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Ulusal Travma Ve Acil Cerrahi Dergisi =... Nov 2018The purpose of this study was to investigate factors affecting wound dehiscence due to blunt trauma following penetrating keratoplasty (PK) and the clinical outcomes.
BACKGROUND
The purpose of this study was to investigate factors affecting wound dehiscence due to blunt trauma following penetrating keratoplasty (PK) and the clinical outcomes.
METHODS
The medical records of patients who experienced blunt traumatic wound dehiscence after PK between 1995 and 2015 were analyzed retrospectively. The incidence and etiology of the trauma, the time interval between PK and globe rupture, final graft clarity, best-corrected visual acuity, complications, secondary surgeries, and factors potentially affecting wound dehiscence size were recorded.
RESULTS
This study included a total of 39 patients with a mean age of 42.66±16.66 years, of whom 23 patients were male and 16 patients were female. The incidence of wound dehiscence was 2.3%. The mean interval between the PK procedure and wound dehiscence was 25.91±47.24 months and the mean follow-up time was 34.43±51.02 months. The most common trauma mechanism was force with a blunt object (53.8%) and the most frequent site of wound dehiscence was the temporal quadrant (30.8%), the wound ranging from 30° to 270° in size. The patients were divided into 4 groups according to wound dehiscence size. As the size of the wound dehiscence size increased, the male ratio increased, wound dehiscence was more commonly located in the nasal and superior quadrants, lens injury and posterior segment complications were more frequent, and graft transparency was achieved at a lower rate.
CONCLUSION
Traumatic wound dehiscence after PK is rare, but may lead to serious, lifelong consequences, including eye loss. Patients should be well informed about the risks and potential sequelae of wound dehiscence.
Topics: Adult; Eye Injuries; Female; Humans; Keratoplasty, Penetrating; Male; Middle Aged; Retrospective Studies; Surgical Wound Dehiscence; Wounds, Nonpenetrating
PubMed: 30516257
DOI: 10.5505/tjtes.2018.44450 -
Journal of Wound Care Mar 20171. Introduction Since its introduction in clinical practice in the early 1990's negative pressure wounds therapy (NPWT) has become widely used in the management of... (Review)
Review
1. Introduction Since its introduction in clinical practice in the early 1990's negative pressure wounds therapy (NPWT) has become widely used in the management of complex wounds in both inpatient and outpatient care. NPWT has been described as a effective treatment for wounds of many different aetiologies and suggested as a gold standard for treatment of wounds such as open abdominal wounds, dehisced sternal wounds following cardiac surgery and as a valuable agent in complex non-healing wounds. Increasingly, NPWT is being applied in the primary and home-care setting, where it is described as having the potential to improve the efficacy of wound management and help reduce the reliance on hospital-based care. While the potential of NPWT is promising and the clinical use of the treatment is widespread, highlevel evidence of its effectiveness and economic benefits remain sparse. The ongoing controversy regarding high-level evidence in wound care in general is well known. There is a consensus that clinical practice should be evidence-based, which can be difficult to achieve due to confusion about the value of the various approaches to wound management; however, we have to rely on the best available evidence. The need to review wound strategies and treatments in order to reduce the burden of care in an efficient way is urgent. If patients at risk of delayed wound healing are identified earlier and aggressive interventions are taken before the wound deteriorates and complications occur, both patient morbidity and health-care costs can be significantly reduced. There is further a fundamental confusion over the best way to evaluate the effectiveness of interventions in this complex patient population. This is illustrated by reviews of the value of various treatment strategies for non-healing wounds, which have highlighted methodological inconsistencies in primary research. This situation is confounded by differences in the advice given by regulatory and reimbursement bodies in various countries regarding both study design and the ways in which results are interpreted. In response to this confusion, the European Wound Management Association (EWMA) has been publishing a number of interdisciplinary documents with the intention of highlighting: The nature and extent of the problem for wound management: from the clinical perspective as well as that of care givers and the patients Evidence-based practice as an integration of clinical expertise with the best available clinical evidence from systematic research The nature and extent of the problem for wound management: from the policy maker and healthcare system perspectives The controversy regarding the value of various approaches to wound management and care is illustrated by the case of NPWT, synonymous with topical negative pressure or vacuum therapy and cited as branded VAC (vacuum-assisted closure) therapy. This is a mode of therapy used to encourage wound healing. It is used as a primary treatment of chronic wounds, in complex acute wounds and as an adjunct for temporary closure and wound bed preparation preceding surgical procedures such as skin grafts and flap surgery. Aim An increasing number of papers on the effect of NPWT are being published. However, due to the low evidence level the treatment remains controversial from the policy maker and health-care system's points of view-particularly with regard to evidence-based medicine. In response EWMA has established an interdisciplinary working group to describe the present knowledge with regard to NPWT and provide overview of its implications for organisation of care, documentation, communication, patient safety, and health economic aspects. These goals will be achieved by the following: Present the rational and scientific support for each delivered statement Uncover controversies and issues related to the use of NPWT in wound management Implications of implementing NPWT as a treatment strategy in the health-care system Provide information and offer perspectives of NPWT from the viewpoints of health-care staff, policy makers, politicians, industry, patients and hospital administrators who are indirectly or directly involved in wound management.
