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Plastic and Reconstructive Surgery Mar 2024Tissue expansion for treating giant congenital melanocytic nevi (GCMN) is a commonly employed surgical method. However, the procedure's efficacy is often hindered by...
BACKGROUND
Tissue expansion for treating giant congenital melanocytic nevi (GCMN) is a commonly employed surgical method. However, the procedure's efficacy is often hindered by anatomical and histological characteristics as well as blood supply, particularly in the extremities and trunk. Enhancing expansion efficiency while reducing complications is thus a topic to be investigated, especially for pediatric patients undergoing rapid physical and psychological development with higher risks of non-compliance to medical instructions.
OBJECT
To explore the effectiveness of expansion in extremities and trunk by immobilizing the acellular dermal matrix (ADM) in the gravitational force zone of inflating expanders.
METHODS
All patients involved in this research underwent ADM-assisted tissue expansion in either the extremities or trunk. ADM was fully flattened, securely fixed to the lower pole of the expander, and subsequently attached to the inner surface of the expanding flap.
RESULTS
From 2021 to 2023, a total of nine pediatric patients with GCMN underwent the ADM-assisted tissue expansion. All patients achieved the desired expanding volume without experiencing petechiae, ecchymosis, or skin ulceration in the ADM-covered area. The process was well tolerated by all patients, with no reports of itching, pain, allergic reaction, or fever. During the flap transfer, the ADM was observed to be firmly adhered to the expanding flap with discernible capillary network.
CONCLUSION
ADM-assisted tissue expansion demonstrates promise in augmenting expansion efficiency and reducing the time needed for surgical intervention in the extremities and trunk, thereby presenting significant clinical value for pediatric patients afflicted with GCMN.
PubMed: 38546404
DOI: 10.1097/PRS.0000000000011434 -
The Journal of Vascular Access Mar 2024Catheterization of central vessels can be associated with early and late, potentially fatal complications. A proactive approach is imperative to reduce the frequency and...
BACKGROUND
Catheterization of central vessels can be associated with early and late, potentially fatal complications. A proactive approach is imperative to reduce the frequency and magnitude of adverse events. Recently, the GAVeCeLT has proposed a protocol called SICA-PED (i.e. Safe Insertion of Central Access in Pediatric patients) and includes seven evidence-based strategies.
METHODS
Through a single-center prospective observational study, the authors wanted to consolidate the efficacy and safety of these protocol in newborns. In a series of 104 newborns, the seven steps of the protocol were applied (1) pre-procedural ultrasound study of the RaCeVA veins, (2) correct aseptic technique, (3) ultrasound-guided venipuncture, (4) intraprocedural localization of the tip of the catheter with TTE (ECHO TIP) and (iECG) intracavitary electrocardiogram, (5) reasoned choice of the implant exit site with the RAVESTO Tunneling technique, (6) anchoring without stitches, and (7) exit point protection with the use of glue and transparent semipermeable membrane. The authors have included a further precaution in point (6) the subcutaneous anchoring system has added the counter-fixation of the catheter wings that we will call 6Plus Point.
RESULTS
All infants requiring implantation of elective us-guided central venous access were enrolled in the study. None of the 104 implanted central venous catheters experienced early complications (accidental arterial puncture, PNX, primary malposition); rare late complications such as ecchymosis, CRBSI, exit site infection or dislodgement were observed, No catheter-related thrombotic phenomena were observed. The CRBSI catheter-related infection rate was 2.47 × 1000 days catheter cases.
CONCLUSION
The results of this prospective study strengthen the feasibility and efficacy of the SICA-Ped Protocol. Demonstrating that the systematic application of the evidence-based seven-step implantation strategy increases the success rate, minimizes early and late complications, which result in increased patient safety.
PubMed: 38539039
DOI: 10.1177/11297298241239998 -
Aesthetic Plastic Surgery Mar 2024The aim of this study was to evaluate the effectiveness of the intravenous, oral and local application of tranexamic acid in operation time, intraoperative bleeding,...
BACKGROUND
The aim of this study was to evaluate the effectiveness of the intravenous, oral and local application of tranexamic acid in operation time, intraoperative bleeding, postoperative edema and ecchymosis in rhinoplasty.
