Journal articles on the topic 'Hand Wounds and injuries Patients Rehabilitation'
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Aristov, A. M., S. B. Bogdanov, S. N. Kurinniy, A. V. Karakulev, and V. A. Aladina. "Surgical reconstruction for high-pressure injection injuries to the hand." Genij Ortopedii 28, no. 1 (February 25, 2022): 97–103. http://dx.doi.org/10.18019/1028-4427-2022-28-1-97-103.
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Introduction High-pressure injection injuries to the hand result from injection of substances by high-pressure industrial devices. These are rare lesions with high risk of substantial long-term morbidity. Tissue defects resulting from staged debridement require skin grafting or vascularized island flap coverage. Hand therapy is an important part of the complex rehabilitation of such patients. The objective is to present complex surgical reconstruction of severe high-pressure injection injury of the hand aimed at preserving limb function. Material and methods Methods and results of surgical reconstruction of a patient with severe high-pressure injection injury of the hand treated at the Research Institute – S.V. Ochapovsky Regional Clinic Hospital No.1 in 2018–2019. Results Short-term result of surgical treatment demonstrated complete skin restoration and maximum possible preservation of underlying deep anatomical structures of the hand. Subsequent surgical interventions were aimed at restoring the hand function. Conclusion The restorative treatment of a high-pressure injection injury of the hand includes the earliest possible primary surgical treatment of the wound with wide revision, maximum removal of the injected substance and non-viable tissues and prevention of secondary injuries and infection in the wound. Nonfree vascularized flaps, full-thickness free grafts or split-skin autografts are used for skin reconstruction. Restoration of other functionally significant structures can be considered at a long term with wounds healed and autografts completely implanted. Hand therapy is integral to the comprehensive functional rehabilitation of the high-pressure injection injuries to the hand.
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G'sell, David, Jeffrey E. Carter, Nicole M. Kopari, and William L. Hickerson. "725 Case Series: New Porcine Placental ECM for Burn Injuries." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S168—S169. http://dx.doi.org/10.1093/jbcr/irac012.279.
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Abstract Introduction Human amniotic membrane (HAM) has been used as a biologic dressing for burn wounds since 1955 but limited due to availability, size, and processing costs. In 2021 a new porcine placental product was FDA-approved overcoming challenges with human-sourced products. Our study is the first case series to report outcomes using porcine placental extracellular matrix (PPECM) in the use of adult burn patients. Methods Adults with thermal burns resulting in partial-thickness burn wounds (PTBW) were consented and included in the study from 03/2021 to 09/2021. Patients with full-thickness injures, concomitant trauma, or adverse beliefs to porcine products were not included in the study. Serial still images and initial wound measurements were obtained intraoperatively and post-operatively. PPECM trial product processed with a proprietary decellularization method to produce single sheets up to 15x20cm was approved by the facility value assessment committee. Adverse events were defined a priori as infection, increased pain or itching relative to adjacent autografts, or failure to heal. Infection was defined as a PPECM treatment site requiring any change from standard of care or initiation of local or systemic antibiotics. Pain was assessed using a visual analogue scale. Itching was assessed at discharge and follow-up. Healing was assessed using the FDA guidance for wound closure with 2 consecutive visits 2 weeks apart demonstrating 100% epithelialization without drainage or dressing requirements. Results Four patients were treated during the study period with wounds involving the torso and major joints such as the hands/wrists and knees. None of the PPECM wounds demonstrated failure to heal or required revision excision, or autograft. None of the PPECM wounds had evidence of infection. PPECM wounds had decreased pain/itching relative to adjacent burn wounds which were treated with split-thickness autograft, autologous skin cell suspension, or allogeneic cultured skin substitute (VAS mean 1 vs 3.1). Healing was noted in all wounds at 1-week primary dressing removal with confirmation at 2-week interval follow-up. Conclusions PPECM treatment of PTBW was not associated with adverse events and resulted in favorable outcomes clinically. The large size, ease of use, and lower costs relative to HAM is an intriguing alternative for PTBW. Comparative studies are needed in the field to determine best practices and overall value.
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Taylor, George M., Jeffrey E. Carter, Charles T. Tuggle, Scott Barnett, and Herb A. Phelan. "35 Outcomes for Hand Burns Treated with Autologous Skin Cell Suspension in 20% TBSA and Smaller Injuries." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S27—S28. http://dx.doi.org/10.1093/jbcr/irab032.039.
