-
Canadian Family Physician Medecin de... Apr 2021A 4-year-old child presented to my office recently with a 2-cm forehead laceration. The child had needle phobia and was very upset, so suturing in the office might have...
QUESTION
A 4-year-old child presented to my office recently with a 2-cm forehead laceration. The child had needle phobia and was very upset, so suturing in the office might have been very challenging. The parents were also concerned about the use of suture. Can topical skin adhesives (TSAs) be used instead of sutures, and what factors should be considered?
ANSWER
Lacerations in children are common and TSAs are useful alternatives to sutures. They achieve comparable outcomes to suturing in appropriately selected wounds. Appropriate lacerations are small, superficial, appropriately cleaned, and have well approximated edges that are not under tension. Complications such as wound dehiscence and infection are rare and cosmetic outcomes are comparable to sutures. Using TSAs can also save time, minimize patient anxiety, and eliminate the need for suture removal.
Topics: Adhesives; Child, Preschool; Humans; Lacerations; Skin; Sutures; Tissue Adhesives
PubMed: 33853912
DOI: 10.46747/cfp.6704260 -
Wound Repair and Regeneration :... Jan 2023Wound dehiscence, oftentimes a result of the poor tensile strength of early healing wounds, is a significant threat to the post-operative patient, potentially causing...
Wound dehiscence, oftentimes a result of the poor tensile strength of early healing wounds, is a significant threat to the post-operative patient, potentially causing life-threatening complications. Vanadate, a protein tyrosine phosphatase inhibitor, has been shown to alter the organisation of deposited collagen in healing wounds and significantly improve the tensile strength of incisional wounds in rats. In this study, we sought to explore the effects of locally administered vanadate on tensile strength and collagen organisation in both the early and remodelling phases of excisional wound healing in a murine model. Wild-type mice underwent stented excisional wounding on their dorsal skin and were divided equally into three treatment conditions: vanadate injection, saline injection control and an untreated control. Tensile strength testing, in vivo suction Cutometer analysis, gross wound measurements and histologic analysis were performed during healing, immediately upon wound closure, and after 4 weeks of remodelling. We found that vanadate treatment significantly increased the tensile strength of wounds and their stiffness relative to control wounds, both immediately upon healing and into the remodelling phase. Histologic analysis revealed that these biomechanical changes were likely the result of increased collagen deposition and an altered collagen organisation composed of thicker and distinctly organised collagen bundles. Given the risk that dehiscence poses to all operative patients, vanadate presents an interesting therapeutic avenue to improve the strength of post-operative wounds and unstable chronic wounds to reduce the risk of dehiscence.
Topics: Rats; Mice; Animals; Wound Healing; Vanadates; Disease Models, Animal; Tensile Strength; Collagen; Skin; Surgical Wound
PubMed: 36484112
DOI: 10.1111/wrr.13062 -
International Wound Journal Dec 2022Total hip or knee arthroplasty is a highly effective intervention for treating the symptoms of degenerative joint disease or osteoarthritis (OA), often an unwelcome... (Clinical Trial)
Clinical Trial
A non-randomised pragmatic trial for the early detection and prevention of surgical wound complications using an advanced hydropolymer wound dressing and smartphone technology: The EDISON trial protocol.
