorative surgery (partial thickness skin graft) at the perineal level was performed in only one case. Despite the better understanding of its etiopathogenesis, the advent of targeted antibiotic therapy, the establishment of a better codification of surgical procedures, the contribution of hyperbaric oxygenation and reconstruction techniques, mortality rates are still high and FG remains a real health threat, thus constituting a real medical and surgical emergency.


Assuntos
Desbridamento/métodos , Gangrena de Fournier/terapia , Cicatrização , Adulto , Idoso , Antibacterianos/administração & dosagem , Bandagens , Terapia Combinada , Feminino , Seguimentos , Gangrena de Fournier/patologia , Humanos , Oxigenação Hiperbárica/métodos , Masculino , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa/métodos , Estudos Retrospectivos , Fatores de Risco
9.
Ann R Coll Surg Engl ; 103(5): e141-e143, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33682434

RESUMO

At the onset of the COVID-19 crisis, a 63-year-old woman with multiple life-limiting comorbidities was referred with a necrotic infected left breast mass on a background of breast cancer treated with conservation surgery and radiotherapy 22 years previously. The clinical diagnosis was locally advanced breast cancer, but four separate biopsies were non-diagnostic. Deteriorating renal function and incipient sepsis and endocarditis resulted in urgent salvage mastectomy during the peak of the COVID19 pandemic. The final diagnosis was infected ischaemic/infarcted breast (wet gangrene) secondary to vascular insufficiency related to diabetes, cardiac revascularisation surgery and breast radiotherapy.


Assuntos
Antibacterianos/uso terapêutico , Mama/cirurgia , Angiopatias Diabéticas/terapia , Infecções por Enterobacteriaceae/terapia , Gangrena/terapia , Mastectomia/métodos , Mastite/terapia , Tratamento de Ferimentos com Pressão Negativa/métodos , Mama/irrigação sanguínea , Neoplasias da Mama/diagnóstico , COVID-19 , Carcinoma Ductal de Mama/diagnóstico , Ponte de Artéria Coronária , Desbridamento/métodos , Diabetes Mellitus Tipo 2/complicações , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/etiologia , Diagnóstico Diferencial , Infecções por Enterobacteriaceae/diagnóstico , Feminino , Gangrena/diagnóstico , Humanos , Infarto , Artéria Torácica Interna/cirurgia , Mastectomia Segmentar , Mastite/diagnóstico , Pessoa de Meia-Idade , Morganella morganii , Recidiva Local de Neoplasia/diagnóstico , Radioterapia , SARS-CoV-2 , Terapia de Salvação
10.
Diabetes Res Clin Pract ; 174: 108743, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33713718

RESUMO

AIMS: To investigate the therapeutic effect of continuous diffusion of oxygen (CDO) combined with traditional moist wound dressing (MWD) on the diabetic foot ulcers (DFUs) inpatients. METHODS: The inpatients from May 2016 to April 2018 were enrolled and randomly divided into MWD, CDO and combination treatment groups (n = 40 each group). The moist dressing was used in the MWD group while a micro-oxygen supply device was used in the CDO group. The combination treatment group was given both MWD and CDO. All patients were treated for 8 weeks. The wound healing, amputation rate, and inflammatory control were evaluated. RESULTS: Compared with MWD and CDO groups, the combination group showed a higher wound healing rate (P < 0.05), lower white blood cell count (P < 0.05) and lower high-sensitivity C-reactive protein level (P < 0.05). During 1-year follow-up, the amputation rate was 0% in combination group, which was significantly lower than that in other two groups (P < 0.05). CONCLUSIONS: The combination of MWD and CDO was effective in promoting healing and preventing infection of DFUs, which holds a potential to be a new strategy for the treatment of this critical clinical condition.


Assuntos
Bandagens/normas , Desbridamento/métodos , Pé Diabético/terapia , Oxigênio/uso terapêutico , Cicatrização/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
11.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33547110

RESUMO

A young man presented to our centre needing an urgent debridement of his postcraniotomy wound due to massive myiasis during the COVID-19 pandemic in October 2020. Prior to the surgery, his nasopharyngeal swab real-time PCR test result was unknown. One day later, it returned as SARS-CoV-2 positive. All healthcare workers who were involved in the patient management avoided cross infection as they wore appropriate personal protective equipment. This article depicts the importance of adequate preparations when handling potentially infectious patients and the perioperative issues associated with it.


