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Ugeskrift For Laeger Sep 2014Correct treatment of traumatic facial lacerations is essential to achieve the best cosmetic and functional outcome. This article discusses wound management, anatomy and... (Review)
Review
Correct treatment of traumatic facial lacerations is essential to achieve the best cosmetic and functional outcome. This article discusses wound management, anatomy and techniques to repair lacerations of scalp, eyelid, nose, lip and ear. Scalp lacerations should be sutured in layers. Injury to the eyelid mandates a careful examination of the eye. Accurate adaptation of the lid margin is required. Nasal septum haematoma must be drained and the nares and alar margins aligned. The key to proper repair of lip laceration is alignment of the vermillion border. Injury to the ear can often be closed in one layer.
Topics: Ear; Eyelids; Facial Injuries; Facial Nerve Injuries; Humans; Lacerations; Lip; Nose; Scalp; Sutures
PubMed: 25294326
DOI: No ID Found -
The Cochrane Database of Systematic... Feb 2014Perineal hyaluronidase (HAase) injection was widely used to reduce the occurrence of perineal trauma, pain and need for episiotomy in the 1950s to 1960s. Reports... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Perineal hyaluronidase (HAase) injection was widely used to reduce the occurrence of perineal trauma, pain and need for episiotomy in the 1950s to 1960s. Reports suggested that the administration of HAase was a simple, low risk, low cost and effective way to decrease perineal trauma without adverse effects.
OBJECTIVES
The objective of this review was to assess the effectiveness and safety of perineal HAase injection for reducing spontaneous perineal trauma, episiotomy and perineal pain in vaginal deliveries.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2013), the International Clinical Trials Registry Platform (ICTRP) and the Networked Digital Library of Theses and Dissertations (both on 1 April 2013), and reference lists of retrieved studies. We also contacted relevant organisations.
SELECTION CRITERIA
Published and unpublished randomised and quasi-randomised controlled trials comparing perineal HAase injection with placebo injection or no intervention in vaginal deliveries.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion, extracted data and evaluated methodological quality. Data were checked for accuracy.
MAIN RESULTS
The search strategy identified six potentially eligible studies. Two studies were excluded. We included four randomised controlled trials that randomised a total of 599 women (data were available for 595 women).Two trials (283 women) compared the effects of perineal HAase injection during the second stage of labour with placebo injection and were at low risk of bias. Three trials (one three-armed trial was analysed twice) (373 women) compared the effects of perineal HAase injection during second stage of labour with no intervention and two out of the three trials were at high risk of bias. Data from four trials involving 599 women suggested that perineal HAase injection during second stage of labour had a lower incidence of perineal trauma (average risk ratio (RR) 0.69, 95% confidence interval (CI) 0.50 to 0.95,Tau² = 0.08, I² = 82% compared with women in the control group, but there was no clear evidence of a reduction in the incidence of episiotomy (average RR 0.74, 95% CI 0.43 to 1.29, Tau² = 0.17, I² = 66%), first and second degree perineal lacerations (average RR 0.54, 95% CI 0.38 to 1.33, Tau² = 0.30 , I² = 85%) and third and fourth degree perineal lacerations (RR 0.12, 95% CI 0.01 to 2.13). Data from two trials involving 283 women indicated that there was no clear evidence of a reduction in the incidence of perineal trauma (RR 0.90, 95% CI 0.77 to 1.06, Tau²=1.07, I² = 7%), episiotomy (RR 0.77, 95% CI 0.32 to 1.89, Tau² = 0.27, I² = 54%), first and second degree perineal lacerations (RR 1.08, 95% CI 0.83 to 1.40, Tau² = 1.11, I² = 10%) and third and fourth degree perineal lacerations (RR 0.12, 95% CI 0.01 to 2.13) with perineal HAase injection. Data from three trials involving 373 women suggested that perineal HAase injection during second stage of labour had a lower incidence of perineal trauma (RR 0.61, 95% CI 0.42 to 0.88, Tau² = 0.08, I² = 78%) compared with no intervention, but had no clear effect on in the incidence of episiotomy (RR 0.79, 95% CI 0.44 to 1.42, Tau² = 0.16, I² = 70%) and first and second degree perineal lacerations (RR 0.58, 95% CI 0.31 to 1.10, Tau² = 0.18, I² = 59%). No side effects were reported in the included trials.No included trials reported on perineal pain and other pre-specified secondary outcomes: perineal trauma requiring suturing; blood loss; dyspareunia; urinary incontinence; faecal incontinence; assisted delivery rate; women's satisfaction; Apgar score less than seven at five minutes and need for admission to special care baby unit.
