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Wounds : a Compendium of Clinical... Jan 2019A skin tear is a partial-thickness wound whose main characteristic is the presence of a skin flap. There are many contributing factors to skin tears, but few practical... (Review)
Review
UNLABELLED
A skin tear is a partial-thickness wound whose main characteristic is the presence of a skin flap. There are many contributing factors to skin tears, but few practical guidelines are available in the literature for their prevention and management.
OBJECTIVE
The aim of this study is to develop a manual for the prevention and treatment of skin tear injuries.
METHODS
A literature review on skin tears was conducted. The manual was organized into 7 chapters of topics of interest to health care professionals. Its content validity was assessed in 2 rounds of consultation by 7 health professionals with a master's or doctoral degree who were experienced in skin lesions.
RESULTS
The manual was successfully validated for content by the expert panel. The content validity index (CVI) was 0.96 for the topic Objective, 0.96 for Structure and Presentation, and 0.93 for Relevance. The final version of the manual showed an excellent overall CVI of 0.95.
CONCLUSIONS
A content-validated manual for the prevention and treatment of skin tears was created to guide nursing professionals in the management of patients with skin tears, which contributes to the identification of risk factors and development of preventive measures.
Topics: Evidence-Based Medicine; Humans; Lacerations; Preventive Medicine; Risk Factors; Skin; Trauma Severity Indices; Wound Healing
PubMed: 30260318
DOI: No ID Found -
BMJ Open Sep 2015A rise in obstetric anal sphincter injuries (OASIS) has been observed and a preventive approach, originating in Finland, has been introduced in several European... (Review)
Review
OBJECTIVES
A rise in obstetric anal sphincter injuries (OASIS) has been observed and a preventive approach, originating in Finland, has been introduced in several European hospitals. The aim of this paper was to systematically evaluate the evidence behind the 'Finnish intervention'.
DESIGN
A systematic review of the literature conducted according to the Preferred Reporting for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
OUTCOME MEASURES
The primary outcome was OASIS. Secondary outcomes were (perinatal): Apgar scores, pH and standard base excess in the umbilical cord, and (maternal): episiotomy, intact perineum, first and second-degree perineal lacerations, duration of second stage, birth position and women's perceptions/birth experiences.
METHODS
Multiple databases (Cochrane, Embase, Pubmed and SveMed) were systematically searched for studies published up to December 2014. Both randomised controlled trials and observational studies were eligible for inclusion. Studies were excluded if a full-text article was not available. Studies were evaluated by use of international reporting guidelines (eg, STROBE).
RESULTS
Overall, 1042 articles were screened and 65 retrieved for full-text evaluation. Seven studies, all observational and with a level of evidence at 2c or lower, were included and consistently reported a significant reduction in OASIS. All evaluated episiotomy and found a significant increase. Three studies evaluated perinatal outcomes and reported conflicting results. No study reported on other perineal outcomes, duration of the second stage, birth positions or women's perceptions.
CONCLUSIONS
A reduction in OASIS has been contributed to the Finnish intervention in seven observational studies, all with a low level of evidence. Knowledge about the potential perinatal and maternal side effects and women's perceptions of the intervention is extremely limited and the biological mechanisms underlying the Finnish intervention are not well documented. Studies with a high level of evidence are needed to assess the effects of the intervention before implementation in clinical settings can be recommended.
Topics: Adult; Anal Canal; Episiotomy; Fecal Incontinence; Female; Finland; Humans; Infant, Newborn; Lacerations; Obstetric Labor Complications; Perineum; Pregnancy; Treatment Outcome
PubMed: 26369797
DOI: 10.1136/bmjopen-2015-008346 -
BMC Medical Education Mar 2021Repair of margin-involving eyelid lacerations is a challenge for beginning ophthalmology residents, yet no commercially-available simulation models exist for learning...
BACKGROUND
Repair of margin-involving eyelid lacerations is a challenge for beginning ophthalmology residents, yet no commercially-available simulation models exist for learning this skill. The objective of the study was to modify a mannequin-based surgical simulator originally developed for trachomatous trichiasis surgery training to teach margin-involving eyelid laceration repair and to evaluate its success within a residency wet-lab environment.
METHODS
We modified a previously developed mannequin-based training system for trachomatous trichiasis surgery into a simulator for margin-involving eyelid laceration repair. Six ophthalmology residents from a tertiary care academic institution performed at least one simulated margin-involving eyelid laceration repair using the surgical simulator between September 2019 and March 2020. Each session was video recorded. Two oculoplastic surgeons reviewed the videos in a blinded fashion to assess surgical proficiency using a standardized grading system. Participants were surveyed on their comfort level with eyelid laceration repair pre- and post-completion of simulation. They were also queried on their perceived usefulness of the surgical simulator compared to past methods and experiences.