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Abstract Introduction Our group has previously reported our experience with autologous skin cell suspension (ASCS) in the treatment of all subjects with hand burns regardless of the total body surface area (TBSA) involved. In order to better address the confounder of TBSA on burn outcomes, we sought to analyze our experience in a cohort of subjects whose TBSA totaled 20% or less. We hypothesized that the use of ASCS in conjunction with a 2:1 meshed autograft would provide comparable outcomes to hand burns treated with smaller meshed autograft alone. Methods A retrospective review was conducted for deep 2nd and 3rd degree hand burns treated with split thickness autograft (STAG) at our urban verified burn center between April 2018 to September 2020. Exclusion criterion was a TBSA greater than 20%. The cohorts were those subjects treated with ASCS in combination with STAG (ASCS(+)) versus those treated with STAG alone (ASCS(-)). All ASCS(+) subjects were treated with 2:1 meshed STAG and ASCS overspray while all ASCS(-) subjects had 1:1 or piecrust mesh only. Outcomes included demographics, proportion returning to work (RTW), length of time for RTW, and time to wound closure. Mann-Whitney U test was used for comparisons of continuous variables, and Fishers Exact test for categorical variables. Values are reported as median and interquartile range. Results Fifty-one subjects fit the study criteria (ASCS(+) n=31, ASCS(-) n=20). The ASCS(+) group was significantly older than the ASCS(-) cohort (44 yrs. [32, 54] vs 32 [27.5, 37], p=0.009) with larger %TBSA burns (15% [9.5, 17] vs 2% [1, 4], p < 0.0001), and larger size hand burns (190 cm2 [120, 349.5] vs 126 cm2 [73.5, 182], p=0.015). Comparable results were seen between ASCS(+) and ASCS(-), respectively, for time to wound closure (9 days [7, 13] vs 11.5 [6.75, 14], p=0.63), proportion RTW (61% vs 70%, p=0.56), and days for RTW among those returning (35 [28.5, 57] vs 33 [20.25, 59], p=0.52). The ASCS(+) group had two graft infections with no reoperations, while ASCS(-) had one infection with one reoperation. No subjects in either group had a dermal substitute placed. Conclusions Despite being significantly older, having larger hand wounds, and larger overall wounds within the parameters of the study criteria, patients with 20% TBSA burns or smaller whose hand burns were treated with 2:1 mesh and ASCS overspray had comparable time to wound closure and return to work as subjects treated with 1:1 or pie-crust meshed STAG. Our group plans to follow this work with scar assessments for a more granular picture of pliability and reconstructive needs.
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Shim, Hyung Sup, Ji Seon Choi, and Sang Wha Kim. "A Role for Postoperative Negative Pressure Wound Therapy in Multitissue Hand Injuries." BioMed Research International 2018 (2018): 1–7. http://dx.doi.org/10.1155/2018/3629643.
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In this study, we compared outcomes in patients with acute hand injury, who were managed with or without negative pressure wound therapy (NPWT) after reconstructive surgery. All of the patients who sustained acute and multitissue injuries of the hand were identified. After reconstructive surgery, a conventional dressing was applied in Group 1 and NPWT was applied in Group 2. The dressing and NPWT were changed every 3 days. The mean age and Hand Injury Severity Scoring System score of both groups were not significantly different. Disabilities of the Arm, Shoulder, and Hand (DASH) scores were evaluated 1 month after all the sutures were removed and 1 year postoperatively, which were both significantly lower in Group 2. Applying NPWT to the hand promoted wound healing by reducing edema, stabilizing the wound, and providing immobilization in a functional position. Early wound healing and decreased complications enabled early rehabilitation, which led to successful functional recovery, both objectively and subjectively.
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Özgen, Merih, Ayşe Merve Aydoğan, Ali Uygur, Onur Armağan, Funda Berkan, and Fezan Mutlu. "Rehabilitation cost share and cost analysis of traumatic hand injuries: Our single-center results." Turkish Journal of Physical Medicine and Rehabilitation 67, no. 3 (September 1, 2021): 308–14. http://dx.doi.org/10.5606/tftrd.2021.5457.
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Objectives: This study aims to evaluate the cost expenses and rehabilitation share of hand and/or wrist injuries and to contribute to the development of health and economic policies. Patients and methods: A total of 59 patients (55 males, 4 females; mean age: 39.1±11.3 years; range, 20 to 64 years) who presented with hand and/or wrist injuries between January 2015 and December 2017 were retrospectively reviewed. Demographic data, hand injury information, and the Modified Hand Injury Severity Scores (MHISS) were retrieved from the patient file system. The cost analysis with direct and indirect costs was performed. Results: According to the MHISS, 27.1% of patients had a minor injury, 23.7% had a moderate injury, 18.6% had a severe injury, and 30.5% had a major injury. The mean direct cost of the patients was $726.00±641.87 and the total cost of the indirect cost was $2,776.93±1,619.00. The mean day-off time was 125±68.62 days. Indirect costs accounted for 79% of the total cost. The mean cost of rehabilitation was $150.18±86.88. Rehabilitation costs accounted for 4% of the total cost. There was a positive correlation between the MHISS and direct, indirect and total cost, but not between the MHISS and rehabilitation cost. Conclusion: The proportion of the share allocated to rehabilitation expenditures, which is the subunit of direct cost, is low and not related to the injury severity. The data obtained from the study contributed to the creation of evidence-based health and economic policies. We believe that these data also contribute to the planning of rehabilitation services according to the severity of injury which would improve the quality of life and return to work.
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Maldonado Carrasco, Claudia Lucía, Manuel Edmundo Espinoza Espinoza, Rómulo Augusto Idrovo Carrasco, and Luis Alberto Tinoco Cazorla. "Reporte de un caso clínico: Reimplante de mano." Revista Médica del Hospital José Carrasco Arteaga 13, no. 1 (July 31, 2021): 125–30. http://dx.doi.org/10.14410/2021.13.2.cc.20.
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BACKGROUND: The upper limb plays a vital role in our daily function; injuries to this vital structure can result in devastating consequences to functional, psychological and social well-being; especially traumatic amputations of the upper limb are challenging to manage and deciding which patients would benefit from limb salvage versus amputation is critical. CASE REPORTS: A 52-year-old male patient, who suffered a traumatic partial amputation in the distal third of his right forearm with an industrial machine, presenting an ulnar and radius fracture, with severe soft tissue injuries, who underwent a replantation surgery after 12 hours of ischemia. EVOLUTION: Patient presented good postsurgical outcome. 24 hours after surgery he presented normal Allen’s test results, adequate temperature, pink coloration, hypoesthesia and 2/5 muscle strength in the injured limb. He was discharged 7 days after surgery with follow-up and rehabilitation prescription. The percutaneous needles were removed 13 weeks after, with proper bone healing of the fracture. 5 months after surgery, he presented a DASH Score of 60.83. CONCLUSION: The replantation field has become very sophisticated in recent years; the decision to perform replantation of the amputated limb must be individualized to each patient, based on several established factors such as the characteristics of the injury, patient related factors, and the functional recovery capacity.
