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The Cochrane Database of Systematic... Sep 2013Each year approximately 350,000 women in the United Kingdom and millions more worldwide, experience perineal suturing following childbirth. The postpartum management of... (Review)
Review
BACKGROUND
Each year approximately 350,000 women in the United Kingdom and millions more worldwide, experience perineal suturing following childbirth. The postpartum management of perineal trauma is a core component of routine maternity care. However, for those women whose perineal wound dehisces (breaks down), the management varies depending on individual practitioners preferences as there is limited scientific evidence and no clear guidelines to inform best practice. For most women the wound will be managed expectantly whereas, others may be offered secondary suturing.
OBJECTIVES
To evaluate the therapeutic effectiveness of secondary suturing of dehisced perineal wounds compared to non-suturing (healing by secondary intention, expectancy).
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2013) and reference lists of retrieved studies.
SELECTION CRITERIA
Randomised controlled trials of secondary suturing of dehisced perineal wounds (second-, third- or fourth-degree tear or episiotomy), following wound debridement and the removal of any remaining suture material within the first six weeks following childbirth compared with non-suturing.
DATA COLLECTION AND ANALYSIS
Three review authors independently assessed trials for inclusion. Two review authors independently assessed trial quality and extracted data. Data were checked for accuracy.
MAIN RESULTS
Two small studies of poor methodological quality including 52 women with a dehisced and/or infected episiotomy wound at point of entry have been included.Only one small study presented data in relation to wound healing at less than four weeks, (the primary outcome measure for this review), although no reference was made to demonstrate how healing was measured. There was a trend to favour this outcome in the resuturing group, however, this difference was not statistically significant (risk ratio (RR) 1.69, 95% confidence interval (CI) 0.73 to 3.88, one study, 17 women).Similarly, only one trial reported on rates of dyspareunia (a secondary outcome measure for this review) at two months and six months with no statistically significant difference between both groups; two months, (RR 0.44, 95% CI 0.18 to 1.11, one study, 26 women) and six months, (RR 0.39, 95% CI 0.04 to 3.87, one study 32 women). This trial also included data on the numbers of women who resumed sexual intercourse by two months and six months. Significantly more women in the secondary suturing group had resumed intercourse by two months (RR 1.78, 95% CI 1.10 to 2.89, one study, 35 women), although by six months there was no significant difference between the two groups (RR 1.08, 95% CI, 0.91 to 1.28).Neither of the trials included data in relation to the following prespecified secondary outcome measures: pain at any time interval; the woman's satisfaction with the aesthetic results of the perineal wound; exclusive breastfeeding; maternal anxiety or depression.
AUTHORS' CONCLUSIONS
Based on this review, there is currently insufficient evidence available to either support or refute secondary suturing for the management of broken down perineal wounds following childbirth. There is an urgent need for a robust randomised controlled trial to evaluate fully the comparative effects of both treatment options.
Topics: Delivery, Obstetric; Episiotomy; Female; Humans; Perineum; Pregnancy; Randomized Controlled Trials as Topic; Retreatment; Surgical Wound Dehiscence; Sutures; Time Factors; Watchful Waiting; Wound Healing
PubMed: 24065561
DOI: 10.1002/14651858.CD008977.pub2 -
BMC Surgery Jun 2018Negative pressure wound therapy (NPWT) is a widely accepted technique to treat local infectious wounds of the skin, subcutaneous tissue, fascia, or muscle. Recently,...
BACKGROUND
Negative pressure wound therapy (NPWT) is a widely accepted technique to treat local infectious wounds of the skin, subcutaneous tissue, fascia, or muscle. Recently, several reports describing the efficacy of NPWT for various types of fistulas and anastomotic leaks have been published. We herein describe a patient with an open abdominal wound due to colonic anastomotic leakage and diffuse peritonitis, in whom abdominal vacuum sealing (AVS) as a modified NPWT was useful for the management of this complex wound.
CASE PRESENTATION
A 32-year-old man was admitted to our hospital with late presenting traumatic diaphragmatic hernia and strangulated ileum complicated by necrosis of the ileum and transverse colon. He had a history of cervical spinal cord injury due to suicide attempt 14 years earlier and, as a result of cervical spinal cord injury, he was paralyzed in the lower body. The patient underwent an urgent hernia repair and bowel resection. Postoperatively, he developed severe septic shock. On postoperative day (POD) 6, wound dehiscence due to colonic anastomotic leakage with diffuse peritonitis was diagnosed, but he was unable to undergo re-operation because of refractory severe septic shock combined with neurogenic shock due to the cervical cord injury. The patient was treated with AVS therapy. He gradually recovered from septic shock, and the anastomotic leakage healed after a 2-month period. The wound dehiscence was also reduced. The patient resumed oral intake on POD 112 and was discharged on POD 190.