RESULTS
Six residents completed 11 simulation surgeries. For three residents who completed more than one session, a slight increase in their skills assessment score and a decrease in operative time over two to three simulation sessions were found. Self-reported comfort level with margin-involving eyelid laceration repairs was significantly higher post-simulation compared to pre-simulation (p = 0.02). Residents ranked the usefulness of our surgical simulator higher than past methods such as fruit peels, surgical skill boards, gloves, and pig feet (p = 0.03) but lower than operating room experience (p = 0.02). Residents perceived the surgical simulator to be as useful as cadaver head and emergency department/consult experience.
CONCLUSIONS
We developed a surgical simulator for teaching eyelid laceration repair and showed its utility in developing trainees' surgical skills. Our surgical simulator was rated to be as useful as a cadaver head but is more readily available and cost effective.
Topics: Animals; Clinical Competence; Eyelids; Humans; Internship and Residency; Lacerations; Manikins; Pilot Projects; Simulation Training; Swine
PubMed: 33740979
DOI: 10.1186/s12909-021-02600-3 -
American Family Physician Jun 2005Surfers are prone to acute injuries as well as conditions resulting from chronic environmental exposure. Sprains, lacerations, strains, and fractures are the most common... (Review)
Review
Surfers are prone to acute injuries as well as conditions resulting from chronic environmental exposure. Sprains, lacerations, strains, and fractures are the most common types of trauma. Injury from the rider's own surfboard may be the prevailing mechanism. Minor wound infections can be treated on an outpatient basis with ciprofloxacin or trimethoprim-sulfamethoxazole. Jellyfish stings are common and may be treated with heat application. Other treatment regimens have had mixed results. Seabather's eruption is a pruritic skin reaction caused by exposure to nematocyst-containing coelenterate larvae. Additional surfing hazards include stingrays, coral reefs, and, occasionally, sharks. Otologic sequelae of surfing include auditory exostoses, tympanic membrane rupture, and otitis externa. Sun exposure and skin cancer risk are inherent dangers of this sport.
Topics: Animals; Anthozoa; Athletic Injuries; Dermatitis, Contact; Exostoses; Humans; Lacerations; Marine Toxins; Oceans and Seas; Otitis Externa; Sea Urchins; Seawater; Skin Neoplasms; Sports Equipment; Sunburn; Tympanic Membrane Perforation; Urticaria
PubMed: 15999868
DOI: No ID Found -
Joint Diseases and Related Surgery 2022This study aims to point out the key principles for the management of multicomponent soft tissue injuries of the wrist and forearm to discuss whether we should expand...
OBJECTIVES
This study aims to point out the key principles for the management of multicomponent soft tissue injuries of the wrist and forearm to discuss whether we should expand the term "spaghetti" from the wrist to forearm in such terrifying cases.
PATIENTS AND METHODS
Data from a total of 50 patients (44 males, 6 females; mean age: 48.5±25.7 years; range, 10 to 70 years) who were treated for multicomponent soft tissue injuries of the wrist and forearm, including at least one major artery and one major nerve, between February 2020 and December 2021 were retrospectively analyzed. The patients were divided into the wrist injury group (n=30) and forearm injury group (n=20) according to the location of laceration. Demographic characteristics, including age, sex ratio and mechanism and side of injury, total lacerated structures, and outcomes, including tendon function, opposition, intrinsic muscle function, deformities, sensation and grip strength were evaluated.
RESULTS
In the wrist injury group, a mean of 12.27±3.53 structures at the volar side were injured. It took a mean time of 1.8±0.4 h for emergency surgical repair and, after a mean of 16.6±5.3 month follow-up, most patients received excellent/good outcomes in the six aspects. In the forearm injury group, a mean of 12.95±2.96 structures at the volar side were injured. It took an average time of 2.1±0.4 h for emergency surgical repair and, after a mean of 15.4±6.4 month follow-up, most patients received excellent/good outcomes and were satisfied with the functional recovery. Only surgical time (p=0.018) and final grip strength (p=0.023) between the two groups showed a statistically significant difference.
CONCLUSION
We propose to merge the severe wrist and proximal forearm laceration of multiple tendons/muscles with at least one major artery and one major nerve as a whole, namely the spaghetti-ketchup injury, since the laceration of wrist and that of proximal forearm in this study share similar mechanisms and outcomes after primary repair or reconstruction.