Topics: Health Care Costs; Humans; Negative-Pressure Wound Therapy; Postoperative Care; Skin Transplantation; Treatment Outcome; Wound Healing; Wounds and Injuries
PubMed: 28345371
DOI: 10.12968/jowc.2017.26.Sup3.S1 -
Nutricion Hospitalaria Sep 2021Nutrition plays an essential role in chronic wound healing as extra nutrients are needed for tissue repair and to restore losses through wound exudate. Insufficient...
Nutrition plays an essential role in chronic wound healing as extra nutrients are needed for tissue repair and to restore losses through wound exudate. Insufficient intake of energy, protein, antioxidants (vitamin C, A, and zinc) and vitamin D are common in patients with chronic wounds and have been linked to delayed wound healing and dehiscence. Other risk factors such as obesity, diabetes, advanced age, corticosteroid use, and dehydration can also reduce or impede the healing process, and nutritional screening is important to identify patients with malnutrition. Proteins, amino acids (arginine, glutamine and methionine), vitamins C and A, and zinc have been used as pharmacological nutrients in pressure ulcer healing; however, omega-3 fatty acids, although they appear to slow progression, do not show improved healing rates. In patients with diabetic foot, supplementation with vitamins D, C, A, and E, magnesium, zinc, omega-3 fatty acids, and probiotics reduces ulcer size and improves glycemic control, although they have not been associated with complete healing; however, supplementation with arginine, glutamine, and β-hydroxy-β-methylbutyrate does show wound healing, although further evidence is needed to confirm these results.
Topics: Diabetic Foot; Humans; Nutrition Assessment; Nutrition Therapy; Wound Healing; Wounds and Injuries
PubMed: 34323091
DOI: 10.20960/nh.03800 -
Wounds : a Compendium of Clinical... Dec 2021Achilles tendon rupture is a common injury requiring surgical repair. Re-ruptures, infections, delayed wound healing, and hematomas have been reported postoperatively.
INTRODUCTION
Achilles tendon rupture is a common injury requiring surgical repair. Re-ruptures, infections, delayed wound healing, and hematomas have been reported postoperatively.
OBJECTIVE
This case series described the use of ultraportable negative pressure wound therapy (NPWT) and compression bandaging following postoperative dehiscence of Achilles tendon repair.
MATERIALS AND METHODS
Retrospective records were reviewed to identify patients who underwent wound management for Achilles tendon dehiscence between January 2014 and January 2018. Patient demographics, wound size at first and last visit, number of visits, and previous treatment data were extracted. Wound management included wound irrigation, surgical debridement, and application of silver dressings, as needed. Therapy was transitioned to ultraportable NPWT with twice-weekly dressing changes. When possible, patients with an ankle-brachial index greater than 0.8 received multilayer, multicomponent compression. Treatment response was evaluated using a wound imaging system at 2-week to 4-week intervals for a total of 24 weeks.
RESULTS
Nine male patients with a mean age of 69.7 years presented for care. One patient sustained injury during sports activities, and the other 8 patients sustained injuries resulting from household accidents. Six patients achieved complete wound closure. Three patients achieved a mean 90% wound closure. No adverse effects were observed during treatment with NPWT and compression therapy.