CONCLUSIONS
Although surgical repair would be the best method for the treatment of diffuse peritonitis due to gastrointestinal perforation or anastomotic leakage, our case suggests that AVS with 'conventional' drainage is a treatment of choice for open abdominal wounds even in the presence of diffuse peritonitis caused by intestinal anastomotic leakage, especially in patients with poor general medical condition.
Topics: Abdomen; Abdominal Injuries; Adult; Anastomotic Leak; Colon; Drainage; Humans; Ileum; Male; Peritonitis; Postoperative Complications; Vacuum
PubMed: 29907107
DOI: 10.1186/s12893-018-0375-6 -
The Journal of Surgical Research Apr 2010Matrix metalloproteinases (MMPs) are crucial in the inflammatory and remodeling phases of wound healing. We previously reported the correlation between pro-inflammatory...
BACKGROUND
Matrix metalloproteinases (MMPs) are crucial in the inflammatory and remodeling phases of wound healing. We previously reported the correlation between pro-inflammatory cytokines and timing of successful combat-wound closure. We now extend our studies to investigate the correlation between wound-remodeling MMP expression and wound healing.
METHODS
Thirty-eight wounds in 25 patients with traumatic extremity combat wounds were prospectively studied. Surgical debridement with vacuum-assisted closure (VAC) device application was repeated every 48 to 72h until surgical wound closure. Wound effluent and patient serum were collected at each wound debridement and analyzed for five matrix metalloproteinases using the Luminex multiplex system; Millipore Corp, Billerica, MA. The primary outcome was wound healing within 30 d of definitive wound closure. Impairment was defined as delayed wound closure (>21 d from injury) or wound dehiscence. MMP expression was compared between impaired and normal healing wounds.
RESULTS
Elevated levels of serum MMP-2 and MMP-7 and reduced levels of effluent MMP3 were seen in impaired wounds (n = 9) compared with wounds that healed (n = 29; P<0.001). Receiver operating characteristic (ROC) curve analysis yielded area-under-the-curve (AUC) of 0.744, 0.783, and 0.805, respectively.
CONCLUSIONS
Impaired wound healing is characterized by pro-inflammatory MMP-2 and MMP-7. Serum and effluent concentrations of MMP-2, MMP-3, and MMP-7 can effectively predict the outcome of traumatic war wounds and can potentially provide decision-supportive, objective evidence for the timing of wound closure.
Topics: Adolescent; Adult; Amputation, Surgical; Debridement; Female; Humans; Male; Matrix Metalloproteinase 2; Matrix Metalloproteinase 3; Matrix Metalloproteinase 7; Matrix Metalloproteinases; Military Medicine; Prospective Studies; Wound Healing; Wounds and Injuries; Wounds, Penetrating; Young Adult
PubMed: 20056248
DOI: 10.1016/j.jss.2009.08.021 -
Current Opinion in Obstetrics &... Apr 2006The increasing rates of primary caesarean section are likely to contribute to a rise in the incidence of uterine rupture in developed countries. Uterine rupture... (Review)
Review
PURPOSE OF REVIEW
The increasing rates of primary caesarean section are likely to contribute to a rise in the incidence of uterine rupture in developed countries. Uterine rupture continues to be an important cause of maternal death in less and least developed countries. Recent publications adressing the diagnosis, aetiology and management of primary caesarian section are reviewed.
RECENT FINDINGS
Uterine rupture is commonly associated with vaginal birth after caesarean section, although the absolute risk varies according to previous obstetric history, gestational age, and induction of labour. Quantification of risk for a range of circumstances allows informed counselling of pregnant women. Imaging techniques may improve the early detection of uterine dehiscence but in the acute setting abnormal fetal heart rate patterns provide early diagnostic information. The scale of the problem in less and least developed countries is sobering and maternal mortality can be determined by the ability to access basic obstetric care.
SUMMARY
Uterine rupture remains one of the most frightening complications in obstetric care. The risk of its occurrence is likely to increase for many parous women, placing the emphasis on counselling and early prediction and prevention wherever possible.
Topics: Female; Humans; Misoprostol; Odds Ratio; Oxytocics; Risk Factors; Ultrasonography, Prenatal; Uterine Rupture; Uterus; Vaginal Birth after Cesarean; Wounds and Injuries
PubMed: 16601473
DOI: 10.1097/01.gco.0000192989.45589.57 -
Annals of Plastic Surgery Sep 2020Closed incisional negative pressure wound therapy (ciNPWT) has become commonplace in surgery. One mechanism ciNPWT may prevent incision site complications is by...