METHODS
This was a randomized, double-blinded, prospective study. We included 146 patients who underwent rhinoplasty at the Bezmialem Vakif University Medical Faculty Otorhinolaryngology Clinic between April 2021 and April 2022. The patients were divided into four groups: Group 1 (intravenous TXA), Group 2 (oral TXA), Group 3 (topical TXA), and Group 4 (control). Operation time was recorded. Bleeding volume was measured in the suction chamber and nasopharyngeal pack. Postoperative edema and ecchymosis were evaluated using a scale at the end of the operation, on the 1st, 3rd, and 7th days.
RESULTS
There was no statistically significant difference between groups in terms of mean operation time (p = 0.894). There was a statistically significant lower mean intraoperative bleeding level in Group 2 from the other groups (p = 0.020). Group 3 had significantly lower scores for postoperative edema than the other groups at the end of the operation, on the 1st, 3rd, and 7th days (p < 0.05), and significantly lower scores for postoperative ecchymosis at the end of the operation (p = 0.013) and on the 3rd day (p = 0.024). Although group 3 had a lower score than the other groups in the ecchymosis measurements on the 1st, and 7th days, no statistically significant results were obtained.
CONCLUSIONS
Local application of tranexamic acid is founded more beneficial for reducing postoperative edema and ecchymosis in rhinoplasty than intravenous and/or oral applications in this study.
LEVEL OF EVIDENCE I
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
PubMed: 38538769
DOI: 10.1007/s00266-024-03951-0 -
BMC Neurology Mar 2024No uniform consensus has been achieved regarding the ambulation protocol after transfemoral cerebral angiography (TFA). Until now, in most hospitals patients are...
BACKGROUND
No uniform consensus has been achieved regarding the ambulation protocol after transfemoral cerebral angiography (TFA). Until now, in most hospitals patients are prescribed 8-12 h strict immobilization along with bed rest in the supine position after TFA in China, which causes great discomfort to patients.
OBJECTIVE
To evaluate the effect of an evidence-based early ambulation protocol on the prevention of vascular complications and general discomfort in patients following transfemoral cerebral angiography (TFA).
METHODS
A prospective quasi-experimental study was conducted on 214 patients undergoing TFA with manual compression. Patients in the experimental group were placed supine position for 2 h with a sandbag placed on the wound dressing, followed by a semi-seated position for another 2 h. After this period, patients took 2 h bed rest (move freely) with the sandbag removed, and were allowed to get out of bed 6 h after TFA. Patients in the control group were restricted to an 8 h bed rest in a supine position with the affected leg straight and immobilized. The vascular complications (bleeding, hematoma, ecchymosis) and levels of comfort (low back pain, leg pain, and blood pressure) were evaluated after the procedure. Numeric Rating Scale (NRS) pain scores, systolic blood pressure (SBP); diastolic blood pressure (DBP) were measured hourly for 8 h after TFA.
RESULTS
There was no significant difference in the two groups with regard to vascular complications including bleeding events (P = 0.621), bleeding volume (P = 0.321), and area of hematoma (P = 0.156). The area of ecchymosis in the experimental group was significantly smaller than the control group (P = 0.031). Compared with the control group, the NRS score for low back pain in the 4th, 5th, 6th, 7th, and 8th hour after TFA were significantly lower (P < 0.05), and the NRS score for leg pain in the 5th, 6th, 7th, 8th hour after TFA were significantly lower (P < 0.05). The SBP and DBP in the 6th, 7th, and 8th hour after TFA were significantly lower than the control group (all P < 0.05).
CONCLUSIONS
The evidence-based early ambulation protocol can effectively and safely increase comfort and decrease the pain level for patients undergoing TFA, without change in the incidence of vascular complications.
Topics: Humans; Cerebral Angiography; Prospective Studies; Low Back Pain; Early Ambulation; Ecchymosis; Hemorrhage; Hematoma
PubMed: 38528480
DOI: 10.1186/s12883-024-03595-2 -
Pediatric Investigation Mar 2024Necrotizing soft tissue infection (NSTI) is a serious infectious disease. However, the early clinical manifestations and indicators of NSTI in children are still unclear.
IMPORTANCE
Necrotizing soft tissue infection (NSTI) is a serious infectious disease. However, the early clinical manifestations and indicators of NSTI in children are still unclear.
OBJECTIVE
The purpose of this study was to analyze the clinical characteristics and risk factors of NSTI in pediatric patients.
