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International Wound Journal Sep 2016Autologous skin grafts, such as full- and split-thickness, have long been part of the reconstructive ladder as an option to close skin defects. Although they are... (Review)
Review
Autologous skin grafts, such as full- and split-thickness, have long been part of the reconstructive ladder as an option to close skin defects. Although they are effective in providing coverage, they require the need for a trained surgeon, use of anaesthesia and operating room and creation of a wound at the donor site. These drawbacks can be overcome with the use of epidermal skin grafts (ESGs), which can be harvested without the use of anaesthesia in an office setting and with minimal to no scarring at the donor site. ESGs consist only of the epidermal layer and have emerged as an appealing alternative to other autologous grafts for the treatment of acute and chronic wounds. In this article, we provide an overview of epidermal grafting and its role in wound management.
Topics: Autografts; Epidermis; Humans; Plastic Surgery Procedures; Skin Transplantation; Wound Healing; Wounds and Injuries
PubMed: 27547964
DOI: 10.1111/iwj.12631 -
Advances in Physiology Education Dec 2003Contractions of skeletal muscles provide the stability and power for all body movements. Consequently, any impairment in skeletal muscle function results in some degree... (Review)
Review
Contractions of skeletal muscles provide the stability and power for all body movements. Consequently, any impairment in skeletal muscle function results in some degree of instability or immobility. Factors that influence skeletal muscle structure and function are therefore of great interest both scientifically and clinically. Injury, disease, and old age are among the factors that commonly contribute to impairment in skeletal muscle function. The goal of this article is to update current concepts of skeletal muscle physiology. Particular emphasis is placed on mechanisms of injury, repair, and adaptation in skeletal muscle as well as mechanisms underlying the declining skeletal muscle structure and function associated with aging. For additional materials please refer to the "Skeletal Muscle Physiology" presentation located on the American Physiological Society Archive of Teaching Resources Web site (http://www.apsarchive.org).
Topics: Aging; Humans; Models, Biological; Muscle Contraction; Muscle, Skeletal; Muscular Diseases; Physiology; Teaching; Wounds and Injuries
PubMed: 14627615
DOI: 10.1152/advan.2003.27.4.171 -
Emergency Medicine Clinics of North... Feb 2018Airway management in the trauma patient presents numerous unique challenges beyond placement of an endotracheal tube and outcomes are dependent on the provider's ability... (Review)
Review
Airway management in the trauma patient presents numerous unique challenges beyond placement of an endotracheal tube and outcomes are dependent on the provider's ability to anticipate difficulty. Airway management strategies for the care of the polytrauma patient are reviewed, with specific considerations for those presenting with traumatic brain injury, suspected c-spine injury, the contaminated airway, the agitated trauma patient, maxillofacial trauma, and the traumatized airway. An approach to airway management that considers the potential anatomic and physiologic challenges in caring for these complicated trauma patients is presented.
Topics: Airway Management; Airway Obstruction; Craniocerebral Trauma; Humans; Intubation, Intratracheal; Wounds and Injuries
PubMed: 29132582
DOI: 10.1016/j.emc.2017.08.006 -
Journal of Wound Care May 2016Surgical site infections (SSI) are serious complications that can lead to adverse patient outcomes such as prolonged hospital length of stay, increased health-care... (Review)
Review
OBJECTIVE
Surgical site infections (SSI) are serious complications that can lead to adverse patient outcomes such as prolonged hospital length of stay, increased health-care costs, and even death. There is an imperative worldwide to reduce the morbidity associated with SSIs. The importance of surgical wound assessment and documentation to reduce SSI complications is increasingly recognised. Evidence-based guidelines have been published internationally to highlight recommended practices. The aim of this integrated review is to evaluate current surgical wound assessment and documentation practices of nurses in order to inform future evidence-based research on acute wound care practices.
METHOD
Databases including CINAHL, Cochrane, Medline and Proquest Nursing were searched using key terms of 'wound assessment' AND 'surgical, wound assessment' AND 'documentation, wound assessment' AND 'practice, wound assessment' AND 'postoperative, wound assessment' AND 'nurse, and wound assessment' AND 'surgical site infection'.
RESULTS
A total of 188 articles were identified from the database searches; searching the reference lists provided an additional 8 articles. After careful exclusion processes, a total of six papers were included in the review. Despite the recommendations around wound assessment, there is little discussion on how the clinical characteristics of surgical wounds should be assessed, the frequency of the wound assessments and to what extent wound assessments are documented in the literature.
CONCLUSION
There is limited research evidence on acute wound assessment and documentation. Therefore, further research is needed to provide evidence for surgical nurses in relation to wound assessment and documentation practices.
DECLARATION OF INTEREST
The authors declare that they have no conflict of interest.