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Jeong, Seong-Ho, Ja Hea Gu, and Woo-Kyung Kim. "Analysis of Self-Inflicted Lacerations to the Wrist: A Multi-Disciplinary Approach to Treating." Journal of Hand Surgery (Asian-Pacific Volume) 25, no. 01 (January 31, 2020): 47–53. http://dx.doi.org/10.1142/s242483552050006x.
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Background: Self-inflicted wrist lacerations have the potential to lead to crippling sequelae and repeated suicidal attempt. To obtain good results, we have treated self-inflicted wrist lacerations using a multidisciplinary team - emergency, hand surgery, psychiatry, and rehabilitation. This study aims to review features of this type of injuries and suggest multidisciplinary team approach as an optimal treatment. Methods: Our multidisciplinary approach can be summarized as follows: initial evaluation, psychological interview, surgery, and rehabilitation. The medical records including wound features, injured structures and psychological data were reviewed retrospectively. Assessment of functional outcomes, and comparative analysis of various psychological parameters were conducted. Results: Most patients resulted in excellent or good functional outcomes. Five patients reattempted wrist cutting with suicidal intent during follow-up. Only 21.3% patients had a suicidal intent and it was not associated with injury severity and functional recovery. Alcohol ingestion and presence of associated injuries was significant different between severity groups. Presence of suicidal intent was irrelevant to injury severity and functional recovery, but relevant to alcohol ingestion, presence of associated injuries and presence of psychiatric diagnosis. Conclusions: In order to minimize catastrophic disability and repeated suicide attempts, a balanced multidisciplinary approach is one of the best methods to obtain excellent functional outcomes and prevent repeated injuries in patients with self-inflicted wrist lacerations.
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Thurston, A. J., and A. McChesney. "THE BACTERIAL COLONISATION OF SILICONE OIL USED IN THE MANAGEMENT OF WOUNDS OF THE HANDS — A SOURCE OF NOSOCOMIAL INFECTION?" Hand Surgery 07, no. 01 (July 2002): 21–26. http://dx.doi.org/10.1142/s0218810402000844.
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For 30 years, silicone oil has been used for the management and rehabilitation of the injured hand. Its benefits accrue from its providing a non-irritant, bland, air-free medium in which the hand can undergo early movement, which prevents drying out of the tissues and helps in the separation of necrotic and infected tissue. It has been reported, however, that the silicone oil might act as a reservoir for nosocomial infection after two patients developed epidemic methicillin-resistant Staphylococcus aureus (EMRSA) infections. Since no firm guidelines exist with regard to open and/or infected wounds and the continued use of the same oil, a prospective study was set up to study the bacterial colonisation of the silicone oil. Thirty-five consecutive patients were entered into the study. The oil for each patient was changed each week but if any wound became clinically infected the oil was changed earlier. Treatment was continued until the wound was healed or until the treatment was stopped by the referring doctor. Bacteriology swabs taken from the wound and the oil before each treatment and from the oil after each treatment were analysed for bacterial colonisation. The results indicated that while bacteria were transferred into the oil from the wound, the inoculum was small and had no effect on wound healing. There was no evidence that wounds were being re-infected from the oil. The conclusion was that silicone oil remains a safe medium in which to exercise injured hands.
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Skibba, Kathryn, Chelsea Cleveland, and Derek Bell. "823 Airbag Burns: An Unnecessary Consequence of Motor Vehicle Safety." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S250—S251. http://dx.doi.org/10.1093/jbcr/iraa024.399.
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Abstract Introduction Over 7,500 Americans are injured by motor vehicle crashes every day and air bags save an estimated 2,790 lives per year.6,7 All vehicles are mandated to have airbags installed. The ubiquity of airbags has shown a surge in airbag related injuries including abrasions, contusions, lacerations, burns, fractures, and retinal detachment.1,3 Methods A retrospective review of all patients evaluated by the burn service was performed from 5/1/2015-4/30/2019. Inclusion criteria was patients of all ages with burn injuries resulting from airbag deployment. Demographic data and burn characteristics were reviewed. Results A total of seventeen patients met inclusion criteria: 82.4% female, 17.6% male. The average age was 40.4 years. No patients required hospitalization for their burn care. Etiology of the burn was often not clinically distinguishable; six patients were categorized as chemical burns and three from thermal injury. The remaining eight patients had unspecified etiology. Fifteen patients had second degree and two had third degree burns. The average TBSA for all patients was 0.45%. Burn location: ten hand or wrist; six arm, two chest, one neck, and anterior thigh burn. Eight patients suffered burns to more than one site. All patients were able to heal from their burns with wound care; no patients required surgical intervention. The average time to re-epithelialization was 11 days. Conclusions There is no question about the efficacy of airbags in preventing death and serious injury. However, the current mechanism of airbag deployment is intrinsically hazardous to passengers as it releases hot gases and alkaline substance into the cabin. The clinical manifestation of the burn may not distinguish whether it was a chemical or thermal etiology, as seen in 47% of our patients. If there is a suspicion for burn resulting from an airbag, the wound should be copiously irrigated and treated as though there is alkali chemical contamination. The average wound size was small at 0.45% TBSA. Most wounds were determined to be second degree and all were able to heal without surgical intervention. The most common area burned was the hands or upper extremity (88%). Airbag related burns should not be minimized as they cause pain, scarring, and a financial and time burden to the patient. Applicability of Research to Practice It is important to recognize and properly treat burns related to airbag deployment. If etiology of the burn is in question, the wound should be irrigated copiously as it may be caused by chemical contamination.
