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BMJ Case Reports Jun 2017
Topics: Corneal Ulcer; Eye Injuries; Humans; Iris Diseases; Keratoplasty, Penetrating; Male; Middle Aged; Surgical Wound Dehiscence; Wounds, Nonpenetrating
PubMed: 28611140
DOI: 10.1136/bcr-2017-220753 -
Clinical & Experimental Ophthalmology Aug 2015Careful surgical management of traumatic wounds is important in open globe injury repair. This study examines the clinical outcomes following repair of open globe...
BACKGROUND
Careful surgical management of traumatic wounds is important in open globe injury repair. This study examines the clinical outcomes following repair of open globe injuries with particular focus on wound-related issues.
DESIGN
Retrospective, cohort study of consecutive open globe injuries presenting to a tertiary referral eye hospital from 1 January 2009 to 31 December 2011.
PARTICIPANTS
A total of 267 eyes of 263 patients, mainly male (82.5%) with a mean age of 44.8 (range: 4-97) years. Average follow up was 6.9 months.
METHODS
All cases classified according to Ocular Trauma Classification Group.
MAIN OUTCOME MEASURES
Visual outcomes, risk factors for and rates of postoperative complications and endophthalmitis.
RESULTS
There were 83 globe ruptures, 182 penetrating and 2 perforating eye injuries, of which 43 cases had intraocular foreign body. Factors contributing to final visual acuity (VA) <6/60 were poor presenting VA (odds ratio [OR] = 16.0, 95% confidence interval [CI]: 4.81-53.1), globe rupture (OR = 4.64, [1.99-10.8]), retinal detachment (OR = 3.40, [1.19-9.74]) and age ≥50 (OR = 2.45, [1.05-5.74]). Wound leak occurred in 44 eyes (16%). Of these, 18 (41%) proceeded to re-suturing. Factors contributing to wound leak were stellate-shaped wound (OR = 3.28, [1.39-7.73]) and delayed presentation (OR = 2.80, [1.02-7.71]). Ten eyes (3.7%) developed endophthalmitis. Factors associated with endophthalmitis were delayed presentation (OR = 8.91, [1.71-46.6]), microbial keratitis (OR = 12.5, [1.85-85.0]) and lens capsule breach (OR = 12.4, [1.85-83.1]).
CONCLUSIONS
Wound leak is an important postoperative complication of open globe injury repair. Delayed presentation is an important risk factor for postoperative wound leak and endophthalmitis. Prompt and meticulous wound management of open globe injury may reduce these complications.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Corneal Injuries; Endophthalmitis; Eye Foreign Bodies; Eye Injuries, Penetrating; Female; Humans; Male; Middle Aged; Ophthalmologic Surgical Procedures; Postoperative Complications; Retrospective Studies; Risk Factors; Sclera; Surgical Wound Dehiscence; Visual Acuity; Wound Healing
PubMed: 25688653
DOI: 10.1111/ceo.12511 -
The Orthopedic Clinics of North America Jan 2014The management of complex wounds remains a challenge, and although there have been many promising advances, patients often undergo a morbid and lengthy process to obtain... (Review)
Review
The management of complex wounds remains a challenge, and although there have been many promising advances, patients often undergo a morbid and lengthy process to obtain sufficient, satisfactory healing. Sarcoma patients are especially vulnerable to soft tissue wound-healing complications. These patients are often treated with neoadjuvant radiation and/or chemotherapy and have compromised local vascularity to healing tissue. The advent and refinement of wound vacuum-assisted closure technology have been shown to have a tremendous impact. This article reviews the benefits of some novel technologies currently undergoing investigation in orthopedic oncology that will likely have applications in wound management from other causes.