Topics: Documentation; Humans; Postoperative Care; Surgical Wound Infection; Wound Healing; Wounds and Injuries
PubMed: 27169338
DOI: 10.12968/jowc.2016.25.5.232 -
Lymphatic Research and Biology Apr 2019Australia was one of nine participating countries in the epidemiology Phase II Lymphoedema Impact and Prevalence - International (LIMPRINT) project to determine the...
Australia was one of nine participating countries in the epidemiology Phase II Lymphoedema Impact and Prevalence - International (LIMPRINT) project to determine the number of people with chronic edema (CO) in local health services. Data collection occurred through questionnaire-based interviews and clinical assessment with provided LIMPRINT tools. Four different types of services across three states in Australia participated. A total of 222 adults participated with an age range from 22 to 102 years, and 60% were female. Site 1 included three residential care facilities (54% of participants had swelling), site 2 was community-delivered aged care services (24% of participants had swelling), site 3 was a hospital setting (facility-based prevalence study; 28% of participants had swelling), and site 4 was a wound treatment center (specific patient population; 100% of participants had swelling). Of those with CO or secondary lymphedema, 93% were not related to cancer, the lower limbs were affected in 51% of cases, and 18% of participants with swelling reported one or more episodes of cellulitis in the previous year. Wounds were identified in 47% ( = 105) of all participants with more than half of those with wounds coming from the dedicated wound clinic. Leg/foot ulcer was the most common type of wound (65%, = 68). Distances between services, lack of specialized services, and various state funding models contribute to inequities in CO treatment. Understanding the high number of noncancer-related CO presentations will assist health services to provide timely effective care and improve referral pathways.
Topics: Adult; Aged; Aged, 80 and over; Australia; Cellulitis; Chronic Disease; Community Health Centers; Diagnosis, Differential; Edema; Female; Healthcare Disparities; Humans; Leg Ulcer; Lymphatic System; Lymphedema; Male; Middle Aged; Prevalence; Residential Facilities; Risk Factors; Surveys and Questionnaires; Wounds and Injuries
PubMed: 30995183
DOI: 10.1089/lrb.2018.0087 -
International Wound Journal Feb 2017Reactive oxygen species (ROS) play a pivotal role in the orchestration of the normal wound-healing response. They act as secondary messengers to many immunocytes and...
Reactive oxygen species (ROS) play a pivotal role in the orchestration of the normal wound-healing response. They act as secondary messengers to many immunocytes and non-lymphoid cells, which are involved in the repair process, and appear to be important in coordinating the recruitment of lymphoid cells to the wound site and effective tissue repair. ROS also possess the ability to regulate the formation of blood vessels (angiogenesis) at the wound site and the optimal perfusion of blood into the wound-healing area. ROS act in the host's defence through phagocytes that induce an ROS burst onto the pathogens present in wounds, leading to their destruction, and during this period, excess ROS leakage into the surrounding environment has further bacteriostatic effects. In light of these important roles of ROS in wound healing and the continued quest for therapeutic strategies to treat wounds in general and chronic wounds, such as diabetic foot ulcers, venous and arterial leg ulcers and pressure ulcers in particular, the manipulation of ROS represents a promising avenue for improving wound-healing responses when they are stalled. This article presents a review of the evidence supporting the critical role of ROS in wound healing and infection control at the wound site, and some of the new emerging concepts associated with ROS modulation and its potential in improving wound healing are discussed.
Topics: Cell Proliferation; Humans; Reactive Oxygen Species; Wound Healing; Wound Infection; Wounds and Injuries
PubMed: 26688157
DOI: 10.1111/iwj.12557 -
Value in Health : the Journal of the... Jan 2018The aim of this study was to determine the cost of chronic wound care for Medicare beneficiaries in aggregate, by wound type and by setting.
OBJECTIVE
The aim of this study was to determine the cost of chronic wound care for Medicare beneficiaries in aggregate, by wound type and by setting.
METHODS
This retrospective analysis of the Medicare 5% Limited Data Set for calendar year 2014 included beneficiaries who experienced episodes of care for one or more of the following: arterial ulcers, chronic ulcers, diabetic foot ulcers, diabetic infections, pressure ulcers, skin disorders, skin infections, surgical wounds, surgical infections, traumatic wounds, venous ulcers, or venous infections. The main outcomes were the prevalence of each wound type, Medicare expenditure for each wound type and aggregate, and expenditure by type of service.
RESULTS
Nearly 15% of Medicare beneficiaries (8.2 million) had at least one type of wound or infection (not pneumonia). Surgical infections were the largest prevalence category (4.0%), followed by diabetic infections (3.4%). Total Medicare spending estimates for all wound types ranged from $28.1 to $96.8 billion. Including infection costs, the most expensive estimates were for surgical wounds ($11.7, $13.1, and $38.3 billion), followed by diabetic foot ulcers ($6.2, $6.9, and $18.7 billion,). The highest cost estimates in regard to site of service were for hospital outpatients ($9.9-$35.8 billion), followed by hospital inpatients ($5.0-$24.3 billion).