AUTHORS' CONCLUSIONS
Perineal HAase injection during second stage of labour had a lower incidence of perineal trauma compared with control or no intervention, but there was no clear evidence of benefit compared with placebo injection. The difference in incidence of perineal trauma may probably be due to bias and confounding in the non-placebo controlled comparison, this result should be interpreted cautiously. The potential use of perineal HAase injection as a method to reduce perineal trauma were yet to be determined as there was no appropriate established dose for HAase, no evidence of follow up, and the number of high-quality trials and outcomes reported were too limited to draw conclusions on its effectiveness and safety. Further rigorous randomised controlled trials are required to evaluate the role of perineal HAase injection in vaginal deliveries.
Topics: Adult; Delivery, Obstetric; Episiotomy; Female; Humans; Hyaluronoglucosaminidase; Labor Stage, Second; Lacerations; Obstetric Labor Complications; Perineum; Pregnancy; Randomized Controlled Trials as Topic
PubMed: 24497276
DOI: 10.1002/14651858.CD010441.pub2 -
Canadian Family Physician Medecin de... Mar 2017
Review
Topics: Gloves, Surgical; Humans; Lacerations; Minor Surgical Procedures; Sterilization; Wound Infection
PubMed: 28292800
DOI: No ID Found -
BMC Ophthalmology Jun 2020To evaluate the etiology of lacrimal canalicular laceration and explore the possible risk factors influencing prognosis.
BACKGROUND
To evaluate the etiology of lacrimal canalicular laceration and explore the possible risk factors influencing prognosis.
METHODS
The data of 142 patients (142 eyes) with lacrimal canalicular lacerations who were surgically treated using canalicular anastomosis combined with bicanalicular stent intubation between March 2017 and March 2018 were reviewed. The analyzed data contained demographic information, types of trauma, injury locations, associated additional ocular injuries, and surgical outcomes at follow-up. The main outcome measures were anatomic success rate, functional success rate, and complications of surgery.
RESULTS
The mean patient age was 42.07 years (ranging from 1 to 75 years). Among the 142 patients, 112 (78.87%) were males. Upper and lower canalicular lacerations were found in 14 (9.86%) and 112 (78.87%) patients, respectively. Meanwhile, both upper and lower canalicular lacerations were found in 16 (11.27%) patients. Electric bike accidents comprised the leading cause of injury, accounting for 76 (53.52%) cases. There were 100 (70.42%) patients who had lid lacerations without tarsal plate fracture and 42 (29.58%) patients who had lid lacerations with tarsal plate fractures. The anatomic success rate was 98.59% and the functional success rate was 83.8%. The functional reconstruction failure rates were higher in patients with indirect injuries, lid lacerations with tarsal plate fractures, and those with punctum splitting (P < 0.05). Surgical complications were detected in the form of lacrimal punctum ectropion in 3 (2.11%) patients, punctum splitting in 2 (1.41%) patients, and stent extrusion and loss in 2 (1.41%) patients.
CONCLUSIONS
Electric bike accidents have become the leading cause of injury instead of motor vehicle accidents because of the changes in the lifestyles of people. Indirect injuries, lid lacerations with tarsal plate fractures, and those with punctum splitting were significantly more likely to lead to poor prognosis, as confirmed by the lower functional success rate of surgery.
Topics: Adult; Anastomosis, Surgical; Female; Humans; Intubation; Intubation, Intratracheal; Lacerations; Lacrimal Apparatus; Male; Prognosis; Retrospective Studies; Stents
PubMed: 32571261
DOI: 10.1186/s12886-020-01506-w -
Toxins Aug 2021Apamin is a minor component of bee venom and is a polypeptide with 18 amino acid residues. Although apamin is considered a neurotoxic compound that blocks the potassium...