CONCLUSIONS
In the current study, ultraportable NPWT and compression bandaging were found to be effective in the management of wounds with critical local vascularity. Larger, randomized controlled studies are necessary to fully assess the potential clinical benefit of NPWT and compression therapy in the management of postoperative wounds of the Achilles tendon.
Topics: Achilles Tendon; Aged; Humans; Male; Negative-Pressure Wound Therapy; Retrospective Studies; Rupture; Tendon Injuries
PubMed: 35100134
DOI: No ID Found -
Home Healthcare Nurse Jun 2004Most surgical wounds heal uneventfully--the dehisced surgical incision is definitely the exception to the rule. However, management of a dehisced incision is a fairly... (Review)
Review
Most surgical wounds heal uneventfully--the dehisced surgical incision is definitely the exception to the rule. However, management of a dehisced incision is a fairly common home care challenge that must be understood. This month's column answers the questions: Why do some incisions dehisce, and what, if anything, can be done to prevent dehiscence? Are there early warning signs to look for? How should a dehisced wound be managed?
Topics: Female; Follow-Up Studies; Humans; Male; Nurse's Role; Practice Guidelines as Topic; Primary Prevention; Surgical Wound Dehiscence; Surgical Wound Infection; Wound Healing
PubMed: 15184776
DOI: 10.1097/00004045-200406000-00003 -
European Journal of Ophthalmology 2012Blunt trauma after penetrating keratoplasty (PK) is a high risk for wound rupture at the donor-recipient interface. We present 6 cases of traumatic wound dehiscence... (Review)
Review
PURPOSE
Blunt trauma after penetrating keratoplasty (PK) is a high risk for wound rupture at the donor-recipient interface. We present 6 cases of traumatic wound dehiscence after PK; we describe the morphologic and functional outcome after surgical intervention and provide a review of the current literature.
METHODS
Six patients with a traumatic wound dehiscence after PK were analyzed retrospectively from the files of the University Eye Hospital Hamburg-Eppendorf (1998-2009). In addition, a comprehensive literature review was performed.
RESULTS
The indications for PK were keratoconus, corneal scars, and Fuchs endothelial dystrophy. The age range was 22-81 years; the time span between PK and globe rupture was 1 month to 27 years. The cause of the dislocation was a fall or blunt trauma, through a branch, airbag, fist, or finger. The corrected distance visual acuity (CDVA) pretrauma ranged between hand movement and 20/32. The CDVA after wound repair was 20/400 to 20/25 depending on the severity of the trauma. In 3 of the 6 cases, visual rehabilitation was superior to the pretrauma vision, whereas in 3 cases the pretrauma CDVA could not be reached.
CONCLUSIONS
If a timely and adequate treatment of the traumatically dislocated transplant can be given, it is likely that the transplant will survive. Nevertheless, severely reduced visual acuity (i.e., < hand movement) and lens damage at the time of trauma are the most reliable predictors for the final visual outcome. A permanent loss of visual acuity is related rather to the intraocular damage (vitreous loss, vitreous bleeding, retinal tears, and retinal detachment) than to the readapted transplant itself.
Topics: Adult; Aged, 80 and over; Corneal Diseases; Corneal Injuries; Eye Injuries; Female; Humans; Keratoplasty, Penetrating; Lens Implantation, Intraocular; Male; Retrospective Studies; Surgical Wound Dehiscence; Time Factors; Visual Acuity; Wounds, Nonpenetrating; Young Adult
PubMed: 22009915
DOI: 10.5301/ejo.5000057 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Sep 2016The aim of this study was to evaluate risks and consequences of traumatic wound dehiscence after penetrating keratoplasty (PK).
BACKGROUND
The aim of this study was to evaluate risks and consequences of traumatic wound dehiscence after penetrating keratoplasty (PK).
METHODS
Data regarding 34 eyes of 34 patients who were treated for traumatic wound dehiscence after PK between 1995 and 2014 were studied. Patient records were reviewed for type and time of insult, corrected distance visual acuity (CDVA), clinical presentation signs, operative method, and outcome.