Topics: Bandages; Chemotherapy, Adjuvant; Debridement; Humans; Neoplasm Recurrence, Local; Organ Sparing Treatments; Osteotomy; Outcome Assessment, Health Care; Radiotherapy, Adjuvant; Risk Factors; Sarcoma; Soft Tissue Injuries; Surgical Wound Dehiscence; Wound Closure Techniques; Wound Healing
PubMed: 24267211
DOI: 10.1016/j.ocl.2013.08.006 -
Emergency Medicine Clinics of North... Feb 2007Diligent posttreatment wound care management undoubtedly will improve wound outcome and patient satisfaction. There are limited recommendations in the literature to... (Review)
Review
Diligent posttreatment wound care management undoubtedly will improve wound outcome and patient satisfaction. There are limited recommendations in the literature to guide management plans. Nevertheless patients must receive specific instructions to complete wound care. These instructions should include whether a dressing is indicated, which dressing should be used, the duration of use, and the method of application. The plan must explain clearly the reasons for returning for further medical attention, for follow-up, for routine removal of sutures/staples, and an earlier return for possible concerns of infection or dehiscence. Preprinted discharge instruction sheets are useful, and illustrations can be helpful.
Topics: Anti-Bacterial Agents; Bandages; Emergency Service, Hospital; Humans; Patient Discharge; Wound Healing; Wounds and Injuries
PubMed: 17400078
DOI: 10.1016/j.emc.2007.01.006 -
Surgery Jun 2020Surgical site infections cause substantial morbidity and mortality. Negative pressure wound therapy may reduce the risk of surgical site infections, but current evidence... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Surgical site infections cause substantial morbidity and mortality. Negative pressure wound therapy may reduce the risk of surgical site infections, but current evidence is unclear. The objective of this study was to examine whether negative pressure wound therapy reduces the risk of surgical site infections and other wound complications when compared with conventional dressings in all patients with primarily closed surgical wounds.
METHODS
A comprehensive systematic review of randomized controlled trials was conducted. Trials that compared a negative pressure wound therapy system to any non-negative pressure wound therapy dressing in surgical wound(s) intended to heal by primary intention were eligible. Surgical site infection was the primary outcome, and secondary outcomes included wound dehiscence, pain, seroma, healing time, length of stay, device-related complications, cost-effectiveness, and quality of life. Selection, extraction, and risk of bias steps were done in duplicate, and data were synthesized using random effects meta-analyses. A priori sensitivity and subgroup analyses of the primary outcome were completed. The Grading of Recommendations, Assessment, Development, and Evaluations framework was used to appraise the quality of the evidence.
RESULTS
Forty-four randomized controlled trials with N = 5,693 patients were included. Patients treated with negative pressure wound therapy experienced nearly a 40% reduction in the risk of surgical site infections relative to those with conventional dressings, which was statistically significant: pooled risk ratio 0.61, 95% confidence interval 0.49-0.74, I = 26%. The effect remained consistent across surgical specialties and brands of negative pressure wound therapy devices. A statistically significant reduction in wound dehiscence and seroma incidence was also observed.
CONCLUSION
There is moderate certainty that negative pressure wound therapy applied to closed surgical incisions reduces the risk of surgical site infections across all surgical procedures.
