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Arquivos Brasileiros de Oftalmologia 2015To assess patient characteristics, risk factors, outcomes, and the treatment of wound dehiscence (WD) in patients after corneal keratoplasty.
PURPOSE
To assess patient characteristics, risk factors, outcomes, and the treatment of wound dehiscence (WD) in patients after corneal keratoplasty.
METHODS
Retrospective chart review of 11 eyes of 11 patients with corneal grafts who underwent repair of WD from January 1, 2004 to December 31, 2012 at Hospital Oftalmologico de Brasilia.
RESULTS
Eight (72.7%) patients were men and three were women. Six (54.5%) patients had deep anterior lamellar keratoplasty (DALK) and 5 had penetrating keratoplasty. The mean age at trauma was 31.1 years. The mean time from corneal keratoplasty to WD was 12.82 months (range, 3-33 months). The mean best-corrected visual acuity of patients before trauma was 20/60 (0.48 logMAR) and after final treatment was 20/160 (0.90 logMAR) (P=0.15). In one case, visual acuity decreased to no light perception because of retinal detachment and phthisis bulbi. Accidental blunt trauma and fall were the most common causes of WD.
CONCLUSION
Patients who undergo corneal keratoplasty have a life-long risk of WD. The full-thickness rupture at the graft-host junction in our study suggests that the junction remains vulnerable, even following DALK, and can rupture with trauma. In our series, depending upon the severity of the trauma, postkeratoplastic WD can be associated with a good visual prognosis.
Topics: Adolescent; Adult; Corneal Transplantation; Eye Injuries; Female; Humans; Male; Retinal Detachment; Retrospective Studies; Risk Factors; Statistics, Nonparametric; Surgical Wound Dehiscence; Sutures; Time Factors; Visual Acuity; Wounds, Nonpenetrating; Young Adult
PubMed: 26466231
DOI: 10.5935/0004-2749.20150081 -
American Journal of Ophthalmology Oct 2013To analyze the outcomes of traumatic wound dehiscence after deep anterior lamellar keratoplasty (DALK).
PURPOSE
To analyze the outcomes of traumatic wound dehiscence after deep anterior lamellar keratoplasty (DALK).
DESIGN
Retrospective and interventional case series.
SETTING
Single hospital.
PATIENTS
A total of 338 consecutive cases were reviewed. Eleven eyes that had wound dehiscence related to ocular trauma were included.
MAIN OUTCOME MEASURES
Incidence and causes, best-corrected visual acuity (BCVA), and endothelial cell density were evaluated. Complications and secondary surgeries were recorded.
RESULTS
Seven patients were male (63.6%) and 4 patients were female (36.4%), with a mean age of 30.6 years (range, 24-40 years). The incidence of wound dehiscence was 3.2% (11/338). The mean interval between the initial DALK procedure and wound dehiscence was 9.45 months (range, 2-16 months). The mean follow-up time was 6 years. The most common trauma was a fist blow injury (36.3%). Descemet membrane perforation was observed in 8 eyes (72.7%); lens damage and vitreous prolapse occurred in 2 eyes (18.1%). The final BCVA was 0.51 and was maintained in 4 eyes (36.3%). At the final visit, 10 grafts (90.9%) were clear. The mean endothelial cell loss was 55.8% between before DALK and last visit.
CONCLUSION
Although the intact Descemet membrane protects against dehiscing traumas after DALK, a relative weakness at the graft-host junction tends to persist and a severe deforming force may result in graft dehiscence. This case series indicates that despite the fact that the visual results following the repair are acceptable, corneal endothelium seems to be subjected to severe damage, which puts graft survival chances at risk in the long term.
Topics: Adult; Cell Count; Corneal Diseases; Corneal Endothelial Cell Loss; Corneal Transplantation; Descemet Membrane; Endothelium, Corneal; Eye Diseases; Eye Injuries; Female; Humans; Incidence; Lens, Crystalline; Male; Postoperative Complications; Prolapse; Retrospective Studies; Surgical Wound Dehiscence; Treatment Outcome; Visual Acuity; Vitreous Body; Wounds, Nonpenetrating; Young Adult
PubMed: 23831222
DOI: 10.1016/j.ajo.2013.05.014 -
American Journal of Ophthalmology Aug 2011To characterize the clinical course of cataract wound dehiscence. (Comparative Study)
Comparative Study
PURPOSE
To characterize the clinical course of cataract wound dehiscence.
DESIGN
Retrospective, comparative case series.
METHODS
Charts of open globe injuries (848 injuries in 846 patients) treated surgically at the Massachusetts Eye and Ear Infirmary between 2000 and 2009 were retrospectively reviewed. Time from original surgery to wound dehiscence, type of initial surgery, Ocular Trauma Score, age, gender, mechanism of injury, and visual acuity were analyzed.