RESULTS
The interval between PK and trauma ranged from 1 month to 100 months, with median of 14 months. Median age at trauma was 31.5 years (range: 5-81 years). Wound dehiscence occurred at donor-recipient interface in all patients. In 58.8% of patients, extent of dehiscence was ≥6 clock hours. Most frequent type of trauma was blunt trauma by hand/finger (35.2%). Median CDVA before and just after trauma were 0.5 logMAR (range: 0.1-3.0 logMAR) and 3.0 logMAR (range: 0.7-3.0 logMAR), respectively. Wound dehiscence was managed with primary wound closure in all patients. Most frequent additional surgical procedure was anterior vitrectomy (26.4%). Anatomical globe loss occurred in 2 patients. Median CDVA was 0.7 logMAR (range: 0.1-3.0 logMAR) at final visit. Most common complication after primary suturation was graft failure (23.5%). Graft remained clear in 67.6% of patients.
CONCLUSION
Traumatic wound dehiscence is one of the potentially devastating postoperative complications that can occur following PK. Prognosis depends on existence and severity of additional anterior/posterior segment damage. In order to prevent this catastrophic condition, patients should be warned against ocular trauma after undergoing PK.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Eye Injuries; Female; Humans; Keratoplasty, Penetrating; Male; Medical Records; Middle Aged; Prognosis; Retrospective Studies; Risk Factors; Surgical Wound Dehiscence; Turkey; Visual Acuity; Wounds, Nonpenetrating; Young Adult
PubMed: 27849319
DOI: 10.5505/tjtes.2016.26963 -
The Veterinary Clinics of North... Nov 2017Wounds are often addressed by primary or delayed primary closure. Although many skin wounds could go on to heal by second intention, this results in a less cosmetic... (Review)
Review
Wounds are often addressed by primary or delayed primary closure. Although many skin wounds could go on to heal by second intention, this results in a less cosmetic outcome, takes longer, and in the long run, is often more expensive. As a general rule, the simplest method of wound closure that is likely to succeed should be chosen. If tension is present at the wound edges, wound dehiscence is likely to occur. Using specific techniques to relieve tension on wound edges and recruiting local flaps from neighboring regions are useful ways to achieve wound closure.
Topics: Animals; Soft Tissue Injuries; Surgical Flaps; Wound Healing
PubMed: 28807399
DOI: 10.1016/j.cvsm.2017.06.007 -
The Surgical Clinics of North America Dec 2010Surgeons often care for patients with conditions of abnormal wound healing, which include conditions of excessive wound healing, such as fibrosis, adhesions, and... (Review)
Review
Surgeons often care for patients with conditions of abnormal wound healing, which include conditions of excessive wound healing, such as fibrosis, adhesions, and contractures, as well as conditions of inadequate wound healing, such as chronic nonhealing ulcers, recurrent hernias, and wound dehiscences. Despite many recent advances in the field, which have highlighted the importance of adjunct therapies in maximizing the healing potential, conditions of abnormal wound healing continue to cause significant cost, morbidity, and mortality. To understand how conditions of abnormal wound healing can be corrected, it is important to first understand the basic principles of wound healing.
Topics: Acute Disease; Cell Proliferation; Combined Modality Therapy; Guidelines as Topic; Humans; Male; Severity of Illness Index; Wound Healing; Wounds and Injuries
PubMed: 21074032
DOI: 10.1016/j.suc.2010.08.003 -
Critical Care Nursing Clinics of North... Jun 1996As patients are discharged from the acute care setting to the home care setting at a much earlier time in their recovery, surgical wound care will be delivered by... (Review)
Review
As patients are discharged from the acute care setting to the home care setting at a much earlier time in their recovery, surgical wound care will be delivered by patients, family members, and home health care providers rather than by the hospital nurse in a traditional in-patient setting. This trend, which began in the mid-1980s, is expanding to include not just surgical wounds but also surgical complications such as wound dehiscence and traumatic wounds healing by secondary intention. Intensive care nurses are involved in discharge planning from the time the patient is admitted to the ICU. Early planning and teaching regarding wound care, universal precautions, and medical waste disposal have become a vital component of preparing the patient for optimal continuity of care as the transition is made into the community.
Topics: Ambulatory Care; Humans; Patient Discharge; Patient Education as Topic; Postoperative Care; Wound Healing; Wounds and Injuries
PubMed: 8716389
DOI: No ID Found