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Dawson, William J. "Trauma to the High-level Instrumentalist's Hand and Upper Extremity: An Epidemiologic and Outcome Study." Medical Problems of Performing Artists 22, no. 3 (September 1, 2007): 105–9. http://dx.doi.org/10.21091/mppa.2007.3023.
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Expanding on a pilot study of musician trauma presented several years ago, this paper reports on 276 professional or serious amateur instrumentalists, with 178 followed to a final outcome. The group represents 39.4% of all 701 musicians with trauma and 20.4% of all musicians seen by the author from 1981 to 1996 for hand and upper extremity problems. More than 60% were male, and 75% played strings and keyboards. Performing professionals constituted 38.8% of the total, while dedicated amateurs added 44.9%. Sports (30.1%) and a fall or blow (32.6%) were the most common causes of injury, with sports the most common among musicians aged 10 to 40 yrs. Nearly two-thirds of the sports trauma was due to ball sports, followed by household injuries and motor vehicle accidents. Diagnoses included fractures (32.7%), sprains/strains (24.4%), and open wounds (10.8%). More than one third of the group with open wounds also suffered nerve and/or tendon lacerations. The outcome in 178 patients included complete relief of symptoms in 122 (68.6%) and improvement in 53 (29.8%). Full return to performance occurred in 149 (83.7%) and in modified fashion in 25 (14.1%). Four patients stopped playing because of the injury or its sequelae. Forty-three patients presented with late sequelae from a prior injury, which resulted from sports or a fall/direct blow in 25. Of 27 with a known outcome, 11 returned fully to music, while 14 modified their performance. Division of nerves or tendons were more likely to result in very long-term disability or incomplete recovery, regardless of the accuracy of repair or extent of rehabilitation.
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Graham, L. E., and R. C. Parke. "The Northern Ireland Troubles and limb loss: a retrospective study." Prosthetics and Orthotics International 28, no. 3 (December 2004): 225–29. http://dx.doi.org/10.3109/03093640409167754.
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The Troubles in Northern Ireland have now lasted 34 years. Divisions and strife between the opposing loyalist and republican communities, and between the communities and the security forces, have led to thousands of deaths and injuries. The violence has often been indiscriminate injuring and killing totally innocent people. Staff at the Regional Disablement Services at Musgrave Park Hospital, Belfast have had the responsibility for helping to rehabilitate those who have suffered limb loss, both civilians and security forces personnel. In this study the authors present patient demographics for those survivors, referred for prosthetic fitting, who have sustained limb amputations as a result of the Troubles from 1969 to 2003, with the cause of injury, resulting levels of amputation, associated injuries, time to first prosthetic fitting and reason for any delay in fitting identified. One hundred and twenty-nine (129) patients sustained amputations, 110 male and 19 female with an age range at the time of injury from 7 to 60 years. Seventy-two (72) were civilian. Ninety-three (93) underwent immediate amputation, the most frequent level of amputation being trans-femoral. Delayed healing of deep wounds was the most common reason for delayed amputation; other causes were chronic osteomyelitis, malunited fractures and failed arthrodesis, often associated with chronic pain. Ninety-two (92) patients required amputation of one limb or part thereof, 35 required amputation of 2 limbs and 2 underwent triple amputation. Three (3) patients lost both hands. Sixty seven percent (67%) had other associated physical injuries. Thirty-two (32) patients had a delay of 6 months or more in fitting a prosthesis. The most common cause of injury was the car bomb.
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van de Ven-Stevens, Lucelle A. W., Maud J. L. Graff, Marlijn A. M. Peters, Harmen van der Linde, and Alexander C. H. Geurts. "Construct Validity of the Canadian Occupational Performance Measure in Participants With Tendon Injury and Dupuytren Disease." Physical Therapy 95, no. 5 (May 1, 2015): 750–57. http://dx.doi.org/10.2522/ptj.20130590.
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Background In patient-centered practice, instruments need to assess outcomes that are meaningful to patients with hand conditions. It is unclear which assessment tools address these subjective perspectives best. Objective The aim of this study was to establish the construct validity of the Canadian Occupational Performance Measure (COPM) in relation to the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire and the Michigan Hand Outcomes Questionnaire (MHQ) in people with hand conditions. It was hypothesized that COPM scores would correlate with DASH and MHQ total scores only to a moderate degree and that the COPM, DASH questionnaire, and MHQ would all correlate weakly with measures of hand impairments. Design This was a validation study. Methods The COPM, DASH questionnaire, and MHQ were scored, and then hand impairments were measured (pain [numerical rating scale], active range of motion [goniometer], grip strength [dynamometer], and pinch grip strength [pinch meter]). People who had received postsurgery rehabilitation for flexor tendon injuries, extensor tendon injuries, or Dupuytren disease were eligible. Results Seventy-two participants were included. For all diagnosis groups, the Pearson coefficient of correlation between the DASH questionnaire and the MHQ was higher than .60, whereas the correlation between the performance scale of the COPM and either the DASH questionnaire or the MHQ was lower than .51. Correlations of these assessment tools with measures of hand impairments were lower than .46. Limitations The small sample sizes may limit the generalization of the results. Conclusions The results supported the hypotheses and, thus, the construct validity of the COPM after surgery in people with hand conditions.