Total hip or knee arthroplasty is a highly effective intervention for treating the symptoms of degenerative joint disease or osteoarthritis (OA), often an unwelcome consequence of obesity. A safe and common surgical procedure, hip and knee arthroplasty procedures are not immune to the occurrence of postoperative complications such as surgical site infection (SSI) or surgical wound dehiscence (SWD). While published rates of SSI following hip or knee arthroplasty are low, 1% to 2% in some cases, it is the resulting wound complication and its clinical management and the impact on patient well-being and return to daily life for the 1% to 2% that is of concern. Postoperative complications such as SSI are a major cost driver to the health care system following arthroplasty and often result in extended lengths of stay, readmission for further surgery, primary and community nursing visits, and are a costly burden to health care settings. Early identification of a wound complication through post-discharge surveillance using a fully transparent dressing and smartphone technology and patient education may ameliorate contributing factors or reduce the likelihood of a complication occurring in the first instance. This clinical trial is a non-randomised pragmatic convenience sample carried out in 200 participants of both sexes receiving either a TKA or THA. There will be equal allocation to two groups (100 hips and 100 knees), with 50 in each allocation receiving the interventional dressing and 50 as control. The dressing will be applied prior to discharge and participants will be provided with education on postoperative wound care, when to contact home care nursing for a potential wound problem, and use of their smartphone to capture and send images of their incision site to the study nurses. Participants will also be followed up by home care nursing services at day 14 for suture removal and wound assessment. Participants will complete a patient-reported outcomes survey on day 14 and followed up on day 30 after surgery for wound assessment. The results of this trial may provide a novel pathway using a fully transparent dressing and digital technologies for the prevention of acute readmissions because of wound complications through early detection and intervention.
Topics: Male; Female; Humans; Surgical Wound; Smartphone; Aftercare; Patient Discharge; Bandages; Surgical Wound Infection
PubMed: 35799456
DOI: 10.1111/iwj.13823 -
Wounds : a Compendium of Clinical... Mar 2021The high prevalence of intraoral wound dehiscence (IOWD) following open reduction internal fixation of mandibular fractures has not been well studied.
INTRODUCTION
The high prevalence of intraoral wound dehiscence (IOWD) following open reduction internal fixation of mandibular fractures has not been well studied.
OBJECTIVE
A retrospective cohort study was conducted to investigate and assess possible risk factors for IOWD related to patients and surgical technique.
METHODS
All patients who did not have diabetes, were not medically compromised such as patients with nutritional deficiencies or endocrine disorders, did not smoke, did not consume alcohol, and had mandibular fractures managed through open reduction internal fixation and via intraoral vestibular incision from January 2007 to December 2019, at Al-Azhar University Hospitals, in Cairo, Egypt were included in the study. Study data were collected and grouped according to the demographic characteristics of patient age and sex and fracture-related factors of cause, side, site, displacement severity, fixation device, infection, and history of dehiscence. Follow-up of all patients was conducted daily during the first week and weekly during the first month after surgery. Data were analyzed using cross-tabulation with Pearson chi-squared test to calculate the significance of associations between various independent variables and occurrence of IOWD; P less than or equal to .05 was viewed as statistically significant.
RESULTS
The study included 69 mandibular fracture patients (age range, 13-55 years [mean, 28.13 ± 11.5 years]) treated using different osteosynthesis fixation devices, including miniplates, lag screws, and heavy locking plates. No statistically significant differences were noted between groups in terms of age, sex, and surgical attributes of fracture site, displacement severity, or fixation type with regard to IOWD (P > .05). None of the included patients were medically compromised, smoked, or used alcohol. Intraoral wound dehiscence occurred in 7 patients (10.1%) and was managed conservatively through copious irrigation with warm saline and chlorhexidine mouthwash in intermittent cycles of 5 times a day for 2 weeks; when infection was present, antibiotic prescription and drainage were provided. Complete wound closure was achieved after a maximum period of 2 weeks.
CONCLUSIONS
A small proportion of mandibular fracture patients are expected to have IOWD complication even if a meticulous and appropriate surgical technique is implemented. Intraoral wound dehiscence has a good prognosis and it may require a maximum of 2 weeks to obtain healing with secondary epithelization of the bared bony sites.
Topics: Adolescent; Adult; Fracture Fixation, Internal; Humans; Internal Fixators; Mandibular Fractures; Middle Aged; Postoperative Complications; Retrospective Studies; Surgical Wound Infection; Treatment Outcome; Young Adult
PubMed: 33793410
DOI: No ID Found -
Wounds : a Compendium of Clinical... May 2020Unresolved wound healing represents a major health care cost with a negative impact on patient quality of life, especially among oncology patients who exhibit a delay in...