RESULTS
Of 846 patients with 848 open globe injuries, 63 experienced cataract wound dehiscence. The majority of these cataract wounds (89%) were extracapsular cataract extraction (ECCE), with only 7 (11%) phacoemulsification wounds. The mean patient age in the wound rupture group was 78.2 years. Female patients comprised the majority (67%) of this subpopulation. The most common mechanisms of injury were fall (65%), blunt trauma (23%), and motor vehicle accident (7%). The median raw ocular trauma score was 47 in wound dehiscence patients. Visual acuity at presentation was light perception in the wound dehiscence group. The best postoperative visual acuity was significantly worse in the wound dehiscence group (hand motion) than in the remaining patients (20/40; P=.0002). When considering the phacoemulsification patients alone, these patients fared much better, with a median postoperative vision of 20/60.
CONCLUSIONS
Despite recent advances in cataract surgery, wound dehiscence remains a significant source of visual disability, mainly in the geriatric population. Rupture ECCE wound patients have a poor visual prognosis. Fortunately, patients with phacoemulsification site dehiscence appear to regain the majority of their vision after open globe repair.
Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Cataract Extraction; Child; Child, Preschool; Eye Injuries, Penetrating; Female; Humans; Infant; Male; Middle Aged; Retrospective Studies; Sclera; Sex Distribution; Surgical Wound Dehiscence; Trauma Severity Indices; Visual Acuity; Young Adult
PubMed: 21621188
DOI: 10.1016/j.ajo.2011.01.044 -
International Ophthalmology Feb 2024The study aims to assess if Zone 1 globe injuries hold a favorable prognosis for all situations, including wound dehiscence, or just primary traumatic injuries.
PURPOSE
The study aims to assess if Zone 1 globe injuries hold a favorable prognosis for all situations, including wound dehiscence, or just primary traumatic injuries.
METHODS
Retrospective cross-sectional chart review of patients who underwent open globe repair from 1/1/2019 to 12/1/2020 at an urban hospital setting was evaluated for final visual outcomes, associated ocular pathology, long-term complications, and need for further surgeries.
RESULTS
Fifty-eight eyes were identified-38 primary trauma and 20 dehisced wounds (11 penetrating keratoplasties, five clear corneal incisions, one laceration, one extracapsular cataract extraction, one radial keratotomy, and one tectonic graft). Dehisced wounds had more posterior segment pathology vs primary trauma, i.e., hemorrhagic choroidal, vitreous hemorrhage, retinal detachment, choroidal effusion (all 20% vs 2.63%, 5.26%, 5.26%, and 0%, respectively), vitreous prolapse (20% vs 2.63%), and uveal prolapse (80% vs 36.84%). Dehisced wounds had more traumatic aphakia (40% vs 0%) and dislocated lenses (15% vs 0%). Primary trauma was more likely to have traumatic cataracts (55.26% vs 10%) or no lens changes (44.74% vs 25%). About 10% dehisced wounds required enucleation (0% primary trauma). Cataract/secondary intraocular lens surgery was performed in 34% of the primary traumas (10% in dehisced wounds). Primary traumas achieved 20/40 vision or better in 44.74% (10% dehisced wounds). About 7.89% of patients with wound dehiscence ended with no light perception (none in primary trauma).
CONCLUSION
Zone 1 open globe injuries due to wound dehiscence may exhibit worse prognosis compared to primary trauma open globe injury. More important than the zone of injury may be the source.
Topics: Humans; Cross-Sectional Studies; Retrospective Studies; Eye Injuries; Postoperative Complications; Prolapse
PubMed: 38349413
DOI: 10.1007/s10792-024-02923-2 -
Wound Repair and Regeneration :... May 2019We investigate how wound closure is determined in recent randomized controlled wound trials and real-world studies, identify solutions to the current limitations of... (Review)
Review
We investigate how wound closure is determined in recent randomized controlled wound trials and real-world studies, identify solutions to the current limitations of wound assessment, and propose a standard methodology to define and assess wound healing in research. We searched PubMed for randomized clinical trials using the terms "complete wound closure" and "wound healing rate" and for real-world studies using the terms "real-world wound healing," "real-world wound data," and "wound registries" dating from March 2010 through March 2018. We selected studies that had "complete wound closure" or "healed wound" as an endpoint. Sixty-five trial articles and 10 real-world articles met our criteria, from which we extracted the wound type studied, definition of healed wound used, wound assessment method, the number of weeks assessed, the number of wounds, and the percent of healed wounds in the study group(s) and control group. There were 7,194 trial wounds included. The most common definition of healing used by 26 studies (40.6%) was complete/full/100% (re)epithelialization or closure without discharge, drainage/scab, and/or dressing. Fifty-two studies (81.2%) used blinded wound assessment, and at least 10 studies (15.6%) used blinded adjudication. The real-world studies analyzed more than 901,396 wounds. Only three studies (33.3%) defined a healed/closed wound, two of which used "complete epithelialization." Eight studies (88.9%) did not define the wound assessment method; none indicated a blinded assessment. We support the Food and Drug Administration definition: 100% reepithelialization of the wound surface with no discernable exudate and without drainage or dressing, confirmed at two visits 2 weeks apart, and we recommend blinded adjudication for wound assessment. The widespread adoption of a standard wound healing definition and assessment method in wound care research would allow for stronger comparisons of treatment effects across studies to improve the evidence base and strengthen the treatment decision-making process in clinical practice.
