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Journal of Cardiac Surgery Jul 2020Cardiac wounds have been described for centuries and still remain to be fatal. For a long period of time, the suturing of a myocardial laceration was thought to be... (Review)
Review
BACKGROUND AND AIM OF THE STUDY
Cardiac wounds have been described for centuries and still remain to be fatal. For a long period of time, the suturing of a myocardial laceration was thought to be absolutely impossible if not sacrilege.
METHODS
It is only at the end of the 19th century that pioneers decided to defy such a dogma in desperate cases.
RESULTS
Nowadays, it seems obvious that a cardiac stab wound requires emergent surgery whenever possible.
CONCLUSIONS
The story of cardiac wounds highlights nicely the change of mind that is required to accept progress and new procedures in medicine.
Topics: Cardiac Surgical Procedures; Heart Injuries; Humans; Lacerations; Suture Techniques; Wounds, Stab
PubMed: 32485004
DOI: 10.1111/jocs.14675 -
Journal of the American Veterinary... Jul 2022To characterize clinical findings and outcomes for horses with heel bulb lacerations.
OBJECTIVE
To characterize clinical findings and outcomes for horses with heel bulb lacerations.
ANIMALS
Medical records of a teaching hospital were reviewed to identify horses treated for heel bulb lacerations between February 2004 and October 2018. Long-term outcome was assessed by telephone communication with owners. Results were analyzed to determine association with clinical outcome.
RESULTS
31 mares and 31 geldings of various ages, breeds, and uses were evaluated. Thirty-six horses had a wound of 0 to 2 days' duration, and 17 horses had a wound of > 2 days' duration. Horses with a wound duration of < 2 days had a significantly greater likelihood of a higher outcome score (P = .025; OR = 7.08; 95% CI = 1.28% to 39.08%). Synovial communication with the wound was confirmed in 21 of 62 (33.9%) horses. One synovial structure was involved in 17 horses, and > 1 synovial structure was involved in 4 horses. Fifty-nine horses survived to discharge, and follow-up information was available for 18 (30.5%) horses. Of the horses available for follow-up, 78% returned to the previous level of work (14/18). Degree of lameness at presentation, degree of wound contamination, treatment prior to presentation, treatment with foot casting, and involvement of synovial structures were not found to be significantly associated with clinical outcome.
CLINICAL RELEVANCE
Results suggest that horses with heel bulb lacerations have a good prognosis for survival and a favorable prognosis for return to work. Clinical application of additional findings needs further investigation before clinical relevance can be ascertained.
Topics: Horses; Animals; Female; Male; Horse Diseases; Lacerations; Prognosis; Retrospective Studies; Treatment Outcome
PubMed: 35943929
DOI: 10.2460/javma.22.03.0105 -
Plastic and Reconstructive Surgery Nov 2013Table saws are ubiquitous devices in professional, home, and school woodshops that have the potential to cause severe injuries. Many of these injuries results in finger... (Review)
Review
BACKGROUND
Table saws are ubiquitous devices in professional, home, and school woodshops that have the potential to cause severe injuries. Many of these injuries results in finger and thumb tendon, nerve, and vascular damage or amputation. Long-term outcomes of these injuries can include functional and sensory deficits. Table saw manufacturers are required to equip saws with blade guards to prevent blade contact; nevertheless, treatment of table saw injuries is a common occurrence in U.S. emergency departments.
METHODS
The authors performed a literature search using PubMed and the Cumulative Index to Nursing and Allied Health Literature to compile epidemiology data relevant to table saw injuries. The authors also reviewed the U.S. Consumer Product Safety Commission's briefing package on table saw blade contact injuries.
RESULTS
Over 30,000 table saw injuries occur annually. Fingers and hands are the most frequently injured body parts, and lacerations are the most common injuries. Individuals suffering from occupational injuries tend to be younger than those injured during amateur woodworking. A small but important minority of injuries are to students participating in school shop classes. Medical costs for the treatment of table saw injuries are estimated at more than $2 billion every year.
CONCLUSIONS
SawStop technology stops the saw blade when contact with skin is made, resulting in a small cut rather than a more complicated laceration or amputation. The application of this novel technology in saw designs can prevent serious injuries that deleteriously affect lives at the personal and societal levels.