Closed incisional negative pressure wound therapy (ciNPWT) has become commonplace in surgery. One mechanism ciNPWT may prevent incision site complications is by off-loading tension. This study aimed to find what width sponge using ciNPWT provides the most tension off-loading.A model was designed to test tension off-loading of a wound using ciNPWT. An incision was made in an anatomy model and closed with single stitch at the central axis. Force was applied tangentially using a force gauge at a steady rate until the wound dehisced at a peak force indicated by the 5-0 suture breaking. This was repeated 10 times for the following 4 trials: no ciNPWT and ciNPWT sponges cut a 3-, 6-, and 9-cm widths with 125 mm Hg of negative pressure.The mean peak force to dehisce the wound without ciNPWT was the lowest, 28.7 N. The mean force for the ciNPWT trials was 43.0, 38.7, and 36.4 N for V.A.C. sponges of 3, 6, and 9 cm in width, respectively. There was a statically significant difference among all the trials using one-way analysis of variance with Tukey posttest analysis with a P value of less than 0.0001.Closed incisional negative pressure wound therapy was shown to increase peak force required to dehisce an incision of up to 49.7% compared with closure without. There is an inverse relationship with sponge width and tension off-loading. The smaller the sponge, the more tension is off-loaded across the incision. Closed incisional negative pressure wound therapy with a 3-cm-wide sponge required the greatest peak force for dehiscence.
Topics: Humans; Laboratories; Negative-Pressure Wound Therapy; Surgical Wound; Surgical Wound Infection; Sutures
PubMed: 31923015
DOI: 10.1097/SAP.0000000000002217 -
Transplantation Proceedings Sep 2010Because of potent immunosuppression, impaired wound healing and complications are frequent features after kidney transplantation (KTx).
BACKGROUND
Because of potent immunosuppression, impaired wound healing and complications are frequent features after kidney transplantation (KTx).
OBJECTIVE
To investigate the incidence and nature of impaired wound healing and complications at a single transplantation center in Norway.
PATIENTS
Of 226 patients who underwent KTx, 199 (87%) were followed up prospectively for 1 year (2005) via close and meticulous wound inspection.
RESULTS
The study revealed a high rate of wound complications (200-250/y) in a high-volume center. Fifty-four patients (27%) experienced prolonged wound healing, defined as gaps, secretions, or wound complications, at 3 to 5 weeks posttransplantation, and 41 patients (21%) had impaired wound healing, defined as gaps, secretions, or wound complications after 5 weeks posttransplantation. In total, 50 patients (25%) required surgical or radiologic reintervention. Complications included lymphocele in 29 patients (14.6%), wound dehiscence in 16 (8.0%), bleeding or hematoma in 10 (5.0%), and infection in 9 (4.5%). Risk factors associated with wound complications included recipient older than 60 years, body mass index greater than 30, hemoglobin concentration less than 10 g/dL, albumin concentration less than 36 g/dL, duration of surgery more than 200 minutes, no subcutaneous sutures, and sirolimus or everolimus therapy. At nominal and logistic regression analysis, recipient older than 60 years, body mass index greater than 30, and no subcutaneous sutures were independent risk factors.
CONCLUSION
Risk factor analysis and previous documentation suggest that wound complications might be counteracted using the following measures: subcutaneous sutures, predialysis transplantation, sealing or ligation of lymphatic trunks, prophylactic fenestration, reduction of corticosteroid load, and avoiding sirolimus/everolimus therapy.
Topics: Adult; Aged; Cohort Studies; Diabetic Nephropathies; Female; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Peritoneal Dialysis; Postoperative Complications; Renal Dialysis; Reoperation; Risk Factors; Wound Healing; Wounds and Injuries
PubMed: 20832540
DOI: 10.1016/j.transproceed.2010.05.162 -
Arquivos Brasileiros de Oftalmologia Feb 2016This was a report about a pseudophakic patient who experienced isolated total aniridia without damage to other intraocular structures following blunt trauma to the eye....
This was a report about a pseudophakic patient who experienced isolated total aniridia without damage to other intraocular structures following blunt trauma to the eye. This patient had a history of uneventful cataract surgery using a small clear corneal incision (CCI). This 71-year-old male presented at our clinic with glare in his left eye. He reported that he had fallen down while drunk and struck his left eye against a stone on the road 15 days earlier. He had undergone cataract surgery on his left eye nine months before the accident at another eye clinic. Slit-lamp examination showed total aniridia in his left eye, but there was no hyphema or cells in the anterior chamber. The intraocular lens in his left eye was stable, without decentration, dislocation, or zonular dehiscence and remained in an intact capsular bag. Review of the medical records from the surgical clinic at which he had undergone cataract surgery indicated no specific findings for any intraocular structure including the iris. He had previously undergone an uneventful phacoemulsification for his left eye through a 2.2 mm CCI, followed by the implantation of a single piece acrylic intraocular lens inside an intact capsular bag. This report showed that small-sized CCIs can be opened postoperatively by trauma and that this can result in isolated total aniridia without damage to other intraocular structures.
