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International Wound Journal Oct 2020Active involvement of patients in planning, conducting, and disseminating research has been adopted by many organisations internationally, but the extent to which this... (Review)
Review
Active involvement of patients in planning, conducting, and disseminating research has been adopted by many organisations internationally, but the extent to which this occurs in surgical wound care is not evident. This scoping review aimed to identify how patients have been involved in surgical wound care research and the quality of its reporting. Full-text studies focused on preoperative and postoperative surgical wound care in the acute care setting, published in English between 2004 and 2019, were included in the review. Screening, data charting, and quality assessment were conducted by two reviewers independently, adjudicated by a third, and then reviewed by five others. Thematic analysis synthesised the findings. Of the eight included studies, seven explained the methods for patient involvement and five described aims related to patient involvement and commented on patient involvement in the discussion. None met all of the quality assessment criteria. Three themes emerged: involvement in modifying and refining research processes, connecting and balancing expert and patient views, and sharing personal insights. Recommendations to improve patient involvement in surgical wounds research include the following: using framework and tools to inform future research; training researcher and patients in their respective research roles; and ongoing monitoring of patient involvement.
Topics: Critical Care; Humans; Patient Participation; Surgical Wound
PubMed: 32537915
DOI: 10.1111/iwj.13395 -
Journal of Visualized Experiments : JoVE Aug 2020The murine excisional wound model has been used extensively to study each of the sequentially overlapping phases of wound healing: inflammation, proliferation and...
The murine excisional wound model has been used extensively to study each of the sequentially overlapping phases of wound healing: inflammation, proliferation and remodeling. Murine wounds have a histologically well-defined and easily recognizable wound bed over which these different phases of the healing process are measurable. Within the field, it is common to use an arbitrarily defined "middle" of the wound for histological analyses. However, wounds are a three-dimensional entity and often not histologically symmetrical, supporting the need for a well-defined and robust method of quantification to detect morphometric defects with a small effect size. In this protocol, we describe the procedure for creating bilateral, full-thickness excisional wounds in mice as well as a detailed instruction on how to measure morphometric parameters using an image processing program on select serial sections. The two-dimension measurements of wound length, epidermal length, epidermal area, and wound area are used in combination with the known distance between sections to extrapolate the three-dimension epidermal area covering the wound, overall wound area, epidermal volume and wound volume. Although this detailed histological analysis is more time and resource consuming than conventional analyses, its rigor increases the likelihood of detecting novel phenotypes in an inherently complex wound healing process.
Topics: Animals; Disease Models, Animal; Epidermis; Inflammation; Mice; Surgical Wound; Wound Healing
PubMed: 32894272
DOI: 10.3791/61616 -
Current Opinion in Anaesthesiology Jun 2023Cesarean section is the most frequent surgical intervention, and pain following cesarean delivery unfortunately remains a common issue. The purpose of this article is to... (Review)
Review
PURPOSE OF REVIEW
Cesarean section is the most frequent surgical intervention, and pain following cesarean delivery unfortunately remains a common issue. The purpose of this article is to highlight the most effective and efficient options for postcesarean analgesia and to summarize current guidelines.
RECENT FINDINGS
The most effective form of postoperative analgesia is through neuraxial morphine. With adequate dosing, clinically relevant respiratory depression is extremely rare. It is important to identify women with increased risk of respiratory depression, as they might require more intensive postoperative monitoring. If neuraxial morphine cannot be used, abdominal wall block or surgical wound infiltration are very valuable alternatives. A multimodal regimen with intraoperative intravenous dexamethasone, fixed doses of paracetamol/acetaminophen, and nonsteroidal anti-inflammatory drugs reduce postcesarean opioid use. As the use of postoperative lumbar epidural analgesia impairs mobilization, double epidural catheters with lower thoracic epidural analgesia are a possible alternative.
SUMMARY
Adequate analgesia following cesarean delivery is still underused. Simple measures, such as multimodal analgesia regimens should be standardized according to institutional circumstances and defined as part of a treatment plan. Neuraxial morphine should be used whenever possible. If it cannot be used, abdominal wall blocks or surgical wound infiltration are good alternatives.