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Parmar, Sanjay Tejraj, Anuprita Kanitkar, Nariman Sepehri, Satish Bhairannawar, and Tony Szturm. "Computer Game-Based Telerehabilitation Platform Targeting Manual Dexterity: Exercise Is Fun. “You Are Kidding—Right?”." Sensors 21, no. 17 (August 27, 2021): 5766. http://dx.doi.org/10.3390/s21175766.
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There is a need for innovation to improve the engagement and accessibility of rehabilitation programs for children and adults with upper extremity motor impairments due to neurodevelopmental disorders, acquired brain injuries, or spinal cord injuries. For this purpose, a computer game-based telerehabilitation platform (GTP) was developed to address this need. Through the application of a miniature inertial-based computer mouse and the wide variety of commercial computer games, the developed GTP can provide engaging task-specific exercises for the rehabilitation of manual dexterity (object handling and manipulation). A purpose-built repetitive task practice software (RTP) was also developed to gather event data and synchronize it with patient movements during gameplays. This provides automated monitoring and quantification of patients’ motor skills, while they practice a range of game-based exercises with their hand and/or arm. The GTP would initially be used in a supervised clinical setting followed by a transition to function at home and be monitored by clinician specialists. Clinical support for home and rural communities, with protocols that can be easily updated, will help increase accessibility to targeted and personalized solutions for patients and achieve the desired training effect.
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Grauer, Christine M., and Miranda L. Yelvington. "559 Nursing Management of Multiple Concurrent Pediatric Patients with Cultured Epidermal Autografts." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S115—S116. http://dx.doi.org/10.1093/jbcr/irac012.187.
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Abstract Introduction For patients with large areas of full-thickness burns and limited autologous donor sites, cultured epidermal autografts (CEAs) can provide life-saving coverage. Nursing care of a patient with CEAs can be challenging due to the fragility of these grafts and compounded by the critical status of the patient. Care of a single patient with CEAs can prove challenging, but in cases in which multiple patients receive CEAs concurrently, these challenges are amplified. Methods Three pediatric patients with large burn injuries were admitted on a single day to a large academic hospital with a Burn Center (Table 1). Nursing care of these children with concurrent CEA placement required an all-hands-on-deck approach and collaboration between the Burn Center (BC) and the Pediatric Intensive Care Unit (PICU) with regards to staffing, care, and positioning. Consistent primary RNs from both the BC and PICU staffed patients and volunteered to work additional shifts during a period of high census. To meet patient needs, the multi-disciplinary care team developed a schedule for CEA exposure, wound care, and therapy interventions. Results To meet the needs of these patients under the current staffing pattern, a team schedule was developed (Table 2). Table 2. Care Schedule 0300-0400 Night shift staff removed anterior and extremity dressings with patients in supine. 0800-0900 Therapy staff arrived early during the day shift to perform therapy interventions with anterior CEAs exposed. Multi-disciplinary teams applied anterior and extremity dressings, positioned patients prone, and removed dressings from posterior CEA sites. 1700-1800 After approximately six to eight hours of CEA exposure, teams reapplied dressings and positioned patients supine. Conclusions Staff followed this schedule for these patients until their CEAs were determined to be integrated. Planning and collaboration among all members of the treatment team are integral to the successful care of pediatric patients with CEAs. A schedule for wound care, turning, and CEA exposure can improve staff communication, ease hand-offs, and ensure optimal quality of care for multiple patients with these large burn injuries.
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Ghosh, Jagodish Chandra, Samaresh Chandra Hazra, Sudhangsu Kumar Singha, and Md Faroque Reza Aolad. "Resurfacing of hand injury with groin flap: an analysis of thirty four cases." Bangladesh Medical Journal 43, no. 1 (December 30, 2014): 21–25. http://dx.doi.org/10.3329/bmj.v43i1.21372.
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Hand injuries are prevalent among the young adult and middle aged active people specially who are engaged with machinery works. Hand performs the unique and essential mechanical function and for fulfillment of this function it is imperative to provide good soft tissue coverage with sensibility. Skin grafting causes wound contraction and result in gliding of tendon directly under skin and is also unable to provide sensibility. Though cutting and slicing injury can be closed directly, crushing, degloving and avulsion injury needs coverage with a flap. Free flap require highly skilled microvascular anastomoting technique and needs expertise. Pedicle flap are suitable for this purpose where facilities for free flap transfer are not available. This prospective observational study which was done in National Institute of Traumatology and Orthopadic Rehabilitation during the period from January 2000 to december 2001 involving thirty four patients with a age range of 15-50 yrs who sustained hand injury from machinery injury, road traffic accident and electric burn.The patients were followed up at 4th (week), 6th (week), 8th (week), 16th and 20th week. Majority of patient are male. 58.82% of patient had suffered from machinery injury and 23.52% of patient had suffered from road traffic accident. During resurfacing of hand injuries, 58.82% of patient needed a flap length between 15 to 17 cm and rest of the patient (41.16%) requires flap length below 15 cm.Among all patients, 70.6% required 7 cm to 10 cm wide flap and rest of the patient between 5 cm to 7 cm. About 86% of patients had no loss of flap, 10.71% had marginal distal flap loss, 3.57% patient had distal flap loss up to 5% and no patient had distal flap loss >5%. Functional out come in terms of Eating, drinking, dressing,washing, writing were satisfactory in all cases except only one patient who developed stiffness of hand which was 3.58% of total patient. Functional outcome were evaluated in terms of eating, drinking, dressing, washing, writing and other purposeful movement; and also in terms of joint movement, power grip and pinching. All patient regained full range of movement except one patient who had deficit of finger movement. In conclusion groin flap can be a better choice for resurfacing the hand injury with acceptable results. This study recommends the use of groin flap as routine choice for resurfacing larger hand injuries. DOI: http://dx.doi.org/10.3329/bmj.v43i1.21372 Bangladesh Med J. 2014 January; 43 (1): 21-25
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Coward, Alexandra, Rachel M. Nygaard, and Frederick W. Endorf. "605 Revision Surgery Following Severe Frostbite Compared to Similar Hand and Foot Burns." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S142. http://dx.doi.org/10.1093/jbcr/irac012.233.