Topics: Humans; Negative-Pressure Wound Therapy; Postoperative Complications; Seroma; Surgical Wound; Surgical Wound Dehiscence; Surgical Wound Infection
PubMed: 32143842
DOI: 10.1016/j.surg.2020.01.018 -
The Veterinary Clinics of North... Nov 1994Emergency management of wounds involves examination and protection of the wound with a wet dressing (when possible) to prevent further contamination and desiccation.... (Review)
Review
Emergency management of wounds involves examination and protection of the wound with a wet dressing (when possible) to prevent further contamination and desiccation. Analgesia (or preferably anesthesia) is provided and the patient and the wound are prepared for surgery. Copious amounts of lavage solution are used under moderate pressure. Proper and thorough debridement under irrigation is tedious and time consuming, but is the most important factor that influences subsequent wound healing. Incomplete removal of devitalized or contaminated tissue and debris are a common cause of wound infection, breakdown, and delayed healing. Wound closure is only accomplished when the veterinarian is certain that all devitalized and contaminated tissue has been removed and there is adequate skin. Covering the wound to heal by second intention or delayed closure should be considered more often in veterinary medicine. All too often, the wound is closed prematurely, resulting in dehiscence and infection a few days later. This provides a source of complications to the pet, as well as a source of dissatisfaction for the client. If, after initial debridement and irrigation, there is any doubt about the advisability of surgical closure, the clinician should cover the wound with a proper dressing and continue daily (or more often) dressing changes with local irrigation and debridement as required. Drainage of wound fluid is critical to healing in contaminated wounds. Wound fluids interfere with healing and increase the likelihood of infection. Passive drains (Penrose) are frequently used, often incorrectly. The exposed end of passive drains should be covered with a sterile, absorbent dressing. Active drainage is more efficient than passive drainage and can be accomplished with minimal additional skill and material. Improper use of drains can cause more problems than no drainage at all. Patients suffering painful traumatic (or surgical) wounds should receive analgesic medications. The patient's response to pain may cause immunocompromise, resulting in increased infection rate. It may also induce a hypermetabolic state that may result in impaired wound healing, multiple organ dysfunction, and, possibly, death. Swelling in the area of wounds can create tension on the wound, which compromises the blood supply. Light pressure bandages are recommended to minimize swelling. Nutritional considerations should be given to the wounded patient. Additional protein, vitamins, and minerals may be required for immune function and wound repair.(ABSTRACT TRUNCATED AT 400 WORDS)
Topics: Animals; Emergencies; Wound Healing; Wounds and Injuries
PubMed: 7879362
DOI: 10.1016/s0195-5616(94)50137-2 -
The Journal of Foot and Ankle Surgery :... 2010Negative-pressure wound therapy (NPWT) is commonly used for chronic wounds, open fractures with soft tissue defects, and coverage over split-thickness skin grafts. NPWT...
Negative-pressure wound therapy (NPWT) is commonly used for chronic wounds, open fractures with soft tissue defects, and coverage over split-thickness skin grafts. NPWT uniformly draws wounds closed by helping to remove interstitial fluid, which contains inflammatory and potentially infectious exudate that could impair healing. Recently in our practice, we have used NPWT in cases involving tenuous incisions, such as those used to access target structures during total ankle replacement or open repair of joint depression calcaneal fractures, in an effort to prevent hematoma or wound dehiscence. Although it is generally understood that NPWT can be efficacious and cost-effective for management of a wide range of lower extremity wounds, we also believe it to be beneficial in the management of low-energy trauma and elective hindfoot and ankle reconstructions, and feel that it has led to decreased pain, swelling, and time to healing in our patients. Based on our experience with ankle arthroplasty and the surgical management of hindfoot and ankle trauma, we believe that the use of NWPT in the immediate postoperative period is both safe and efficacious.
Topics: Ankle Injuries; Combined Modality Therapy; Female; Fracture Fixation, Internal; Fractures, Open; Humans; Injury Severity Score; Male; Negative-Pressure Wound Therapy; Postoperative Care; Prognosis; Plastic Surgery Procedures; Risk Assessment; Soft Tissue Injuries; Surgical Flaps; Time Factors; Wound Healing
PubMed: 20605565
DOI: 10.1053/j.jfas.2010.01.002 -
Current Problems in Surgery Mar 2001As the role of the general surgeon continues to evolve, the surgeon's use of ultrasound imaging will surely influence practice patterns, particularly for the evaluation... (Review)
Review
As the role of the general surgeon continues to evolve, the surgeon's use of ultrasound imaging will surely influence practice patterns, particularly for the evaluation of patients in the acute setting. With the use of real-time imaging, the surgeon receives "instantaneous" information to augment the physical examination, to narrow the differential diagnosis, or to initiate an intervention. With select ultrasound examinations, the surgeon can rapidly evaluate adult and pediatric patients with an acute abdomen, especially those patients who are hypotensive. In the hands of the surgeon, this noninvasive, bedside tool can assess more accurately the presence, depth, and extent of an abscess, confirm complete aspiration, or diagnose wound dehiscence before it is apparent on physical examination. Ultrasound imaging is so accurate for the diagnosis of pyloric stenosis that it has essentially replaced the upper gastrointestinal series in most institutions. The surgeon's use of ultrasound imaging to detect a pleural effusion has virtually supplanted the lateral decubitus radiograph. Furthermore, an ultrasound-guided thoracentesis not only facilitates the procedure but improves its safety. As surgeons become more facile with ultrasound imaging, it is anticipated that other uses will develop to further enhance its value for the assessment of patients in the acute setting.