INTRODUCTION
Unresolved wound healing represents a major health care cost with a negative impact on patient quality of life, especially among oncology patients who exhibit a delay in the wound healing cascade due to chemotherapy and radiation. In order to address this problem, the author utilized negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d) to cleanse wounds of debris and help promote healing.
OBJECTIVE
The author examines the impact of NPWTi-d on multiple indicators of wound healing progress in 6 cancer patients with complex wounds and multiple comorbidities.
MATERIALS AND METHODS
The NPWTi-d was initiated with instillation of normal saline or 0.125% hypochlorite solution, which was allowed to dwell for 3 to 20 minutes, followed by 2 to 3.5 hours of -125 mm Hg continuous negative pressure. Dressing changes were performed every 2 to 3 days. Debridements, incision and drainage, and antibiotics were administered as necessary.
RESULTS
A total of 1 woman and 5 men (average age, 62 years; range, 53-78 years) presented with the following wounds: surgical dehiscence (n = 3), pressure injury (n = 1), chronic seroma (n = 1), and abdominal wall abscess (n = 1). Malignancy was not detectable in any wounds. Patient comorbidities included diabetes, hypertension, and past treatment for cancers. The NPWTi-d was applied for 1 to 2 weeks, after which the wounds exhibited a reduction in slough, an improvement in granulation tissue, and a decrease in wound volume. Wounds were closed with a flap or transitioned to conventional NPWT prior to discharge home or to a rehabilitation facility for outpatient recovery.
CONCLUSIONS
As shown in this case series, NPWTi-d was a beneficial tool for cleansing the wound bed, thus creating a moist, closed wound environment conducive to healing. Using NPWTi-d supported the formation of a healthy wound bed and contributed to rapid, positive outcomes in this patient population.
Topics: Aged; Female; Humans; Male; Middle Aged; Negative-Pressure Wound Therapy; Neoplasms; Pressure Ulcer; Surgical Wound; Therapeutic Irrigation; Wound Healing; Wounds and Injuries
PubMed: 32804665
DOI: No ID Found -
Radiologia 2021To describe the radiologic findings of extrapulmonary air in the chest and to review atypical and unusual causes of extrapulmonary air, emphasizing the importance of the... (Review)
Review
OBJECTIVE
To describe the radiologic findings of extrapulmonary air in the chest and to review atypical and unusual causes of extrapulmonary air, emphasizing the importance of the diagnosis in managing these patients.
CONCLUSION
In this article, we review a series of cases collected at our center that manifest with extrapulmonary air in the thorax, paying special attention to atypical and uncommon causes. We discuss the causes of extrapulmonary according to its location: mediastinum (spontaneous pneumomediastinum with pneumorrhachis, tracheal rupture, dehiscence of the bronchial anastomosis after lung transplantation, intramucosal esophageal dissection, Boerhaave syndrome, tracheoesophageal fistula in patients with esophageal tumors, bronchial perforation and esophagorespiratory fistula due to lymph-node rupture, and acute mediastinitis), pericardium (pneumopericardium in patients with lung tumors), cardiovascular (venous air embolism), pleura (bronchopleural fistulas, spontaneous pneumothorax in patients with malignant pleural mesotheliomas and primary lung tumors, and bilateral pneumothorax after unilateral lung biopsy), and thoracic wall (infections, transdiaphragmatic intercostal hernia, and subcutaneous emphysema after lung biopsy).
Topics: Humans; Mediastinal Emphysema; Rupture; Subcutaneous Emphysema; Thorax; Trachea
PubMed: 34246426
DOI: 10.1016/j.rxeng.2021.02.005 -
BMJ Open Feb 2022Acute abdominal wound dehiscence (AWD) or burst abdomen is a severe complication after abdominal surgery with an incidence up to 3.8%. Surgical site infection (SSI) is...
Effect of triclosan-coated sutures for abdominal wound closure on the incidence of abdominal wound dehiscence: a protocol for an individual participant data meta-analysis.
