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The Pan African Medical Journal 2020episiotomy induced inflammatory signs like redness, edema, ecchymosis and pain may remain beyond the period of hospitalization and can be objectively measured using...
Episiotomy related morbidities measured using redness, edema, ecchymosis, discharge and apposition scale and numerical pain scale among primiparous women in Mulago National Referral Hospital, Kampala, Uganda.
INTRODUCTION
episiotomy induced inflammatory signs like redness, edema, ecchymosis and pain may remain beyond the period of hospitalization and can be objectively measured using redness, edema, ecchymosis, discharge and apposition (REEDA) scale. Pain in the postpartum period is a common problem and can be measured using the numerical pain scale (NPS). Episiotomy is normally poorly executed and poorly repaired with little attention to the subtle pain-free scar. Postpartum perineal pain has been found to affect more people with episiotomy compared to spontaneous perineal tears or contusion in the first two weeks. This study was aimed at comparing NPS and REEDA scores in the first two weeks of postpartum among primiparous parturients with or without episiotomy in Mulago National Referral Hospital.
METHODS
a prospective cohort study conducted by recruiting primiparous women systematically on the first postnatal day and categorizing them into episiotomy and no episiotomy group. NPS and REEDA scale were taken at baseline and 2 weeks postpartum.
RESULTS
the mean total REEDA score for primiparous women among the episiotomy group was significantly higher both on day 1 and day 14 with p-values <0.0001 and <0.0001 respectively as well as the day 14 mean NPS p-value 0.001.
CONCLUSION
episiotomy, a traumatic obstetric procedure, that heals slowly and with persistent perineal pain compare to spontaneous perineal contusion or tears.
Topics: Adolescent; Cohort Studies; Ecchymosis; Edema; Episiotomy; Erythema; Female; Humans; Pain Measurement; Pain, Postoperative; Postpartum Period; Pregnancy; Prospective Studies; Uganda; Young Adult
PubMed: 33224413
DOI: 10.11604/pamj.2020.36.347.25049 -
Plastic and Reconstructive Surgery.... Sep 2023This practical review critically evaluates the evidence behind the widespread use of postoperative compression therapy intended to improve surgical outcomes, such as... (Review)
Review
This practical review critically evaluates the evidence behind the widespread use of postoperative compression therapy intended to improve surgical outcomes, such as reduced edema, ecchymosis, pain, and seroma formation. A literature search of PubMed was conducted to identify relevant studies concerning the use of compression garments after aesthetic surgery, including rhinoplasty, facelift, neck lift, mammoplasty, abdominoplasty, limb contouring, and others. Additionally, reconstructive and therapeutic procedures closely related in anatomy or technique to these cosmetic operations, such as breast reconstruction, mastectomy, and hernia repair, were also considered to provide further perspective. After study extraction, the volume, quality, and agreement of the evidence found was highly heterogenous depending on the context of specific operations and outcomes evaluated. The most well-supported indications for the use of postoperative compression garments are to mitigate edema and ecchymosis after rhinoplasty and to reduce postoperative pain after breast and abdominal procedures, although no effect on seroma rate was demonstrated. Any potential benefit must be balanced against the associated costs and possible complications of compression, including patient discomfort, increased venous stasis, and skin defects. Thus, we encourage surgeons to critically reassess their use of compression garments. In many settings, such as brachioplasty, there is limited high-quality evidence to inform best practice, and we urge the community to continue researching this important topic so that more definitive and comprehensive guidelines may be established.
PubMed: 37753333
DOI: 10.1097/GOX.0000000000005293 -
JAMA Facial Plastic Surgery Mar 2019Periorbital ecchymosis and edema are commonly associated with rhinoplasty and are the principal limiting factors for return to daily activities after rhinoplasty.... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Periorbital ecchymosis and edema are commonly associated with rhinoplasty and are the principal limiting factors for return to daily activities after rhinoplasty. Several methods have been evaluated to minimize these sequelae including creation of subperiosteal tunnels, which involves elevating the vascular periosteal layer, preserving it from trauma when creating osteotomies.
OBJECTIVE
To assess the efficacy of the creation of subperiosteal tunnels prior to lateral osteotomies during rhinoplasty for reducing postoperative ecchymosis and edema.
DESIGN, SETTING, AND PARTICIPANTS
A randomized, blinded, matched-paired, prospective, clinical trial took place between April 1 and August 30, 2015, in a private practice in a stand-alone clinic and surgical center. All patients who were undergoing aesthetic rhinoplasty requiring bilateral lateral osteotomies were offered inclusion in the trial. All 34 enrolled patients completed the follow-up requirements.
INTERVENTION
Creation of subperiosteal tunnels prior to lateral osteotomies on 1 randomly selected side.