Topics: Accidents, Home; Accidents, Occupational; Adult; Amputation, Traumatic; Child; Finger Injuries; Hand Injuries; Humans; Lacerations; Protective Devices; Schools; Thumb; United States
PubMed: 24165629
DOI: 10.1097/PRS.0b013e3182a3bfb1 -
Acta Medica Portuguesa Dec 2021Post-partum hemorrhage is one of the leading causes of maternal mortality and it's etiology needs to be identified in order for adequate treatment to be provided. We...
Post-partum hemorrhage is one of the leading causes of maternal mortality and it's etiology needs to be identified in order for adequate treatment to be provided. We report a case of a post-partum hemorrhage in a multiparous woman treated with selective coil packing embolization after identification of laceration of the right uterine artery's ascending branch. The patient was admitted to an intensive care unit in hemorrhagic hypovolemic shock and disseminated intravascular coagulation and underwent total hysterectomy due to infectious complications.
Topics: Disseminated Intravascular Coagulation; Female; Humans; Lacerations; Postpartum Hemorrhage; Pregnancy; Uterine Artery; Vacuum Extraction, Obstetrical
PubMed: 34773453
DOI: 10.20344/amp.13399 -
Journal of Paediatrics and Child Health Sep 2022
Topics: Catheterization, Central Venous; Catheters; Humans; Infusions, Intravenous; Lacerations; Parenteral Nutrition, Total; Umbilical Veins
PubMed: 34704646
DOI: 10.1111/jpc.15779 -
MedEdPORTAL : the Journal of Teaching... Feb 2019Laceration repair is a core procedural skill in which pediatric residents are expected to attain proficiency per the Accreditation Council for Graduate Medical... (Comparative Study)
Comparative Study
INTRODUCTION
Laceration repair is a core procedural skill in which pediatric residents are expected to attain proficiency per the Accreditation Council for Graduate Medical Education. Restricted trainee work hours have decreased clinical opportunities for laceration repair, and simulation may be a modality to fill that clinical gap. There is a therefore a need for objective measures of pediatric resident competence in laceration repair.
METHODS
We created a global rating scale and checklist to assess laceration repair in the pediatric emergency department. We adapted the global rating scale from the Objective Structured Assessment of Technical Skills tool used to evaluate surgical residents' technical skills and adapted the checklist from a mastery training checklist related to infant lumbar puncture. We tested both tools in the pediatric emergency department. Eight supervising physicians used the tools to evaluate 30 residents' technical skills in laceration repair. We performed validation testing of both tools in the simulation environment. Based on formal evaluation, we developed a video to train future evaluators on the use of the global rating scale.
RESULTS
The global rating scale and checklist showed fair concordance across reviewers. Both tools received positive feedback from supervising physicians who used them.
DISCUSSION
We found that the global rating scale and checklist are more applicable to formative, rather than summative, training for resident laceration repair. We recommend using these educational tools with trainees in the simulation environment prior to trainees performing laceration repairs on actual patients.
Topics: Checklist; Child; Clinical Competence; Education, Medical, Graduate; Emergency Service, Hospital; Humans; Infant; Internship and Residency; Lacerations; Organization and Administration; Pediatrics; Simulation Training; Spinal Puncture; Teacher Training; Video Recording
PubMed: 30931385
DOI: 10.15766/mep_2374-8265.10806 -
American Journal of Obstetrics and... Nov 2020Obstetrical perineal and anal sphincter lacerations can be associated with considerable sequelae. The diagnosis of short-term bowel, bladder, and healing problems can be...
Obstetrical perineal and anal sphincter lacerations can be associated with considerable sequelae. The diagnosis of short-term bowel, bladder, and healing problems can be delayed if patients are not seen until the traditional postpartum visit at 4 to 6 weeks. Specialized peripartum clinics create a unique opportunity to collaborate with obstetrical specialists to provide early, individualized care for patients experiencing a variety of pelvic floor issues during pregnancy and in the postpartum period. Although implementation of these clinics requires thoughtful planning and partnering with care providers at all levels in the obstetrics care system, many of the necessary resources are available in routine gynecologic practice. Using a multidisciplinary approach with pelvic floor physical therapists, nurses, advanced practice providers, and other specialists is important for the success of this service line and enhances the level of care provided. Overall, these clinics provide a structured means by which pregnant and postpartum women with pelvic floor symptoms can receive specialized counseling and treatment.