Topics: Abdomen, Acute; Algorithms; General Surgery; Humans; Intensive Care Units; Internship and Residency; Surgical Procedures, Operative; Ultrasonography; Ultrasonography, Interventional; Wounds and Injuries
PubMed: 11263096
DOI: 10.1067/msg.2001.112348 -
The Journal of Surgical Research Sep 2013Information regarding the use of negative pressure wound therapy (NPWT) in the pediatric population is limited. Because of adverse outcomes in adult patients, the Food...
BACKGROUND
Information regarding the use of negative pressure wound therapy (NPWT) in the pediatric population is limited. Because of adverse outcomes in adult patients, the Food and Drug Administration issued a warning in 2011 about the use of NPWT in infants and children.
METHODS
We performed an institutional review board-approved, single-institution, retrospective review of pediatric patients who had undergone NPWT from 2007-2011. We collected the types of wounds for which NPWT was initiated, the NPWT outcomes, and the complications encountered.
RESULTS
The data from 290 consecutive patients were reviewed. Their average age was 9.3 y (range 12 d to 18 y), and their average weight was 46.5 kg (range 1.1-177). Of the wounds, 66% were classified as acute, 10% as chronic, and 24% as traumatic. The two most common indications were surgical wound dehiscence (n = 47) and skin grafting (n = 41). NPWT was used in 15 wounds containing surgical hardware, with 2 devices requiring eventual removal. NPWT was used for a median of 9 d per patient (two dressing changes). Complications occurred in 5 patients (1.7%). Documentation problems were noted in 44 patients. After NPWT, about one-third of the patients (n = 95 patients) were able to undergo delayed primary closure.
CONCLUSIONS
NPWT is an effective adjunct in wound healing and closure in the pediatric population, with no mortality ascribed to NPWT. Also, the complication rates were low.
Topics: Abdominal Wound Closure Techniques; Adolescent; Bone Neoplasms; Child; Child, Preschool; Comorbidity; Enteral Nutrition; Female; Hidradenitis Suppurativa; Humans; Infant; Infant, Newborn; Male; Negative-Pressure Wound Therapy; Osteosarcoma; Parenteral Nutrition; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Retrospective Studies; Skin Transplantation; Surgical Wound Dehiscence; Surgical Wound Infection; Wound Healing; Wounds and Injuries
PubMed: 23768766
DOI: 10.1016/j.jss.2013.05.056 -
Journal of Orthopaedic Trauma 2008The use of negative pressure wound therapy with reticulated open cell foam (NPWT/ROCF) as delivered by V.A.C.(R) Therapy (KCI, San Antonio, TX) has been a valuable... (Review)
Review
The use of negative pressure wound therapy with reticulated open cell foam (NPWT/ROCF) as delivered by V.A.C.(R) Therapy (KCI, San Antonio, TX) has been a valuable adjunct in the treatment of complex lower-extremity injuries. The use of NPWT/ROCF for lower extremity traumatic wounds is based on mechanical effects on the surrounding tissues, biological effects at the cellular level, and simplification of wound care for nursing personnel. For patients with compartment syndrome, risk of secondary infection and need for skin grafting to achieve soft-tissue coverage may theoretically be reduced. For traumatic wounds, dressing care may be simplified and healing encouraged. For surgical incisions, risk of secondary wound dehiscence and infection may be lowered.
Topics: Humans; Leg Injuries; Negative-Pressure Wound Therapy; Wound Healing
PubMed: 19034161
DOI: 10.1097/BOT.0b013e318188e2a9