Topics: Aged; Aniridia; Eye Injuries; Humans; Iris; Lenses, Intraocular; Male; Phacoemulsification; Pseudophakia; Surgical Wound Dehiscence; Wounds, Nonpenetrating
PubMed: 26840167
DOI: 10.5935/0004-2749.20160013 -
International Wound Journal Dec 2017In stalled, chronic wounds, more aggressive and proactive wound closure efforts are needed. We describe adjunctive use of epidermal grafting in patients with chronic...
In stalled, chronic wounds, more aggressive and proactive wound closure efforts are needed. We describe adjunctive use of epidermal grafting in patients with chronic wounds. Wound bed preparation consisted of surgical necrotectomy or sharp debridement, hyperbaric oxygen therapy, negative pressure wound therapy, compression therapy, platelet-rich plasma therapy and/or heparan sulphate agents. Epidermal grafts were harvested from the patient's thigh and applied to the wound. Wound and donor site healing was monitored. A total of 78 patients (average age = 64·1 ± 15·6 years) were included in the study. Common comorbidities included hypertension (47·4%), venous insufficiency (37·2%) and obesity (28·2%). Average wound duration was 13·2 months (range: 0·3-180 months). The most common wound types were dehiscence (29·5%), radiation ulcer (24·4%) and venous ulcer (17·9%). Total time from epidermal grafting to wound closure was 10·0 ± 7·3 weeks. Of the 78 wounds, 66 (84·6%) reached full wound closure (49 < 3 months, 16 > 3 months, 1 without time data). Of 78 wounds, 10 (12·8%) underwent partial wound healing, while 2 wounds (2/78; 2·6%) remained unhealed. These results suggest that wound surface reduction can be achieved by proactive early application of biological therapies and epidermal skin grafts, which may help decrease time to wound healing.
Topics: Adult; Aged; Aged, 80 and over; Chronic Disease; Epidermis; Female; Humans; Male; Middle Aged; Negative-Pressure Wound Therapy; Skin Transplantation; Thigh; Wound Healing; Wounds and Injuries
PubMed: 29076239
DOI: 10.1111/iwj.12787 -
Foot and Ankle Clinics Dec 2001Soft tissue deficiencies of the ankle are caused by several mechanisms, such as trauma, tumor, and infection. Compounding the reconstructive problems is that soft tissue... (Review)
Review
Soft tissue deficiencies of the ankle are caused by several mechanisms, such as trauma, tumor, and infection. Compounding the reconstructive problems is that soft tissue problems often present in patients who have underlying diseases such as peripheral vascular disease, diabetes or both. For example, a 65-year-old person with diabetes who smokes two packs of cigarettes per day sustains an ankle fracture. After undergoing open reduction and internal fixation of the fracture, there is subsequent wound behiscence over the patient's fibular plate. The wound edges cannot be reapproximated, and there is loss of soft tissue. What should treatment be for this soft tissue problem? Another example is a 45-year-old rheumatoid patient who takes 20 mg of steroids a day and undergoes posterior tibial tendon repair after rupture. One month after surgery, the surgical wound dehisces, resulting in exposure of the tendon repair. What is the approach for adequate and effective soft tissue treatment? The purpose of this article is to address such complex problems and to provide an algorithm for soft tissue reconstruction of the ankle.
Topics: Algorithms; Ankle; Ankle Injuries; Fractures, Bone; Humans; Plastic Surgery Procedures; Surgical Flaps
PubMed: 12134585
DOI: 10.1016/s1083-7515(02)00015-3 -
Advances in Skin & Wound Care Nov 2011Therapeutic management of nonhealing wounds is often a challenging condition. Postlaparotomy wound dehiscence can become a serious problem in patients affected with...
Therapeutic management of nonhealing wounds is often a challenging condition. Postlaparotomy wound dehiscence can become a serious problem in patients affected with chronic pain and abdomen distension. In this case report, negative-pressure wound therapy with the Chariker-Jeter method was used to treat a dehiscence in a patient affected with type I spinocerebellar ataxia.
Topics: Abdominal Injuries; Adult; Female; Humans; Laparotomy; Negative-Pressure Wound Therapy; Postoperative Complications; Spinocerebellar Ataxias; Surgical Wound Dehiscence; Time Factors; Treatment Failure; Wound Healing
PubMed: 22015748
DOI: 10.1097/01.ASW.0000407646.05209.e2