CONCLUSIONS
Medicare expenditures related to wound care are far greater than previously recognized, with care occurring largely in outpatient settings. The data could be used to develop more appropriate quality measures and reimbursement models, which are needed for better health outcomes and smarter spending for this growing population.
Topics: Aged; Chronic Disease; Cost-Benefit Analysis; Female; Health Policy; Humans; Male; Medicare; Retrospective Studies; United States; Wounds and Injuries
PubMed: 29304937
DOI: 10.1016/j.jval.2017.07.007 -
The British Journal of Radiology Jul 2018Major Trauma Centres and Emergency Departments are treating an increasing number of elderly trauma patients in the UK. Elderly patients, defined as those over the age of... (Review)
Review
Major Trauma Centres and Emergency Departments are treating an increasing number of elderly trauma patients in the UK. Elderly patients, defined as those over the age of 65 years, are more susceptible to injury from lesser mechanisms of trauma than younger adults. The number of elderly trauma cases is rising yearly, accounting for >25% of all major trauma nationally. The elderly have different physiological reserves and a different response to trauma due to premorbid frailty, co-existing conditions and prescribed medication. These factors need to be appreciated in trauma triaging, radiological assessment and clinical management. A lower threshold for trauma-call activation is recommended, including a lower threshold for advanced imaging. We will review general principles of trauma in the elderly, outline injury patterns in this age group and illustrate the radiological features per anatomical site, from head to pelvis and the extremities. We advocate using contrast-enhanced computed tomography as the primary diagnostic imaging modality as concern about intravenous contrast agent-induced nephropathy is relatively minor. Prompt investigation and diagnosis leads to timely appropriate treatment, therefore the radiologist can discerningly improve morbidity and mortality in this vulnerable group.
Topics: Aged; Contrast Media; Humans; Tomography, X-Ray Computed; Trauma Centers; Triage; Wounds and Injuries
PubMed: 29509505
DOI: 10.1259/bjr.20170739 -
Trends in Cell Biology Jul 2015Efficient wound healing requires the coordinated responses of various cell types within an injured tissue. To react to the presence of a wound, cells have to first... (Review)
Review
Efficient wound healing requires the coordinated responses of various cell types within an injured tissue. To react to the presence of a wound, cells have to first detect it. Judging from their initial biochemical and morphological responses, many cells including leukocytes, epithelial cells, and endothelial cells detect wounds from over hundreds of micrometers within seconds-to-minutes. Wound detection involves the conversion of an injury-induced homeostatic perturbation, such as cell lysis, an unconstrained epithelial edge, or permeability barrier breakdown, into a chemical or physical signal. The signal is spatially propagated through the tissue to synchronize protective responses of cells near the wound site and at a distance. This review summarizes the triggers and mechanisms of wound detection in animals.
Topics: Animals; Calcium; Cell Death; Chemotaxis; Endothelial Cells; Epithelial Cells; Humans; Leukocytes; Reactive Oxygen Species; Wound Healing; Wounds and Injuries
PubMed: 25813429
DOI: 10.1016/j.tcb.2015.02.007 -
African Health Sciences Jun 2018We aimed to review the biomechanics of lower limb injuries caused by frontal-impact road traffic collisions. (Review)
Review
AIM
We aimed to review the biomechanics of lower limb injuries caused by frontal-impact road traffic collisions.
METHODS
In this narrative review, we identified articles through pubmed, Scopus and Science Direct search engines for the period of 1990-2014. Search terms included: "biomechanics", "lower limb injury", "hip injury", "knee injury", "foot and ankle injury" and "frontal impact collision". We studied factors affecting the anatomical site, frequency and severity of the injuries.
RESULTS
The most common reported mechanisms of injury were: the impaction of the knee with the dashboard resulting in acetabular fracture or posterior hip dislocation; and toepan intrusion in combination with forceful application of the brake resulting in foot and ankle fractures. The probability of an occupant sustaining significant injury to the hip is increased in taller males, and being out of position during the collision. The probability of an occupant sustaining a fracture to the foot and ankle is increased in shorter female occupants with a large overlap impact or a near oblique collision.
CONCLUSION
Understanding the biomechanics of frontal-impact road traffic collisions is useful in alerting clinicians to the potential lower limb injuries sustained in these collisions.
Topics: Accidents, Traffic; Adult; Ankle Injuries; Biomechanical Phenomena; Female; Foot Injuries; Humans; Knee Injuries; Leg Injuries; Lower Extremity; Male; United Arab Emirates; Wounds and Injuries
PubMed: 30602959
DOI: 10.4314/ahs.v18i2.17