Assuntos
COVID-19/complicações , Desbridamento/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Miíase/complicações , Miíase/cirurgia , Assistência Perioperatória/métodos , Couro Cabeludo/cirurgia , Adulto , COVID-19/prevenção & controle , Humanos , Masculino , Equipamento de Proteção Individual , SARS-CoV-2 , Adulto Jovem
12.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500303

RESUMO

Rib osteomyelitis is a rare disease, comprising 1% or less of all osteomyelitis. Treatment of rib osteomyelitis includes prolonged antibiotic therapy and surgical intervention. Indications for surgical treatment of rib osteomyelitis remain unclear, however, because of few reported cases. We report the first known case of extended-spectrum ß-lactamase-producing Escherichia coli rib osteomyelitis caused by urosepsis. The 69-year-old male patient remains free of recurrence and symptoms after rib resection and vacuum-assisted closure treatment with antibiotic therapy. Rib osteomyelitis should be considered as differential diagnosis when patients report chest pain after bacteraemic infection. We recommend surgical treatment for patients with drug-resistant bacterial rib osteomyelitis.


Assuntos
Abscesso/terapia , Antibacterianos/uso terapêutico , Cefmetazol/uso terapêutico , Desbridamento/métodos , Infecções por Escherichia coli/terapia , Osteomielite/terapia , Costelas/cirurgia , Abscesso/etiologia , Abscesso/patologia , Idoso , Infecções por Escherichia coli/microbiologia , Humanos , Masculino , Tratamento de Ferimentos com Pressão Negativa/métodos , Osteomielite/etiologia , Osteomielite/patologia , Costelas/patologia , Sepse/complicações , Parede Torácica , Tomografia Computadorizada por Raios X , Infecções Urinárias/complicações , Resistência beta-Lactâmica/fisiologia
13.
J Plast Reconstr Aesthet Surg ; 74(6): 1402-1407, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33388270

RESUMO

BACKGROUND: The modern ethos of burn care requires a holistic approach that helps patients to not only survive but also maintain a good quality of life. Bromelain-based enzymatic debridement with Nexobrid™ (NXB) has been shown to selectively debride burnt tissue and allow dermal preservation, which has the potential to reduce surgical burden and improve scarring. In this study, early experience with the use of Nexobrid™ at a tertiary burns centre between July 2016 and December 2019 is presented. In particular, the study assessed whether NXB had changed the acute care delivered to this cohort. METHODS: A retrospective analysis of the patients' records was performed. Results were analysed and presented in the context of current literature. RESULTS: Twenty adult patients (17 male, 3 female) underwent enzymatic debridement with NXB. Median age was 42.5 years. Mean total burn surface area (TBSA) on admission was 20%. Twelve patients were admitted to the intensive care unit, and eight were admitted to the adult burns ward. Mean TBSA treated with NXB was 8.2%, usually within 24 h of admission (mean). All patients had anaesthetist-led analgesia. NXB debridement was successful in 55% of patients, obviating the need for escharotomy in some patients. Sixty percent of all patients required further surgery, and 80% of facial burns treated with NXB required further surgery. Inotrope support was associated with NXB failure (p = 0.015). Mean length of stay was 29 days. DISCUSSION: Current evidence, including our own findings, cannot justify replacing the current surgical standard of care with NXB, but it certainly solidifies enzymatic debridement as a useful adjunct that should form part of the modern burn surgeon's armamentarium.


Assuntos
Bromelaínas/uso terapêutico , Queimaduras , Desbridamento/métodos , Terapia Enzimática/métodos , Qualidade de Vida , Adulto , Queimaduras/psicologia , Queimaduras/terapia , Cicatriz/etiologia , Cicatriz/terapia , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Manejo da Dor/métodos , Estudos Retrospectivos , Transplante de Pele/métodos , Resultado do Tratamento , Reino Unido/epidemiologia , Cicatrização/efeitos dos fármacos
14.
Injury ; 52(3): 402-406, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33341244