Topics: Female; Pregnancy; Humans; Analgesics, Opioid; Pain, Postoperative; Cesarean Section; Surgical Wound; Analgesia; Morphine; Acetaminophen; Respiratory Insufficiency; Analgesia, Epidural
PubMed: 36994740
DOI: 10.1097/ACO.0000000000001259 -
International Journal of Surgery... Dec 2023Since the advent of conventional multiport laparoscopic surgery, the prosperity of minimally invasive surgery has been thriving on the advancement of endoscopic... (Review)
Review
Since the advent of conventional multiport laparoscopic surgery, the prosperity of minimally invasive surgery has been thriving on the advancement of endoscopic techniques. Cosmetic superiority, recovery benefits, and noninferior surgical outcomes weigh single-incision laparoscopic surgery as a promising modality. Although there are surgical challenges posed by steep learning curve and technological difficulties, such as instruments collision, triangulation loss and limited retraction, the establishment of robotic surgical platform as a solution to all is inspiring. Furthermore, with enhanced instrument maneuverability and stability, robotic ergonomic innovations adopt the advantages of single-incision laparoscopic surgery and surmount its recognized barriers by introducing a novel combination, single-incision robotic-assisted surgery. As was gradually diffused in general surgery and other specialties, single-incision robotic-assisted surgery manifests privileges in noninferior clinical outcomes an satisfactory cosmetic effect among strictly selected patients, and has the potential of a preferable surgical option for minimally invasive surgery.
Topics: Humans; Robotic Surgical Procedures; Robotics; Laparoscopy; Minimally Invasive Surgical Procedures; Surgical Wound
PubMed: 37988410
DOI: 10.1097/JS9.0000000000000944 -
Ugeskrift For Laeger Feb 2022This narrative review presents the current evidence on the handling of abdominal surgical incisions. Before surgery, it is possible to reduce the risk of surgical site... (Review)
Review
This narrative review presents the current evidence on the handling of abdominal surgical incisions. Before surgery, it is possible to reduce the risk of surgical site complications by careful consideration of risk factors. Peroperatively, correct handling and protection of the wound edges are important. Standard dressing should be used for uncomplicated cases and can be removed the day after surgery. Complications should be carefully assessed and treated.
Topics: Bandages; Humans; Negative-Pressure Wound Therapy; Surgical Wound; Surgical Wound Infection; Wound Healing
PubMed: 35244011
DOI: No ID Found -
Indian Journal of Ophthalmology Dec 2020The procedure of small incision lenticule extraction (SMILE) was introduced in 2011, and since then there has been an increase in the number of cases undergoing this... (Review)
Review
The procedure of small incision lenticule extraction (SMILE) was introduced in 2011, and since then there has been an increase in the number of cases undergoing this procedure worldwide. The surgery has a learning curve and may be associated with problems in the intraoperative and postoperative periods. The intraoperative problems during SMILE surgery include the loss of suction, the occurrence of altered or irregular opaque bubble layer and black spots, difficulty in lenticular dissection and extraction, cap perforation, incision-related problems, and decentered ablation. Most of the postoperative problems are similar as in other laser refractive procedures, but with decreased incidence. The identification of risk factors, clinical features, and management of complications of SMILE help to obtain optimum refractive outcomes.
Topics: Corneal Stroma; Corneal Surgery, Laser; Humans; Lasers, Excimer; Microsurgery; Myopia; Surgical Wound; Visual Acuity
PubMed: 33229647
DOI: 10.4103/ijo.IJO_3258_20 -
Nutrients Nov 2021Skin tissue repair is of fundamental importance for maintaining homeostasis regulation, protection barrier, absorption, and excretion of skin tissue. Wound healing is a...
Skin tissue repair is of fundamental importance for maintaining homeostasis regulation, protection barrier, absorption, and excretion of skin tissue. Wound healing is a complicated process that can be impaired by infections and therefore have a significant economic and social impact. Simultaneously, the overuse of antibiotics has led to antimicrobial resistance and loss of their efficacy. Thus, the need for alternative antimicrobial agents is urgent. The newest approaches on wound dressings employ new therapeutic agents, such as probiotics. Probiotics alone or in tandem with nanotechnology-based techniques exhibit a broad range of benefits on surgical wounds. This systematic review aims to consider current knowledge of probiotic effects on animals and humans regarding surgical wound healing and provide new insights into the role of nanotechnology. The databases included were PubMed (MEDLINE), Scopus, and Cochrane Library (CENTRAL). Studies focused on burns, chronic wounds, and diabetic ulcers were excluded. The promising industry of probiotics demonstrates a significant upsurge as more and more healthy individuals rely their well-being on alternative medicine. Included probiotics illustrated positive results on wound re-epithelization, neovascularization, and wound healing. No adverse effects were noted.
Topics: Animals; Anti-Infective Agents; Humans; Nanotechnology; Probiotics; Surgical Wound; Surgical Wound Infection; Wound Healing
PubMed: 34959817
DOI: 10.3390/nu13124265 -
The Journal of Arthroplasty Jan 2019Persistent wound drainage after total joint arthroplasty (TJA) is an important complication with potential substantial adverse consequences, in particular periprosthetic... (Review)
Review
BACKGROUND
Persistent wound drainage after total joint arthroplasty (TJA) is an important complication with potential substantial adverse consequences, in particular periprosthetic joint infection.