Topics: Bandages; Biomedical Research; Humans; Randomized Controlled Trials as Topic; Soft Tissue Injuries; Surgical Wound Dehiscence; Suture Techniques; Wound Healing
PubMed: 30767334
DOI: 10.1111/wrr.12707 -
International Wound Journal Jun 2014Soft tissue and wound treatment after orthopaedic interventions (especially after trauma) is still an enormously challenging situation for every surgeon. Since... (Review)
Review
Soft tissue and wound treatment after orthopaedic interventions (especially after trauma) is still an enormously challenging situation for every surgeon. Since development of negative pressure wound therapy (NPWT), new indications have been consistently added to the original field of application. Recently, NPWT has been applied directly over high-risk closed surgical incisions. Review of the literature indicates that this therapy has shown positive effects on incisions after total ankle replacement or calcaneal fractures, preventing haematoma and wound dehiscence. In those cases reduced swelling, decreased pain and healing time of the wound were seen. Additionally, NPWT applied on incisions after acetabular fractures showed a decreased rate of infection and wound healing problems compared with published infection rates. Even after total hip arthroplasty, incisional NPWT reduced incidence of postoperative seroma and improved wound healing. In patients with tibial plateau, pilon or calcaneus fractures requiring surgical stabilisation after blunt trauma, reduced risk of developing acute and chronic wound dehiscence and infection was observed when using incisional NPWT. To conclude, incisional NPWT can help to reduce risk of delayed wound healing and infection after severe trauma and orthopaedic interventions.
Topics: Humans; Negative-Pressure Wound Therapy; Orthopedic Procedures; Postoperative Complications; Surgical Wound Dehiscence; Surgical Wound Infection; Treatment Outcome; Wound Healing; Wounds and Injuries
PubMed: 24851728
DOI: 10.1111/iwj.12252 -
The Veterinary Clinics of North... Dec 2018Wound management in horses can strike fear in some and passion in others. Wounds are common injuries in horses of all descriptions and requires exceptional knowledge and... (Review)
Review
Wound management in horses can strike fear in some and passion in others. Wounds are common injuries in horses of all descriptions and requires exceptional knowledge and care to achieve a successful outcome. New treatments to overcome the critical challenges with equine wounds are always desired: managing dehisced and/or nonhealing wounds, managing exuberant granulation tissue, and ultimately achieving a functional tissue coverage. Regenerative medicine represents a broad set of tools with great promise to manipulate the deficiencies recognized in equine wound healing and improve the outcome.
Topics: Animals; Horse Diseases; Horses; Regenerative Medicine; Wound Healing; Wounds and Injuries
PubMed: 30447771
DOI: 10.1016/j.cveq.2018.07.009 -
Dermatologic Clinics Jul 1986From these observations and others not described in this article, it is clear that there are age-dependent differences in wound healing. Classically, observers have... (Comparative Study)
Comparative Study Review
From these observations and others not described in this article, it is clear that there are age-dependent differences in wound healing. Classically, observers have divided the response to injury into three large phases: inflammatory, proliferative, and remodeling. As indicated elsewhere in this volume, the inflammatory response is decreased with age, and undoubtedly this bears on some of the alterations in healing. The proliferative phase traditionally includes cell migration, proliferation, and maturation, all of which are changed with age. Remodeling encompasses the tertiary binding of collagen molecules, which is also altered with age. Although all of these stages of wound healing differ with age, the changes are qualitative. Events begin later, proceed more slowly, and often do not reach the same level. However, there are neither new events nor an absence of expected events. This is clearly evident by the ease with which the most radical elective surgical wounds heal in the elderly patient. The ability of the aged to heal so well illustrates, therefore, not that their healing processes are equal to those of the young, but rather that our healing capacity is far in excess of what is needed.