Topics: Anal Canal; Delivery, Obstetric; Dyspareunia; Fecal Incontinence; Female; Humans; Lacerations; Obstetrics; Patient Care Team; Pelvic Floor; Pelvic Floor Disorders; Pelvic Organ Prolapse; Pelvic Pain; Perineum; Peripartum Period; Physical Therapy Modalities; Postnatal Care; Pregnancy; Prenatal Care; Referral and Consultation; Urinary Incontinence
PubMed: 32888923
DOI: 10.1016/j.ajog.2020.08.015 -
Hand (New York, N.Y.) Sep 2022The effect of obliquity of tendon laceration on repair strength is not well studied. The overwhelming majority of biomechanical studies assess repair strength following...
BACKGROUND
The effect of obliquity of tendon laceration on repair strength is not well studied. The overwhelming majority of biomechanical studies assess repair strength following a laceration that is perpendicular to the long axis of the tendon. The aim of this study was to investigate whether the angle of tendon laceration affects the core suture strength.
METHODS
In all, 110 fresh human cadaveric flexor tendons were cut at varying angles of 15°, 30°, 45°, and 60° and the control group at 90°. All tendons were repaired with 6-strand modified Tang technique. The repair strength was tested using a custom-made tensioning machine, and the initial static gap force and the ultimate breaking force were measured.
RESULTS
The mean gap force and 95% confidence interval (CI) for the 15°, 30°, 45°, 60°, and 90° groups were 15.2 N (11.4-19.0 N), 15.8 N (13.6-18.1 N), 15.6 N (13.1-18.4 N), 16.6 N (13.7-19.5 N), and 22.3 N (16.6-27.9 N), respectively. In the same respective order, the break force and 95% CI were 25.9 N (21.9-29.8 N), 26.5 N (23.2-29.7 N), 31.1 N (26.1-36.1 N), 35.6 N (28.2-43.1 N), and 51.8 N (62.5-41.0), respectively. The Fisher least significant difference demonstrated significant differences between the control group and all experimental groups for both gap force and break force.
CONCLUSIONS
Obliquity of tendon laceration affects the core suture strength when compared with a transverse cut. Flexor tendons cut at 90° demonstrated a higher overall gap force and breaking strength that were statistically significant when compared with all obliquely cut groups. These findings should be considered when repairing and starting postoperative therapy for obliquely cut tendons.
Topics: Humans; Lacerations; Suture Techniques; Sutures; Tendon Injuries; Tendons; Tensile Strength
PubMed: 33345618
DOI: 10.1177/1558944720974115 -
Orthopaedics & Traumatology, Surgery &... Nov 2022Lacerations comprise 5.6-33.6% of skiing/snowboarding related injuries. This study aimed to investigate the mechanism of injury and the location of these lacerations and...
OBJECTIVES
Lacerations comprise 5.6-33.6% of skiing/snowboarding related injuries. This study aimed to investigate the mechanism of injury and the location of these lacerations and propose preventive measures.
METHODS
After our state ethics committee approval, we retrospectively reviewed the medical records and surgical protocols of 46 patients (mean age (±SD) 34.6 (±15.3); 71.4% men) treated for severe skiing/snowboarding lacerations at our level-1 trauma centre between 2016 and 2021. Patients were asked to answer a questionnaire on their skiing experience, equipment used and the circumstances of the accident.
RESULTS
Lacerations around the hip, thigh, and knee accounted for 94%. The latter was the most common location (45%). Although 91.3% of patients wore appropriate clothing and full standard protection equipment, it did not offer any extra-resistance against skiing/snowboarding's edges. Skiers were more affected (91.3%) than snowboarders (8.7%). The most common mechanism of injury was inadvertent release of the bindings (52.2%), followed by insufficient ski level for the slope (21.7%) and collisions (17.4%). Long-term trends demonstrated an increasing incidence.
CONCLUSION
Identification of body areas at risk and the mechanisms of injury were the most significant findings of this work. These data encourage the development of specific injury prevention programs as the occurrence of these lesions tended to increase over the last few years. To reduce their incidence, we propose skiers to have their bindings regularly adjusted and manufacturers to develop cut-resistant skiwear.
LEVEL OF EVIDENCE
IV.
Topics: Male; Humans; Female; Skiing; Trauma Centers; Cross-Sectional Studies; Retrospective Studies; Seasons; Lacerations; Switzerland; Incidence; Athletic Injuries
PubMed: 35868488
DOI: 10.1016/j.otsr.2022.103370 -
JACC. Clinical Electrophysiology Feb 2021
Topics: Catheter Ablation; Coronary Vessels; Humans; Lacerations; Tachycardia, Ventricular
PubMed: 33602412
DOI: 10.1016/j.jacep.2020.11.011