Topics: Adolescent; Adult; Aged; Child; Female; Forearm; Forearm Injuries; Humans; Lacerations; Male; Middle Aged; Retrospective Studies; Soft Tissue Injuries; Wrist; Wrist Injuries; Young Adult
PubMed: 35852185
DOI: 10.52312/jdrs.2022.652 -
Deutsches Arzteblatt International Jun 2022
Topics: Humans; Lacerations; Liver; Resuscitation
PubMed: 36106875
DOI: 10.3238/arztebl.m2022.0018 -
Revista Brasileira de Ginecologia E... Jun 2016Introduction Episiotomy is a controversial procedure, especially because the discussion that surrounds it has gone beyond the field of scientific debate, being adopted... (Review)
Review
Introduction Episiotomy is a controversial procedure, especially because the discussion that surrounds it has gone beyond the field of scientific debate, being adopted as an indicator of the "humanization of childbirth". The scientific literature indicates that episiotomy should not be performed routinely, but selectively. Objectives To review the literature in order to assess whether the implementation of selective episiotomy protects against severe perineal lacerations, the indications for the procedure, and the best technique to perform it. Methods A literature search was performed in PubMed using the terms episiotomy or perineal lacerations, and the filter clinical trial. The articles concerning the risk of severe perineal lacerations with or without episiotomy, perineal protection, or episiotomy techniques were selected. Results A total of 141 articles were identified, and 24 of them were included in the review. Out of the 13 studies that evaluated the risk of severe lacerations with and without episiotomy, 5 demonstrated a protective role of selective episiotomy, and 4 showed no significant differences between the groups. Three small studies confirmed the finding that episiotomy should be performed selectively and not routinely, and one study showed that midline episiotomy increased the risk of severe lacerations. The most cited indications were primiparity, fetal weight greater than 4 kg, prolonged second stage, operative delivery, and shoulder dystocia. As for the surgical technique, episiotomies performed with wider angles (> 40°) and earlier in the second stage (before "crowning ") appeared to be more protective. Conclusions Selective episiotomy decreases the risk of severe lacerations when compared with the non-performance or the performance of routine episiotomy. The use of a proper surgical technique is fundamental to obtain better results, especially in relation to the angle of incision, the distance from the vaginal introitus, and the correct timing for performing the procedure. Not performing the episiotomy when indicated or not applying the correct technique may increase the risk of severe perineal lacerations.
Topics: Episiotomy; Female; Humans; Injury Severity Score; Lacerations; Perineum; Pregnancy
PubMed: 27399925
DOI: 10.1055/s-0036-1584942 -
Acta Clinica Croatica Jun 2019In the era of new molecular, epigenetic and proteomic discoveries, birth canal injuries seem like outdated discussion. A vast increase in the incidence of obstetric anal... (Review)
Review
In the era of new molecular, epigenetic and proteomic discoveries, birth canal injuries seem like outdated discussion. A vast increase in the incidence of obstetric anal sphincter injuries (OASIS) has been recorded in the last two decades despite advantages in modern medicine and new obstetric methods. This increase might be attributed to the new classification of perineal injury but also to the new imaging methods, including endoanal sonography, which earlier identifies injuries that previously were considered to be occult and actually underwent unrecognized, and which should have been recognized immediately postpartum. OASIS are third and fourth degree perineal injuries that occur during delivery. The reported incidence of OASIS varies from 0.1% to 10.9%. It is well known that third and fourth degree perineal injuries occur more often in primiparae, and in cases of macrosomic newborn, dorsoposterior position of fetal head and shoulder dystocia. The protective role of episiotomy is controversial. Birth canal injury during delivery can happen to any parturient woman. It is important for obstetricians to have this in mind at every delivery. Repercussions of OASIS are serious and can persist for life. They include emotional, psychological, social, physical and sexual disturbances. Therefore, it is very important to recognize the risk factors, diagnose the injury on time and treat it properly by a multidisciplinary team. Accordingly, it can be concluded that the increased incidence of OASIS is a result of better recognition of the risk factors, reduced rates of unrecognized sphincter injuries, adoption of the new classification and better postpartum imagining methods for detection of occult injuries.
Topics: Anal Canal; Episiotomy; Female; Humans; Incidence; Lacerations; Parturition; Perineum; Pregnancy; Quality of Health Care; Risk Factors; Ultrasonography
PubMed: 31819335
DOI: 10.20471/acc.2019.58.02.22 -
Circulation. Cardiovascular... May 2022
Topics: Cardiac Catheterization; Electrosurgery; Heart Valve Prosthesis Implantation; Humans; Lacerations; Mitral Valve; Mitral Valve Insufficiency; Treatment Outcome
PubMed: 35580205
DOI: 10.1161/CIRCINTERVENTIONS.122.012014 -
Journal of Wound Care May 2021
Topics: Emergency Responders; Emergency Treatment; Humans; Lacerations; Skin; Skin Abnormalities; Soft Tissue Injuries
PubMed: 33979222
DOI: 10.12968/jowc.2021.30.5.332