Topics: Adult; Aged; Aging; Animals; Collagen; Epithelium; Humans; Middle Aged; Oxygen Consumption; Rabbits; Rats; Skin; Surgical Wound Dehiscence; Time Factors; Wound Healing; Wounds, Penetrating
PubMed: 3521993
DOI: No ID Found -
Cornea Sep 1999To describe the characteristics, causes, treatment, and outcome, particularly the fate of the intraocular implant and visual acuity, of traumatic wound dehiscence...
PURPOSE
To describe the characteristics, causes, treatment, and outcome, particularly the fate of the intraocular implant and visual acuity, of traumatic wound dehiscence occurring in patients who had penetrating keratoplasty (PK).
METHODS
Between 1989 and 1997, 21 corneal transplant patients sustained traumatic wound dehiscence and were treated at our hospital. Graft dehiscence was managed with primary wound closure in all patients, except in some who required some combination of anterior vitrectomy, intraocular lens removal and reimplantation, and corneal regrafting.
RESULTS
The incidence of traumatic wound dehiscence among patients on whom we performed PK over a period of 9 years was 2.53%. This complication occurred, on average, 3.4 years (2 months to 13 years) after PK. Most patients (76%) were men, and the average age at dehiscence was 59 years (range, 15-82 years). All corneal ruptures occurred at the graft-host junction, which had neither particular site preference nor quadrant specificity. Of the 16 eyes that were pseudophakic, nine (56.3%) had either loss of implants or dislocation of intraocular lens so severe that lens removal was imperative. In the end, only five (23.8%) of the 21 grafts retained clarity. Of the remaining 16 eyes, seven were regrafted, of which five (71.4%) grafts remained clear. Of the nine grafts that became opaque, six eyes (28.6%) atrophied. At the last follow-up, only six eyes (28.6%) had visual acuity of 20/200 or better, and six eyes had no perception of light. Final visual acuity was found to correlate inversely with the severity and extent of wound separation.
CONCLUSION
Traumatic wound dehiscence is not rare after PK. The elderly corneal transplant patient may be more prone to such an injury. Corneal rupture at the graft-host junction in all of our cases means the persistence of wound weakness after PK. Although graft survival and visual outcome are generally poor after the injury, the restoration of a satisfactory visual result is possible after regrafting, insofar as the involved eye is free of intractable glaucoma or posterior segment damage.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cornea; Corneal Diseases; Corneal Injuries; Eye Injuries; Female; Foreign-Body Migration; Graft Survival; Humans; Keratoplasty, Penetrating; Lens Implantation, Intraocular; Male; Middle Aged; Reoperation; Rupture; Surgical Wound Dehiscence; Treatment Outcome; Visual Acuity; Wounds, Nonpenetrating
PubMed: 10487429
DOI: No ID Found -
Plastic and Reconstructive Surgery Jan 2011Currently, no biological assay exists to objectively assess wounds to aid in timing of wound closure and guide therapy. In this article, the authors review military... (Review)
Review
BACKGROUND
Currently, no biological assay exists to objectively assess wounds to aid in timing of wound closure and guide therapy. In this article, the authors review military investigations in biomarkers as a method of objectively determining acute traumatic wound physiology and their applicability in predicting healing of complex soft-tissue wounds.
METHODS
The civilian literature related to biomarkers and wound physiology related to chronic and acute wounds was reviewed as a basis for current research into acute traumatic soft-tissue wounds.
RESULTS
Analysis of serum and wound effluent from traumatic extremity soft-tissue combat wounds revealed changes in specific proinflammatory matrix metalloproteinases associated with impaired wound healing. Forsberg et al. analyzed serum and wound effluent for chemokines and cytokines. An increase in serum procalcitonin levels correlated with wound dehiscence. Lastly, serum, wound effluent, and wound bed tissue biopsy specimens were analyzed by Hawksworth et al. Consistent with previous studies, elevation in proinflammatory cytokines was associated with wound dehiscence.
CONCLUSIONS
Changes in levels of proteases, protease inhibitors, and inflammatory markers have been correlated with wound healing. These findings further support the idea that inflammatory dysregulation and a persistent inflammatory state leads to failure of wound healing in the acute setting. These findings highlight potential targets for the development of a biological assay to individualize management of complex soft-tissue wounds, based on patient physiology and response, that would be applicable to not only military trauma but also civilian trauma. Ultimately, this would result in earlier wound closure, reduction in the number of operating room trips, and reduced health care costs.
Topics: Biomarkers; Humans; Predictive Value of Tests; Prognosis; Warfare; Wound Healing; Wounds and Injuries
PubMed: 21200268
DOI: 10.1097/PRS.0b013e3181fbe291