Apamin is a minor component of bee venom and is a polypeptide with 18 amino acid residues. Although apamin is considered a neurotoxic compound that blocks the potassium channel, its neuroprotective effects on neurons have been recently reported. However, there is little information about the underlying mechanism and very little is known regarding the toxicological characterization of other compounds in bee venom. Here, cultured mature cortical neurons were treated with bee venom components, including apamin, phospholipase A2, and the main component, melittin. Melittin and phospholipase A2 from bee venom caused a neurotoxic effect in dose-dependent manner, but apamin did not induce neurotoxicity in mature cortical neurons in doses of up to 10 µg/mL. Next, 1 and 10 µg/mL of apamin were applied to cultivate mature cortical neurons. Apamin accelerated neurite outgrowth and axon regeneration after laceration injury. Furthermore, apamin induced the upregulation of brain-derived neurotrophic factor and neurotrophin nerve growth factor, as well as regeneration-associated gene expression in mature cortical neurons. Due to its neurotherapeutic effects, apamin may be a promising candidate for the treatment of a wide range of neurological diseases.
Topics: Animals; Apamin; Bee Venoms; Cerebellar Diseases; Disease Models, Animal; Humans; Lacerations; Nerve Regeneration; Neurons; Neuroprotective Agents; Rats; Rats, Sprague-Dawley
PubMed: 34564607
DOI: 10.3390/toxins13090603 -
International Orthopaedics Nov 2012Mangled describes an injury caused by cutting, tearing, or crushing, which leads to the limb becoming unrecognizable; in essence, there are two treatment options for... (Review)
Review
Mangled describes an injury caused by cutting, tearing, or crushing, which leads to the limb becoming unrecognizable; in essence, there are two treatment options for mangled upper extremities, amputation and salvage reconstruction. With advances in our understanding of human physiology and basic science, and with the development of new fixation devices, modern microsurgical techniques and the possibility of different types of bony and soft tissue reconstruction, the clinical and functional outcomes are often good, and certainly preferable to those of contemporary prosthetics. Early or even immediate (emergency) complete upper extremity reconstruction appears to give better results than delayed or late reconstruction and should be the treatment of choice where possible. Before any reconstruction is attempted, injuries to other organs must be excluded. Each step in the assessment and treatment of a mangled extremity is of utmost importance. These include radical tissue debridement, prophylactic antibiotics, copious irrigation with a lavage system, stable bone fixation, revascularization, nerve repair, and soft tissue coverage. Well-planned and early rehabilitation leads to a better functional outcome. Despite the use of scoring systems to help guide decisions and predict outcomes, the decision to reconstruct or to amputate still ultimately lies with the surgical judgment and experience of the treating surgeon.
Topics: Amputation, Surgical; Antibiotic Prophylaxis; Clinical Competence; Debridement; Decision Making; Fracture Fixation, Internal; Fractures, Open; Humans; Lacerations; Limb Salvage; Postoperative Complications; Plastic Surgery Procedures; Recovery of Function; Soft Tissue Injuries; Therapeutic Irrigation; Time-to-Treatment; Trauma Severity Indices; Upper Extremity
PubMed: 22923227
DOI: 10.1007/s00264-012-1638-y -
Australian Journal of General Practice Sep 2019Given appropriate case selection and capability, many acute lacerations can be managed in the primary care setting. An understanding of the basic pathophysiology,...
BACKGROUND
Given appropriate case selection and capability, many acute lacerations can be managed in the primary care setting. An understanding of the basic pathophysiology, assessment and management principles is essential.
OBJECTIVE
The aim of this article is to provide a basic framework for assessing and managing simple acute lacerations.
DISCUSSION
The aim of assessment is initially to decide whether the laceration is suitable for office-based treatment, and then whether it requires formal surgical closure with sutures or staples. Two non-surgical techniques for skin closure in amenable wounds are described. A companion article in this issue provides details of surgical closure techniques and wound aftercare.