METHODS
This review evaluated the available literature regarding several issues in the field of persistent wound drainage after TJA and offers a classification of persistent wound drainage and an algorithmic approach to the decision-making process.
RESULTS
Available literature addressing the diagnosis and treatment of persistent wound drainage after TJA is scarce and an evidence-based clinical guideline is lacking. This is partially caused by the absence of a universally accepted definition of persistent wound drainage. In patients with persistent wound drainage, clinical signs and serological tests can be helpful in the diagnosis of a developing infection. Regarding the treatment of persistent wound drainage, nonsurgical treatment consists of absorbent dressings, pressure bandages, and temporary joint immobilization. Surgical treatment is advised when wound drainage persists for more than 5-7 days and consists of open debridement with irrigation and exchange of modular components and antimicrobial treatment.
CONCLUSION
Based on this literature review, we proposed a classification and algorithmic approach for the management of patients with persistent wound drainage after TJA. Hopefully, this offers the orthopedic surgeon a practical clinical guideline by finding the right balance between overtreatment and undertreatment, weighing the risks and benefits. However, this classification and algorithmic approach should first be evaluated in a prospective trial.
Topics: Algorithms; Arthroplasty, Replacement; Body Fluids; Humans; Prosthesis-Related Infections; Surgical Wound; Surgical Wound Infection; Time Factors
PubMed: 30245124
DOI: 10.1016/j.arth.2018.08.034 -
CMAJ : Canadian Medical Association... Feb 2018
Topics: Adult; Cesarean Section; Cesarean Section, Repeat; Female; Humans; Hysterectomy; Magnetic Resonance Imaging; Placenta Accreta; Pregnancy; Pregnancy Trimester, Second; Surgical Wound; Ultrasonography, Prenatal
PubMed: 29440338
DOI: 10.1503/cmaj.171411 -
The Laryngoscope Mar 2018Smoking impairs wound healing, yet the underlying pathophysiological mechanisms are unclear. We evaluated tobacco-altered healing in head and neck surgery by studying...
OBJECTIVE
Smoking impairs wound healing, yet the underlying pathophysiological mechanisms are unclear. We evaluated tobacco-altered healing in head and neck surgery by studying the association between biomarkers and tobacco exposure, as well as cutaneous perfusion by smoking status.
STUDY DESIGN
Prospective cohort study, tertiary/academic care center, 2011 to present.
METHODS
Patients who required head and neck surgery were enrolled prospectively. Postsurgical drain fluid was collected 24 hours postoperatively. Biomarkers associated with postulated mechanisms of smoking-impaired healing were assayed. These included interleukin-1, -6, and -8; tumor necrosis factor- alpha; transforming growth factor-beta; epidermal growth factor (EGF); basic fibroblastic growth factor (bFGF); C-reactive protein; vascular endothelial growth factor; soluble FMS-like tyrosine kinase-1 (sFLT-1); and placental growth factor. Tobacco exposure and clinical outcomes were recorded. Two sample two-sided t tests evaluated the differences in cytokine levels by tobacco exposure. In a second cohort, cutaneous vascular assessment via indocyanine green angiography was compared by smoking status.
RESULTS
Twenty-eight patients were enrolled with drain fluid collection. Twenty-one subjects were current/former smokers, whereas seven were never smokers. EGF was higher in never smokers than smokers in a statistically significant manner (P = 0.030). Likewise, sFLT-1 was significantly higher in never smokers (P = 0.011). Cutaneous angiography revealed nonsmokers to have significantly higher cutaneous perfusion than smokers.
CONCLUSION
In this head and neck surgical cohort, significantly higher EGF and sFLT-1 levels in wound fluid were associated with never smoking, suggesting that smoking has adverse effects on the inflammatory phase of wound healing. Cutaneous angiography supports the detrimental effect of smoking on skin perfusion. These findings suggest the need for further study as well as therapeutic targets for smokers undergoing surgery.
LEVEL OF EVIDENCE
2b. Laryngoscope, 128:618-625, 2018.
Topics: Adult; Aged; Aged, 80 and over; C-Reactive Protein; Cytokines; Female; Head; Humans; Male; Middle Aged; Neck; Prospective Studies; Smoking; Surgical Wound; Treatment Outcome; Vascular Endothelial Growth Factor Receptor-1; Vascular Endothelial Growth Factors; Wound Healing
PubMed: 28940252
DOI: 10.1002/lary.26813