INTRODUCTION
Acute abdominal wound dehiscence (AWD) or burst abdomen is a severe complication after abdominal surgery with an incidence up to 3.8%. Surgical site infection (SSI) is the biggest risk factor for the development of AWD. It is strongly suggested that the use of triclosan-coated sutures (TCS) for wound closure reduces the risk of SSI. We hypothesise that the use of TCS for abdominal wound closure may reduce the risk of AWD. Current randomised controlled trials (RCTs) lack power to investigate this. Therefore, the purpose of this individual participant data meta-analysis is to evaluate the effect of TCS for abdominal wound closure on the incidence of AWD.
METHODS AND ANALYSIS
We will conduct a systematic review of Medline, Embase and Cochrane Central Register of Controlled Trials for RCTs investigating the effect of TCS compared with non-coated sutures for abdominal wound closure in adult participants scheduled for open abdominal surgery. Two independent reviewers will assess eligible studies for inclusion and methodological quality. Authors of eligible studies will be invited to collaborate and share individual participant data. The primary outcome will be AWD within 30 days after surgery requiring reoperation. Secondary outcomes include SSI, all-cause reoperations, length of hospital stay and all-cause mortality within 30 days after surgery. Data will be analysed with a one-step approach, followed by a two-step approach. In the one-step approach, treatment effects will be estimated as a risk ratio with corresponding 95% CI in a generalised linear mixed model framework with a log link and binomial distribution assumption. The quality of evidence will be judged using the Grading of Recommendations Assessment Development and Evaluation approach.
ETHICS AND DISSEMINATION
The medical ethics committee of the Amsterdam UMC, location AMC in the Netherlands waived the necessity for a formal approval of this study, as this research does not fall under the Medical Research involving Human Subjects Act. Collaborating investigators will deidentify data before sharing. The results will be submitted to a peer-reviewed journal.
PROSPERO REGISTRATION NUMBER
CRD42019121173.
Topics: Abdomen; Abdominal Injuries; Abdominal Wound Closure Techniques; Adult; Humans; Incidence; Meta-Analysis as Topic; Surgical Wound Dehiscence; Surgical Wound Infection; Sutures; Systematic Reviews as Topic; Triclosan
PubMed: 35197346
DOI: 10.1136/bmjopen-2021-054534 -
Trials Mar 2024Approximately 85% of women experience an obstetric tear at delivery and up to 25% subsequently experience wound dehiscence and/or infection. Previous publications... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Approximately 85% of women experience an obstetric tear at delivery and up to 25% subsequently experience wound dehiscence and/or infection. Previous publications suggest that intravenous antibiotics administrated during delivery reduces this risk. We do not know if oral antibiotics given after delivery can reduce the risk of wound dehiscence or infection. Our aim is to investigate whether three doses of oral antibiotics (amoxicillin 500 mg/clavulanic acid 125 mg) given after delivery can reduce the risk of wound dehiscence and infection in patients with a second-degree obstetric tear or episiotomy.
METHODS
We will perform a randomized, controlled, double-blinded study including 221women in each arm with allocation 1:1 in relation to the randomization. The study is carried out at Department of Obstetrics & Gynecology, Herlev University Hospital, Copenhagen, Denmark. The women will be included after delivery if they have had a second-degree tear or episiotomy. After inclusion, the women will have a clinical follow-up visit after 1 week. The tear and healing will be evaluated regarding signs of infection and/or dehiscence. The women will again be invited for a 1-year clinical examination including ultrasound. Questionnaires exploring symptoms related to the obstetric tear and possible complications will be answered at both visits. Our primary outcome is wound dehiscence and/or wound infection, which will be calculated using χ tests to compare groups. Secondary outcomes are variables that relate to wound healing, as pain, use of painkillers and antibiotics, need for further follow-up, as well as outcomes that may be related to the birth or healing process, urinary or anal incontinence, symptoms of prolapse, female body image, and sexual problems.
DISCUSSION
Reducing the risk of wound dehiscence and/or infection would decrease the number of control visits, prevent the need for longer antibiotic treatment, and possibly also decrease both short-term and long-term symptoms. This would be of great importance so the mother, her partner, and the baby could establish and optimize their initial family relation.