Topics: Anesthesia, Local; Antisepsis; Bandages; General Practice; Humans; Lacerations; Personal Protective Equipment; Sutureless Surgical Procedures; Tetanus; Tetanus Toxoid; Therapeutic Irrigation; Tissue Adhesives; Wound Closure Techniques
PubMed: 31476833
DOI: 10.31128/AJGP-06-19-4962 -
The American Journal of Case Reports Dec 2020BACKGROUND Duodenal trauma usually consists of retroperitoneal lesions. Its management can be complicated by the location of the injury and difficulty in making an early... (Review)
Review
BACKGROUND Duodenal trauma usually consists of retroperitoneal lesions. Its management can be complicated by the location of the injury and difficulty in making an early diagnosis. Duodenal injuries are divided into blunt and penetrating trauma, and the possible results are hematoma, laceration, and devascularization. Duodenal lesions due to blunt trauma are usually accompanied by lesions of nearby organs. We present a rare case of a single duodenal laceration due to blunt abdominal trauma caused by a horse kick, along with a literature review. CASE REPORT A 13-year-old boy presented to our emergency department after being kicked by a horse in his abdomen. He was stable and complained of abdominal pain without any other specifications. Computed tomography imaging revealed a retropneumoperitoneum and free fluid in the abdominal cavity. The patient was taken for an emergency laparotomy, which showed a single duodenal laceration of the second and third portions of the duodenum. The laceration was repaired with a double-layer closure using monofilament 3-0 polypropylene suture. The patient recovered from his injuries and was well at his last follow-up. CONCLUSIONS This case highlights the possible outcomes of an innocent blunt trauma and the importance of early diagnosis for the best outcome of a duodenal laceration. It also identifies the dissociation between the patient's clinical presentation and his significant intra-abdominal injury.
Topics: Abdominal Injuries; Animals; Duodenum; Horses; Humans; Lacerations; Laparotomy; Wounds, Nonpenetrating
PubMed: 33277459
DOI: 10.12659/AJCR.927461 -
Australian Family Physician Sep 2014Issues faced in the management of lacerations in children include control of pain and distress, wound cleaning and closure, referral decisions, awareness of potential...
BACKGROUND
Issues faced in the management of lacerations in children include control of pain and distress, wound cleaning and closure, referral decisions, awareness of potential associated injuries and strategies to prevent complications and optimise cosmetic outcome. The possibility of non-accidental injury may also require exploration.
OBJECTIVE
This update will attempt to offer a current, evidence-informed approach to management of the most commonly seen lacerations, and discuss when specialist referral is appropriate.
DISCUSSION
Successful laceration repair in children is a procedure that blends the arts of anaesthesia, distraction and reassurance with the mechanics of tissue repair itself. Although each laceration and each child deserves an individualised approach, certain principles remain consistent and provide the backbone of a decision-making structure in this therapeutic area.
Topics: Child; Cicatrix; Disease Management; Humans; Lacerations; Pain; Pain Measurement; Wound Healing; Wound Infection
PubMed: 25225643
DOI: No ID Found -
Der Hautarzt; Zeitschrift Fur... Jan 2017The challenges of modern wound management, such as the treatment of chronic wounds and their phase-specific handling, are demanding and require optimally adapted... (Review)
Review
BACKGROUND
The challenges of modern wound management, such as the treatment of chronic wounds and their phase-specific handling, are demanding and require optimally adapted therapeutic measures. The principles of moist wound care as well as an adequate debridement have priority here. To support these necessary measures, different options are available, e.g., a new product group operating across several wound phases.
OBJECTIVE
A new treatment principle in modern wound management based on an expert consensus is presented.
METHODS
On the basis of clinical experience reports and published evidence, the current and new principles of wound treatment were discussed in a panel of experts and formulated as a consensus statement.
RESULTS
Enzyme alginogels represent a combination of agents that allow phase-specific wound care. They exhibit autolytic, absorbent, and antimicrobial properties and simultaneously cover three components of wound management based on the TIME framework. Thus, according to the experts, they differ from other wound healing products and can be classified in a distinct product group. Clinical studies, as well as clinical experiences, provide evidence for the efficacy of enzyme alginogels.
DISCUSSION
According to the experts, the potential of enzyme alginogels used considering the principles of moist wound care, comprises the three-fold effect (continuous and significantly simplified debridement, maintaining a moist wound environment and antimicrobial effect without cytotoxicity), the ease of use, and the flexible application. In addition, the flexibility of the product class regarding frequency of application, duration of treatment and combinability with secondary dressings, are of economic benefit in the health care sector.
Topics: Alginates; Anti-Bacterial Agents; Bandages; Combined Modality Therapy; Debridement; Dermatology; Evidence-Based Medicine; Expert Testimony; Germany; Humans; Lacerations; Oxidoreductases; Practice Guidelines as Topic; Treatment Outcome; Wound Healing
PubMed: 27680011
DOI: 10.1007/s00105-016-3878-z