METHODS
A total of 127 children with skin and soft tissue infection (SSTI) were treated at our hospital and divided into two groups: the NSTI group and the non-NSTI group, based on their discharge diagnosis from January 2011 to December 2022. Then, we collected and analyzed the clinical characteristics and risk factors of all patients, including sex and age, disease inducement, admission temperature, local skin manifestations, infection site, the presence of sepsis, bacterial culture, and laboratory indicators.
RESULTS
In our study, there was a statistical difference in the age distribution and disease inducement between NSTI and non-NSTI groups. The occurrence of local skin manifestations (blisters/bullae and ecchymosis) and the presence of sepsis significantly increased in the NSTI group compared to the non-NSTI group. Additionally, only the platelet count on laboratory tests was statistically different between the NSTI and non-NSTI groups. Finally, the logistic regression analysis suggested that local skin manifestations such as blisters/bullae, and ecchymosis, as well as the presence of sepsis, were identified as risk factors for NSTI.
INTERPRETATION
Children with SSTI and skin manifestations such as blisters/bullae, ecchymosis, and the presence of sepsis are at a higher risk of developing NSTI. These symptoms serve as useful indicators for early detection of NSTI.
PubMed: 38516144
DOI: 10.1002/ped4.12408 -
Brain & Spine 2024Orbital pathologies requiring surgery are traditionally treated by open approach with different techniques depending on the lesion location. Recently, minimally invasive...
INTRODUCTION
Orbital pathologies requiring surgery are traditionally treated by open approach with different techniques depending on the lesion location. Recently, minimally invasive endoscopic approaches, such as the Endoscopic Endonasal Approach (EEA) and the Endoscopic Transorbital Approach (ETA) have been introduced in orbital surgery.
RESEARCH QUESTION
The purpose of this study is to report the combined experience of the Neurosurgical and Ear-Nose-Throat (ENT) Units in the endoscopic approach of orbital pathologies.
MATERIAL AND METHODS
We retrospectively retrieved data on patients treated at our Institution between 2016 and 2021 with endoscopic approach for orbital pathologies. The Clavien-Dindo classification and the Scar Cosmesis Assessment and Rating (SCAR) Scale have been used to assess complications and cosmetic outcomes.
RESULTS
39 patients met the inclusion criteria. EEA (15 patients) or ETA (20 patients) were chosen to approach the lesions. In three cases we used a combination of endoscopic and anterior orbitotomy and in one patient a combination of EEA + ETA. The type of procedure performed was orbital biopsy (9 cases), orbital decompression (6 cases), subtotal resection of the lesion (STR) (8 cases) and total resection of the lesion (GTR) (16 cases). The more frequent postoperative complications were diplopia (5.1%, with 1 case of permanent diplopia), trigeminal paraesthesia and dysesthesia (5.1%), palpebral edema (17.9%), periorbital ecchymosis (7.7%). Mean follow up time was 21 months (range 2-63 months).
DISCUSSION AND CONCLUSION
Endoscopic approaches to orbital compartments provide minimally invasive access to every orbital compartment with low complications rate and good cosmetic outcome.
PubMed: 38510598
DOI: 10.1016/j.bas.2024.102770 -
Toxicon : Official Journal of the... Apr 2024Envenomations by the common green racer (Chlorosoma viridissimum) are seldom reported in the literature. Herein, we report three cases caused by the same specimen of C....
Envenomations by the common green racer (Chlorosoma viridissimum) are seldom reported in the literature. Herein, we report three cases caused by the same specimen of C. viridissimum in three different victims in the Brazilian Amazon. In all cases, the victims were either a biologist or biology students that were handling the animal and were bitten in their upper limbs. The victims showed only local symptoms, such as edema, tooth marks, pain, erythema, ecchymoses and bleeding. One of the patients presented extensive ecchymosis. Two patients sought medical care, but were only treated for local manifestations and evolved without complications. Chlorosoma viridissimum is capable of provoking mild to moderate signs and symptoms.
Topics: Animals; Humans; Snake Bites; Brazil; Colubridae; Pain; Hemorrhage; Antivenins
PubMed: 38508243
DOI: 10.1016/j.toxicon.2024.107686 -
Pain Management Nursing : Official... Mar 2024Comparison of the effects of dry heat versus moist heat therapy modalities on the intensity of pain and wound healing of episiotomies among postnatal women. (Review)
Review
OBJECTIVES
Comparison of the effects of dry heat versus moist heat therapy modalities on the intensity of pain and wound healing of episiotomies among postnatal women.