TRIAL REGISTRATION
The conduction of this study is approved the 2/2-2023 with the EU-CT number: 2022-501930-49-00.
CLINICALTRIALS
gov Identifier: NCT05830162.
Topics: Humans; Pregnancy; Female; Anti-Bacterial Agents; Episiotomy; Amoxicillin; Clavulanic Acid; Postoperative Complications; Rupture; Perineum; Delivery, Obstetric
PubMed: 38532503
DOI: 10.1186/s13063-024-08069-x -
Journal of Pharmacy & Bioallied Sciences Jul 2023The study aimed to evaluate the efficacy of octyl-2-cyanoacrylate as well as sutures as a wound closure material. Whether octyl-2-cyanoacrylate can be used as an...
The study aimed to evaluate the efficacy of octyl-2-cyanoacrylate as well as sutures as a wound closure material. Whether octyl-2-cyanoacrylate can be used as an alternative to suture in the closure of facial wounds. Out of total of 19 wounds, 11 wounds were closed with sutures and tissue adhesive both, out of rest 8 wounds, 4 wounds were closed using sutures alone and in 4 wounds, closure was done with tissue adhesive alone. Therefore, a total of 15 facial wounds were divided into two groups: Group-I Cases in whom 3-0 Black silk suture was used for closure of the wound and Group-II Cases in whom Dermabond (Octyl-2-Cyanoacrylate) was used for closure of the wound. Results showed that Octyl-2-cyanoacrylate offered the benefit of decreased procedure time with less pain, no need for its removal, and better cosmetic outcome compared to sutures.
PubMed: 37694035
DOI: 10.4103/jpbs.jpbs_187_23 -
Journal of Orthopaedic Surgery (Hong... 2019Plate fixation using traditional lateral L-shape approach for intra-articular calcaneal fractures is complicated by 30% of wound complications, and the lateral small...
BACKGROUND
Plate fixation using traditional lateral L-shape approach for intra-articular calcaneal fractures is complicated by 30% of wound complications, and the lateral small incision techniques with a tarsal sinus approach cannot sufficiently address all the fragments. A modified tarsal sinus approach with combined advantages of traditional lateral L-shape and tarsal sinus approaches for the treatment of intra-articular calcaneal fractures was developed.
METHOD
This prospective study included 29 patients (13 Sanders type II and 16 type III) with calcaneal fractures were managed with this technique. Calcaneal height, width, length, Bohler's angle, and Gissane angle were measured preoperatively, postoperatively, and at 1-year follow-up. Functional outcomes were assessed based on American Orthopedic Foot and Ankle Society (AOFAS) ankle/hindfoot score.
RESULTS
Twenty-nine patients with average follow-up time of 18 (range 13-29) months were included. The radiographs demonstrated significant corrections of the Bohler's angle and Gissane angle, calcaneal width, length, and height from preoperation to postoperation and 1-year follow-up. Among all follow-up patients, one case had skin necrosis but healed after dressing. Another case had symptoms of numbness in the sural innervation area, which disappeared after 5 months of physical therapy and drug therapy. One case showed degenerative changes of subtalar joint at 1-year follow-up. No other wound complications like incision infection (superficial or deep) and wound dehiscence occurred. At 1-year follow-up, the mean AOFAS score was 90.2 ± 17.7 (range 70-98) and the good and excellent rate was 89.7%.
CONCLUSION
The modified tarsal sinus approach in the treatment of Sander's type II and III calcaneal fractures allowed adequate reduction and rigid fixation with low incidence of wound complications. Compared to sinus tarsi approach, this technique required shorter learning curve and was more easily mastered by young orthopedic surgeons. Thus, it was worthy of application clinically.
Topics: Adolescent; Adult; Aged; Ankle; Ankle Fractures; Bone Plates; Calcaneus; Female; Fracture Fixation, Internal; Heel; Humans; Intra-Articular Fractures; Male; Middle Aged; Prospective Studies; Radiography; Treatment Outcome; Young Adult
PubMed: 30885093
DOI: 10.1177/2309499019836165