RESUMO

BACKGROUND: COVID-19 has created huge pressures on healthcare systems. The ongoing provision of major trauma services during this time has proved challenging. We report our experience of managing open lower limb fractures (oLLFs) during the pandemic in a London major trauma centre (MTC). METHODS: This was a prospective study of all open lower limb fractures presenting to our unit over the initial 48 days of UK government lockdown - 24th March till 10th May 2020. Results were compared to the same time period in 2019 retrospectively. Epidemiological data, mechanism, Gustilo-Anderson (G-A) severity grading, time to initial debridement and definitive coverage were analysed. RESULTS: There was a 64% reduction in emergency department (ED) attendances (25,264 vs 9042). There was an 18% reduction in oLLFs (22 vs 18). Approximately three-quarters of injuries were in males across both cohorts (77% vs 78%) and tended to occur in younger patients (median age, 37 vs 35). Road-traffic-accidents (RTAs) were the most common injury mechanism in both 2019 and lockdown, but a rise in jumpers from height was seen in the latter. A similar pattern of G-A severities were seen, however only 3 injuries during lockdown required major soft tissue reconstruction. There was no significant difference in times taken for initial debridement (p = 0.72786) or definitive wound coverage (p = 0.16152). A greater proportion of independent operating was seen during lockdown between orthopaedics and plastic surgery. CONCLUSIONS: Despite government lockdown measures, oLLFs still placed significant burden on our MTC. Notwithstanding significant staffing alterations and theatre pressures, we have been able to ensure these lower limb emergencies remain a surgical priority and have managed to utilise resources appropriately.


Assuntos
Fraturas do Fêmur/cirurgia , Traumatismos do Pé/cirurgia , Fraturas Expostas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Desbridamento/métodos , Feminino , Fraturas do Fêmur/epidemiologia , Traumatismos do Pé/epidemiologia , Fraturas Expostas/epidemiologia , Retalhos de Tecido Biológico , Humanos , Tempo de Internação , Londres , Masculino , Pessoa de Meia-Idade , Retalho Perfurante , SARS-CoV-2 , Cirurgia Plástica , Retalhos Cirúrgicos , Fraturas da Tíbia/epidemiologia , Fatores de Tempo , Centros de Traumatologia , Técnicas de Fechamento de Ferimentos , Adulto Jovem
15.
Am J Otolaryngol ; 42(1): 102458, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33045536

RESUMO

STUDY OBJECTIVE: Malodor is a multifactorial condition with oral pathology representing the main culprit and the tongue being the first to second contributor to the malodor. Bacterial load can represent a quantifiable measure regardless of the original pathology. We hypothesize that reduction in malodor can be represented by tongue changes both in appearance, bacterial and biofilm load reduction (measured by CFU and volatile gases measurement), organoleptic measurement and subjective improvement. METHODS: A randomized controlled prospective study under IRB approval. Diagnostic criteria for enrollment and follow up were organoleptic test by 2 judges, Halimeter reading, tongue colors changes HALT questionnaire and direct aerobic and anaerobic tongue cultures measured by CFU. Patients were treated with laser tongue debridement (LTD) with an Er,Cr:YSGG solid state laser has been shown to be effective in biofilm reduction. RESULTS: 54 patients recruited with 35 available for follow up. Improvement was observed on all objective and QOL subjective parameters. Treatment was tolerated well with minimal discomfort. CONCLUSIONS: The tongue is proven to be a major contributor to oral malodor and must be addressed in treatment protocol. LTD significantly reduces malodor by subjective and objective criteria. While impossible to determine whether the tongue serves as a bacterial reservoir or is the origin for oral bacteria it is clear that LTD improves oral hygiene and reduces malodor. LTD is safe and easy to perform. We encourage LTD to be a crucial part of any oral malodor treatment protocol. TRIAL REGISTRATION: clinical trials, NCT04120948. Registered 25 September 2019 - Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00098SX&selectaction=Edit&uid=U0000W0Y&ts=51&cx=-elnx7e.


Assuntos
Desbridamento/métodos , Halitose/cirurgia , Lasers de Estado Sólido/uso terapêutico , Língua/microbiologia , Língua/cirurgia , Adolescente , Adulto , Idoso , Fenômenos Fisiológicos Bacterianos , Biofilmes , Feminino , Halitose/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
16.
Methods Mol Biol ; 2193: 175-181, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32808269

RESUMO

A murine model of corneal epithelial wounding can be performed using simple injury and imaging methods. Here, we describe the creation of a central corneal epithelial defect using mechanical debridement under ophthalmic microscopic visualization. Subsequent monitoring with vital dye application and slit-lamp bio microscopy (slit-lamp) is described in detail.