DESIGN
A Systematic review and meta-analysis of controlled trials.
DATA SOURCES
Six databases searched for original articles using relevant keywords until September 10, 2023, without time or language restrictions.
REVIEW/ANALYSIS METHODS
All analyses employed Comprehensive Meta-Analysis (CMA) V.2. The measure of heterogeneity was computed using Cochran's Q-value. The I index was employed to quantitatively demonstrate heterogeneity. Statistical significance was reported for P-values <0.05 and I>50%.
RESULTS
Four quasi-experimental and three randomized controlled trials (RCTs) studies with moderate-to-good quality evidence met inclusion criteria. On the third to fifth day after the intervention in the dry heat group, the amount of pain was significantly lower than in the group that used moist heat [MD (95% CI) =-1.395 (-2.374, -0.416), P=0.005]. The use of a hair dryer significantly reduced pain (P=0.029), but an infrared lamp did not significantly reduce pain compared to moist heat (P=0.064). As compared to the moist heat group, the women using dry heat experienced better wound healing to the extent of 2.002 units of the REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation) scale, which was statistically significant [MD (95% CI) = -2.002 (-2.785, -1.219), P<0.001].
CONCLUSION
Compared to sitz baths, dry heat reduced pain and improved episiotomy site healing in postnatal women. Therefore, dry heat, especially hair dryers, is suggested as a non-pharmacological strategy inside maternity hospitals, but additional targeted, high-quality trials are needed.
PubMed: 38494347
DOI: 10.1016/j.pmn.2024.02.002 -
Aesthetic Plastic Surgery Mar 2024Rhinoplasty, a common surgical procedure for nose reshaping, demands meticulous preoperative evaluation and precise execution. When coupled with septoplasty to address... (Review)
Review
Rhinoplasty, a common surgical procedure for nose reshaping, demands meticulous preoperative evaluation and precise execution. When coupled with septoplasty to address medical issues stemming from a deviated nasal septum, these procedures can lead to noteworthy postoperative complications. These encompass early issues like epistaxis and hematoma, as well as long-term challenges such as scarring and aesthetic deformities. Strategies like steroids and tranexamic acid are employed to prevent and manage these complications. A contentious aspect in postoperative care is the use of nasal packing. While some argue it aids healing and hemostasis, others avoid it due to patient discomfort. This review assesses the pros and cons of postoperative nasal packing following rhinoplasty and septoplasty. A thorough literature review spanning 2000-2023 yielded 30 relevant articles from 62. Discussion reveals that nasal packing offers limited benefits in reducing bleeding, edema and ecchymosis. In conclusion, the decision to employ nasal packing in rhinoplasty and septoplasty should be made carefully, considering patient comfort and surgical context. Evidence suggests that nasal packing may not consistently provide significant advantages and could lead to adverse outcomes. Nasal splints offer similar advantages and may be considered viable alternatives. Surgeons should tailor their approach to individual patient needs, with further research needed to refine postoperative management for these procedures.Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
PubMed: 38485786
DOI: 10.1007/s00266-024-03907-4 -
Cureus Feb 2024Patients with a history of blood clots are commonly placed on anticoagulation therapy, but a common adverse effect of this therapy is hemorrhage. Our patient with a...
Patients with a history of blood clots are commonly placed on anticoagulation therapy, but a common adverse effect of this therapy is hemorrhage. Our patient with a history of left ventricle thrombus in a free-standing inpatient rehabilitation hospital had ecchymoses that expanded over a large portion of the posterior thigh in one day. The rapid expansion of the ecchymoses coupled with a decline in hemoglobin levels prompted an immediate evaluation that showed an intramuscular hematoma. With hemoglobin levels dropping significantly, the patient was then transferred to the emergency department for higher levels of care. A multidisciplinary team of vascular surgery and electrophysiology physicians decided to discontinue anticoagulation and monitor the hematoma with serial compartment checks. The hematoma had stabilized throughout the hospital stay without surgical intervention. This case will discuss the difficulty of managing a patient with a history of previous blood clots with an adductor magnus hematoma in the setting of concurrent iatrogenic anticoagulation. Furthermore, we will review the current management and evaluation of intramuscular hematomas.
PubMed: 38481892
DOI: 10.7759/cureus.54079