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Abstract Introduction Severe frostbite is associated with high levels of morbidity through loss of digits or limbs. The current practice is to salvage as much of the limb/digit as possible with the use of thrombolytic and adjuvant therapies. Sequalae from amputation can include severe nerve pain and poor wound healing requiring revision surgery. The aim of this study was to examine the rate of revision surgery after primary amputation and compare this to revision surgery in isolated hand/foot burns. Methods Frostbite and burn patients from 2006 to 2019 were identified in the prospectively maintained database at a single urban burn and trauma center. Patients with primary amputations related to isolated hand/foot burns or frostbite were included in the study. Descriptive statistics included Student’s T-test and Fisher’s Exact test. Results A total of 63 patients, 54 frostbite injuries and 9 isolated hand or foot burns, met inclusion criteria for the study. The rate of revision surgery was similar following frostbite and burn injury (24% vs 33%, P=0.681). There were no significant differences in age, gender, or LOS on the primary hospitalization. Neither the impacted limb nor the presence of infection or cellulitis on primary amputation were associated with future need for revision surgery. Of the 16 patients requiring revision surgery, 5 (31%) required additional debridement alone, 6 (38%) required re-amputation alone, and 5 required both. A total of 6 patients (38%) had cellulitis or infection at the time of revision surgery. Time from primary surgery to revision ranged from 4 days to 3 years. Conclusions Planned, delayed primary amputation is a mainstay of frostbite management. To our knowledge, this is the first assessment of revision surgery in the setting of severe frostbite injury. Our observed rate of revision surgery following frostbite injury did not differ significantly from revision surgery in the setting of isolated hand or foot burns. This study brings up important questions of timing and surgical planning in these complex patients that will require a multicenter collaborative study.
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Fedirko, Igor, and Nataliia Kosiuk. "Helpful Hand of a Canadian Medical Team for the Severely Wounded Ukrainian Defenders." Journal of Diagnostics and Treatment of Oral and Maxillofacial Pathology 2, no. 1 (February 28, 2019): 36–37. http://dx.doi.org/10.23999/j.dtomp.2019.2.1.
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Oleh M. Antonyshyn, MD, FRCS(C) is a Professor in the Division of Plastic Surgery (University of Toronto) with a subspecialty practice in craniomaxillofacial surgery. Dr. Antonyshyn established a Clinical Fellowship in Adult Craniofacial Surgery in 1993, providing post-residency specialized training in adult craniofacial surgery to candidates from Canada, the United States, Ireland, Israel and the Middle East. In 2008 he was awarded the A. Freiberg Plastic Surgery Resident Teaching Award. Also, Dr. Antonyshyn serves as: • Head, Adult Craniofacial Program (founded by Dr. Antonyshyn in 1996), Sunnybrook Hospital (Toronto, ON, Canada). • Affiliate Scientist, Physical Sciences, Trauma, Emergency & Critical Care Research Program, Sunnybrook Research Institute (Toronto, ON, Canada). • Full time clinical staff, Division of Plastic Surgery, Sunnybrook Health Sciences Centre (Toronto, ON, Canada). • Member, Global Advisory Board of the Advanced Cranio-Maxillo-Facial Forum. • Member, Examination Board in Plastic Surgery for the Royal College. The impact of contribution of Dr. Antonyshyn, his medical team (Fig), and a Canada-Ukrainian Foundation Mission is enormous. A lot of saved faces, given hope for a better quality of life due to novelty complex rehabilitation operations, multiple prosthesis and plenty of minor esthetic procedures for the Ukrainian defenders. The statistics of the Canadian team (doctors, medical assistants) from 2014 to 2018 is numerous, and keeps increasing. In the National Military Medical Clinical Center “Main Military Clinical Hospital” (Kyiv, Ukraine) together with the Ukrainian team of Maxillofacial, Neurocranial, Orthopedic, and Otorhinolaryngology Departments were performed 346 consultations and 239 surgeries to the severely wounded defenders of Ukraine. Predominant amount of patients (85 percent) consists of patients with post-traumatic defects, maxillofacial deformities, cranial, and limbs` injuries. So, the grateful words for Dr. Antonyshyn and Canadian team are endless.
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Khalifa, Andrew, Anzar Sarfraz, Jacob B. Avraham, Ronnie Archie, Matthew Kaminsky, Stathis Poulakidas, Faran Bokhari, and Francesco Bajani. "561 Bilateral Upper Extremity Amputation After High Voltage Electrical Injury: A Case Report." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S130—S131. http://dx.doi.org/10.1093/jbcr/irab032.211.