MAIN OUTCOMES AND MEASURES
Three blinded evaluators independently graded the degree of ecchymosis and edema on a visual analog scale of 0 to 10 on each side of the nose on postoperative days 2 and 7. Each patient had 1 side that was randomly selected to undergo creation of subperiosteal tunnels. A difference in mean score between sides of the nose was calculated for each patient using a paired t test.
RESULTS
Of the 34 patients (28 females and 6 males; mean [SD] age, 27.3 [9.2]), the mean (SD) difference in ecchymosis scores between sides on day 2 was -0.05 (1.94) (95% CI, -0.43 to 0.33) and on day 7 was -0.22 (1.23) (95% CI, -0.47 to 0.02), favoring the side without tunnels. The mean (SD) difference in edema scores on day 2 was -0.21 (1.66) (95% CI, 0.53-0.12) and on day 7 was -0.29 (1.11) (95% CI, -0.51 to -0.07). There were no clinically significant differences between sides in terms of postoperative ecchymosis and edema.
CONCLUSIONS AND RELEVANCE
Ecchymosis and edema can have significant postoperative practical, emotional, and financial effects on patients. Creation of subperiosteal tunnels prior to lateral osteotomies showed no clinically significant differences in edema and ecchymosis after the procedure.
LEVEL OF EVIDENCE
1.
TRIAL REGISTRATION
isrctn.org Identifier: ISRCTN42741475.
Topics: Adult; Ecchymosis; Edema; Female; Humans; Male; Osteotomy; Postoperative Complications; Prospective Studies; Rhinoplasty
PubMed: 30589927
DOI: 10.1001/jamafacial.2018.1716 -
Indian Journal of Psychiatry Apr 2013Psychogenic purpura, also known as Gardner-Diamond syndrome, is a rare, distinctive, localized cutaneous reaction pattern mostly affecting psychologically disturbed...
Psychogenic purpura, also known as Gardner-Diamond syndrome, is a rare, distinctive, localized cutaneous reaction pattern mostly affecting psychologically disturbed adult women. Repeated crops of tender, ill-defined ecchymotic lesions on the extremities and external bleeding from other sites characterize the condition. We report here a case of psychogenic purpura because of the rarity of the condition and to emphasize the importance of consideration of this entity during evaluation of a patient with recurrent ecchymoses. Early diagnosis of this condition will not only minimize the cost of the medical evaluation but will also benefit the patient.
PubMed: 23825859
DOI: 10.4103/0019-5545.111463 -
Plastic and Reconstructive Surgery.... Jul 2023Postrhinoplasty periorbital ecchymosis is an inevitable side effect contributing to patients' psychological aspect and early postoperative morbidity. Efforts are...
UNLABELLED
Postrhinoplasty periorbital ecchymosis is an inevitable side effect contributing to patients' psychological aspect and early postoperative morbidity. Efforts are constantly being made to reduce ecchymosis using different methods with varying success. To evaluate treatment response, it is mandatory to have a reliable score. Several studies suggest other scoring systems, but none has been postrhinoplasty-specific, validated, and accepted. This study aimed to demonstrate the natural history of postrhinoplasty ecchymosis, find potential risk factors for worsening patterns, and suggest a useful and reliable periorbital ecchymosis scoring system for postrhinoplasty follow-up.
METHODS
This prospective study included 183 patients who underwent closed rhinoplasty by the same surgeon and the same principle method. Photographs of the periorbital ecchymosis were taken on postoperative days 1, 2, and 7. The periorbital area was divided into quarters, and three independent physicians assigned the dominant color of each quarter.
RESULTS
There were no significant variations between the three physicians' scoring. The interobserver consistency defined as an excellent scoring system reliability, according to our statistical analysis. The postoperative ecchymosis demonstrated a consistent pattern of spread over time, dominating the medial quarters on early postoperative days 1 and 2, following into the lower lateral quarters in postoperative day 7. We found no correlation between patient demographics and clinical characteristics to ecchymosis patterns and temporal spread.
CONCLUSIONS
Our study suggests a reliable and easy-to-use postrhinoplasty ecchymosis scoring system. This scoring method can be used for postrhinoplasty ecchymosis assessment and as a research-validated tool to quantify different perioperative treatments to reduce ecchymosis and estimate mid-face trauma.
PubMed: 37448765
DOI: 10.1097/GOX.0000000000005112 -
The Pan African Medical Journal 2017
PubMed: 29881496
DOI: 10.11604/pamj.2017.28.252.14366 -
Frontiers in Surgery 2022Ecchymosis is one of the worrisome complications after total knee arthroplasty (TKA) and interferes with functional rehabilitation. Current clinical guidelines do not...