Assuntos
Lesões da Córnea/patologia , Modelos Animais de Doenças , Animais , Lesões da Córnea/etiologia , Desbridamento/instrumentação , Desbridamento/métodos , Epitélio Anterior/patologia , Epitélio Anterior/fisiologia , Camundongos , Camundongos Endogâmicos C57BL , Procedimentos Cirúrgicos Oftalmológicos/instrumentação , Procedimentos Cirúrgicos Oftalmológicos/métodos , Cicatrização
19.
Plast Reconstr Surg ; 147(1S-1): 9S-15S, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33347058

RESUMO

SUMMARY: Wounds have been one of the most prominent pathologies since the beginning of humanity. For the last 5 decades, a drastic improvement of healing has been observed, thanks to new medical devices based on fluid aspiration capacities and the development of negative pressure wound therapy. Negative-pressure wound therapy was initially designed for a double action, fluid aspiration and mechanical stimulation of wound edges by a foam. Successive technical evolutions of negative pressure wound therapy were declined since 1997 when Argenta and Morykwas first presented their solution. The adjunct of instillation in 2009 was considered as the first interactive dressing, allowing topical wound solutions to sequentially reach the wound, in alternance with negative pressure. Other devices based on the same principle were designed to prevent postoperative infections when placed over a suture after surgery. This long evolution could enhance the armamentarium of possible solutions, considerably reducing the wound healing time.


Assuntos
Desbridamento/métodos , Tratamento de Ferimentos com Pressão Negativa/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Irrigação Terapêutica/métodos , Ferimentos e Lesões/terapia , Anti-Infecciosos Locais/administração & dosagem , Bandagens , Doença Crônica/terapia , Soluções Cristaloides/administração & dosagem , Desbridamento/história , Desbridamento/instrumentação , Retalhos de Tecido Biológico/transplante , História do Século XX , História do Século XXI , Humanos , Instilação de Medicamentos , Salvamento de Membro/métodos , Tratamento de Ferimentos com Pressão Negativa/história , Tratamento de Ferimentos com Pressão Negativa/instrumentação , Doença Arterial Periférica/terapia , Transplante de Pele/métodos , Irrigação Terapêutica/história , Irrigação Terapêutica/instrumentação , Resultado do Tratamento , Cicatrização , Ferimentos e Lesões/complicações
20.
Plast Reconstr Surg ; 147(1S-1): 16S-26S, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33347059

RESUMO

SUMMARY: The use of negative-pressure wound therapy (NPWT) has become an established therapy for wound management. There have been many advancements in the technology of NPWT including NPWT with instillation and dwell (NPWTi-d). NPWTi-d promotes wound healing by wound cleansing, irrigation, and nonexcisional debridement. NPWTi-d has been shown in comparative clinical studies to decrease the time to definitive wound healing and length of hospitalization. NPWTi-d-using a reticulated open-cell foam dressing with "through" holes (ROCF-CC)-has been postulated to facilitate solubilization, detachment, and elimination of infectious materials, such as slough and thick exudate, before or after operative debridement, and in cases where surgical debridement is not an option. The authors provide an overview on the use of NPWTi-d by reviewing the components of the system, proposed mechanism of action, clinical outcomes, and current consensus guidelines for its utilization.


Assuntos
Desbridamento/métodos , Tratamento de Ferimentos com Pressão Negativa/métodos , Irrigação Terapêutica/métodos , Infecção dos Ferimentos/prevenção & controle , Ferimentos e Lesões/terapia , Anti-Infecciosos Locais/administração & dosagem , Bandagens , Consenso , Desbridamento/instrumentação , Desbridamento/normas , Desbridamento/tendências , Humanos , Instilação de Medicamentos , Tratamento de Ferimentos com Pressão Negativa/instrumentação , Tratamento de Ferimentos com Pressão Negativa/normas , Tratamento de Ferimentos com Pressão Negativa/tendências , Guias de Prática Clínica como Assunto , Irrigação Terapêutica/instrumentação , Irrigação Terapêutica/normas , Irrigação Terapêutica/tendências , Cicatrização , Ferimentos e Lesões/complicações
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