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Abstract Introduction Electrical injuries represent 0.4–3.2% of admissions to burn units and are responsible for >500 deaths per year in the United States. Approximately half occur in the workplace and are the fourth leading cause of work-related-traumatic death. The extent of injury can be drastically underestimated by total body surface area percentage (TBSA). Along with cutaneous burns, high voltage electrical injuries can lead to necrosis of muscle, bone, nervous tissue, and blood vessels. Aggressive management allows for patient survival, but at significant cost. Newer technologic advances help improve functional outcomes. Methods This case-report was conducted via retrospective chart review of the case presented. Results A 43-year-old male sustained a HVEI (>10, 000 V) after contacting an active wire while working as a linesman for an electric company. He presented after less than 15-minute transport from an outside hospital with full thickness burns and auto-amputation to all fingers on both hands and the distal third of the left hand (Images 1 and 2). There were full thickness circumferential burns to the entire left and right upper extremities with contractures, with the burns extending into the axilla, and chest wall musculature. The patient had 4th degree burns and a large wound to the left shoulder with posterior extension to the scapula, flank and back with approximately 25% TBSA (Image 3). Compartments were tense in both upper extremities. Patient was sedated and intubated to protect the airway and placed on mechanical ventilation. A femoral central line was then placed, and the patient was given pain control, continued fluid resuscitation, and blood products. Dark red colored urine from a foley catheter that was immediately identified as rhabdomyolysis induced myoglobinuria. Labs drawn demonstrated elevated troponin I, CK >40,000. BUN 18, creatinine 1.0, K+ 5.2 and phosphate 5.6. Decision was made immediately for operative intervention with emergent amputation of both upper extremities in the light of rhabdomyolysis secondary to tissue necrosis and oliguria. During the patient’s hospital course, he underwent multiple operations for further debridement with vacuum-assisted closure therapy and skin grafting of sites, as well as targeted muscle reinnervation (TMR) 6 months later at an outside hospital. Conclusions Although HVEI only account for a small percentage of burn admissions, they are associated with greater morbidity than low-voltage injuries. Patients with HVEI often incur multiple injuries, more surgical procedures, have higher rates of complications, and more long term psychological and rehabilitative difficulties. Despite the need for amputation in some of these critically ill patients, options exist that allow for them to obtain long term functional success.
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Toman, Emma, A. Beaven, D. N. Naumann, R. W. Myatt, P. J. Parker, and A. R. Kay. "Non-battle injury among repatriated UK armed forces since cessation of combat operations: a prospective observational study." Journal of the Royal Army Medical Corps 164, no. 1 (August 23, 2017): 19–24. http://dx.doi.org/10.1136/jramc-2017-000766.
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AimTo describe the mechanisms, burden of injury, inpatient management and rehabilitation requirements of wounded military personnel at the UK Role 4 (R4) facility within the first 12 months following cessation of combat operations in Afghanistan.MethodsAll aeromedical evacuations were recorded prospectively between October 2014 and October 2015. Demographic, logistical and clinical data were derived manually from referring medical unit and patient movement requests in addition to host nation and R4 medical records.ResultsNinety-five patients were repatriated to R4 following traumatic injury: 98.9% (n=94) were male, and median age was 27 years (IQR 25–36 years). The most common mechanisms of injury (MOIs) were sports 26.3% (n=25), falls <2 m 11.6% (n=11) and road traffic collisions 9.8% (n=9). The most common anatomical regions of injury were isolated lower limb 24.1% (n=22), isolated hand 20.0% (n=19) and polytrauma 14.7% (n=14). Median Injury Severity Score was 4 (IQR 4–9), mean 8 (range 1–41). Eleven patients (11.6%) were discharged to rehabilitation units, of whom 7 (63.6%) required neurorehabilitation.ConclusionAlthough service personnel sustain civilian-type injuries, the specific rehabilitation goals and shift in the acute rehabilitation requirements for military personnel must be considered in the absence of enduring combat operations. It is notable that permanent medical downgrading secondary to trauma still occurs outside of warfare. The colocation of civilian major trauma services and R4 has ensured a mutually beneficial partnership that contributes to institutional memory and improves the coordination of patient pathways. The importance of relevant resource allocation, training, support and logistical considerations remain, even during the current scale of military activity overseas.
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Ernat, Justin J., Dylan R. Rakowski, Joseph J. Ruzbarsky, Donovon W. Johnson, Aaron J. Casp, Annalise M. Peebles, Jared Hanson, et al. "Arthroscopic Characterization, Treatment, and Outcomes of Glenoid Labral Articular Disruption Lesions." American Journal of Sports Medicine 50, no. 5 (March 2, 2022): 1328–35. http://dx.doi.org/10.1177/03635465221076854.