BACKGROUND
Ecchymosis is one of the worrisome complications after total knee arthroplasty (TKA) and interferes with functional rehabilitation. Current clinical guidelines do not provide individualized approaches for patients with ecchymoses.
METHODS
In this study, we used thromboelastography (TEG) to determine the coagulation state after TKA and to then explore markers that predict the occurrence of ecchymosis events after TKA. In our cohort, patients were divided into ecchymosis ( = 55) and non-ecchymosis ( = 137) groups according to whether ecchymosis events occurred after TKA. Rivaroxaban 10 mg/d was taken orally for thromboprophylaxis after surgery. All patients completed TEG testing. Correlation analysis was used to determine the risk factors for ecchymosis after TKA, and receiver operating characteristic (ROC) curves for variables with significant correlation were plotted.
RESULTS
In all, 55 of the 192 patients (28.65%) developed ecchymosis surrounding the surgical site. Multivariate analysis showed that hidden blood loss (OR = 1.003 and = 0.005) and changes in the coagulation index (ΔCI) values (OR = 0.351 and = 0.001) were risk factors for ecchymosis after TKA. Using the Youden index, 0.1805 was determined as the optimal threshold value of ΔCI for predicting the occurrence of ecchymosis, with a sensitivity of 74.55% and specificity of 72.99%. ΔCI is a promising marker as an alarm for the occurrence of ecchymosis after TKA.
TRIAL REGISTRATION
The study was registered in the Chinese Clinical Trial Registry (ChiCTR1800017245). Registered name: The role of thrombelastography in monitoring the changes of coagulation function during perioperative period of arthroplasty. Registered 19 July 2018. http://www.chictr.org.cn/showproj.aspx?proj=29220.
PubMed: 35495763
DOI: 10.3389/fsurg.2022.871776 -
Indian Journal of Otolaryngology and... Dec 2022In this study we aimed to compare external lateral osteotomy technique vs. internal one in the rhinoplasty. In this before-after clinical trial study 30 patients who...
In this study we aimed to compare external lateral osteotomy technique vs. internal one in the rhinoplasty. In this before-after clinical trial study 30 patients who were candidates for rhinoplasty involved. In each patient, external lateral osteotomy was performed on one side and internal lateral osteotomy was performed on the other side randomly. Information, including patients' age, sex, grade of edema and ecchymosis 1, 3, and 7 days after the surgery, and the type of lateral osteotomy, the amount of step deformity, the need for the specialist intervention, nasal bone mobility, and flail nasal bone was recorded and analyzed. The incidence of edema and ecchymosis on the first and the third day was statistically lower in the external method ( value < 0.001). Although the incidence of edema and ecchymosis on the seventh day was lower in the external method, it was not statistically significant ( value > 0.05). Forty seven percent of patients in the internal method and 36% of patients in the external method had step deformity ( value < 0.001). Fifty percent of patients in the internal method and 41% of patients in the external method needed the specialist intervention ( value > 0.05). Seventy four of patients in the internal method and 83% of patients in the external method had nasal bone mobility ( value > 0.05). Out of 30 patients, only one had flail nasal bone. Based on our findings, the external technique is suggested as a more effective and convenient method with less complications for inexperienced surgeons.
PubMed: 36742672
DOI: 10.1007/s12070-021-02777-5 -
Cureus Aug 2020Periorbital ecchymosis and edema are common after septorhinoplasty surgery. This study aimed to compare internal and external lateral nasal osteotomies performed in...
OBJECTIVE
Periorbital ecchymosis and edema are common after septorhinoplasty surgery. This study aimed to compare internal and external lateral nasal osteotomies performed in septorhinoplasty in terms of postoperative ecchymosis and edema.
METHODS
Patients who underwent septorhinoplasty between January 2020 and July 2020 in our clinic were included in the study. In all patients, right lateral nasal osteotomies were performed endonasally and left lateral nasal osteotomies externally. The postoperative 1st, 7th, and 14th day ecchymosis and edema scores of all patients were calculated separately for the two groups and compared.
RESULTS
A total of 60 patients (29 females, 31 males) were included in the study. The mean age of the patients was 33.88 ± 10.30 years. No significant difference was observed between the two groups in terms of the postoperative periorbital ecchymosis scores on the first day and the first and second weeks (0.314, 0.344, and 0.468, respectively). There was also no significant difference between the two groups in terms of the postoperative periorbital edema scores on the first day and at the first and second weeks (0.272, 0.359, and 0.513, respectively).
CONCLUSION
The results obtained from this study showed no significant difference in the periorbital ecchymosis and edema scores between the patients who had undergone septorhinoplasty with internal or external lateral osteotomies. Further multicenter studies are recommended to verify the findings of this study with a larger sample size.
PubMed: 32923211
DOI: 10.7759/cureus.9609