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Background: The pathoanatomy of glenoid labral articular disruption (GLAD) lesions has been inconsistently and poorly defined in the literature. Purpose/Hypothesis: The purpose was to characterize GLAD lesions as they pertain to the pathoanatomy of labrum, cartilage, and bony structures, and to correlate findings with patient-reported outcomes (PROs). We hypothesized that greater degrees of bony and cartilaginous involvement would correlate with worse outcomes. Study Design: Case series; Level of evidence, 4. Methods: All patients with a diagnosis of a GLAD lesion or a reverse GLAD (RGLAD) lesion at the time of diagnostic arthroscopy (January 2006–February 2019) were included in this study. Patients with ≥13.5% bone loss or previous ipsilateral shoulder surgery were excluded. Patient charts and operative reports/photos were used to identify the location of injury, extent of injury (labral, chondral, and bony), associated injuries, demographic factors, and treatment performed. Three injury patterns were identified: small (type 1), with no chondral defect after labral repair; large (type 2), with residual chondral defect after labral repair; and bony (type 3), with associated glenoid bone loss amenable to labral repair. Characterizations were cross-referenced to PROs at a mean follow-up of 5.5 years (range, 2.6-10.5 years): American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation, shortened version of Disabilities of the Arm, Shoulder and Hand, and patient satisfaction. Results: In total, 50 patients were included, with 40 having GLAD and 10 having RGLAD lesions (mean age, 34.7 and 33.2 years, respectively). There were 14 (35%) type 1, 22 (55%) type 2, and 4 (10%) type 3 GLAD injuries. All PROs improved without any differences in the 3 subgroups postoperatively (ASES, 95.1 vs 91.3 vs 98.8, type 1, 2, and 3, respectively). RGLAD injuries were majority type 2 (7/10; 70%) with the remainder being type 1 (3/10; 30%). Conclusion: With GLAD and RGLAD injuries, 3 distinct injury patterns can be observed correlating with the presence/absence of chondral loss after labral repair or the presence of associated bone loss. This descriptive characterization can facilitate arthroscopic treatment decisions. Future large studies are needed to determine if this is prognostic in nature.
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Huzar, Todd F., Monica L. Gerrek, and Daniel J. Freet. "569 Surrogate Decision Making: Who Has the Ultimate Say in Patient Care?" Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S134—S135. http://dx.doi.org/10.1093/jbcr/irab032.219.
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Abstract Introduction Burn patients may present with an inability to communicate. In these cases, we need to rely on surrogates such as the Medical Power of Attorney (MPoA) or next of kin. A MPoA gives the agent the authority to participate in medical decision and in accordance with their wishes. The agent may consent to, refuse, withdraw, or withhold treatment, including life-sustaining interventions. At times, they may feel unable to participate in decision making without assistance (i.e. family members). The process can become more complicated and decision making can become “muddied” due to others influencing decisions. In our state, the MPoA is the proxy if the patient is unable to participate in decision making; however, there are cases when the patient doesn’t have an MPoA and the next of kin is the surrogate. In these cases, the next of kin would be consulted in the following order: spouse, adult children, parents, and nearest relatives. Some next of kin may not know the patient’s wishes complicating their care. Methods Two cases involving surrogates: #1: 60-year-old man with a history of HIV involved in a MVC and sustained 30% TBSA third and fourth degree burns to the face, torso, and extremities. The severity of his injuries and outcomes were discussed with his wife. She was not certain what her would want and she consulted her family because she did not know what to do; however, she knew that he would not want to live like this. After talking to the family, the kids “over-ruled” her. They wanted aggressive care despite the risks of complications and inability to perform ADLs because of his severe facial and hand burns. Case#2: 40 something year-old man with a history of schizophrenia that sustained 65% TBSA third and fourth degree burns to his face, neck, torso, and extremities due to self-immolation. The patient’s mother was identified, and it was explained to the patient’s mother that if he did survive his injury, he will not be able to perform any of his ADLs due his hand and facial burns. The patient’s mother wanted everything done for her son. Results Both patients were unable to perform ADLs due to their injuries. One patient was discharged for further inpatient care and the other was discharged home because his mother refused further care. The first patient was unable to communicate about his thoughts on his outcome. The other patient was discharged home. He was upset about what he looked like. He also told the staff that he will do his best to finish what he started. Conclusions Complex issues can arise when the patient cannot communicate their wishes and the next of kin plays the role of surrogate. The family may disagree and alter the decision-making process. After seeing this scenario play out and patients not being happy about their outcomes, the policies regarding surrogate decision making should be re-evaluated.
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Yang, Leng, Ascension Santoyo, Jeffery Hati, and Nicole M. Kopari. "835 Annual Burn Competencies for Burn Therapist: Maximizing Patient Outcomes with Ongoing Education." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S256. http://dx.doi.org/10.1093/jbcr/iraa024.408.
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Abstract Introduction Burn injuries often result in functional mobility impairments limiting return to pre-burn activity. Early mobility within 24 hours of admission is recommended to minimize risks of joint and soft tissue contractures while promoting functional independence. To maximize these services, burn therapists undergo annual competency education to evaluate, develop a plan of care, and treat burn patients. Designated burn therapy staff coverage is often not 24/7 resulting in delayed times to early interventions. We identified a need to provide education within the therapy department specifically addressing burn rehab interventions. Methods An in-service presentation introducing Cutaneous Function Units (CFU) as a new functional assessment tool was developed and presented to the therapy department. An 8 question test was administered before and after the presentation to assess staff retention and application of learned techniques. A total of 15 therapist, both occupational and physical, attended the presentation with the results of the tests analyzed. Results Pre-test average scores were 73% with post-test average improved to 95%. Therapist learned 2 additional methods of assessing burn wounds. After analyzing the test results, we were able to identify specific areas that required further education. We used the pre- and post- test results to tailor further educational sessions focusing on hands-on education and small focus groups. Conclusions Despite annual burn rehab competencies with therapy staff, there continues to be a deficit in retention of education. This may result in delay of early mobility and burn rehab services in our burn population. With focused education tailored to specific areas of burn therapy competencies, we were able to impact burn patient therapy sessions. Applicability of Research to Practice Ongoing education can be tailored to specific ares of burn therapy competencies to improve overall patient outcomes.
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Fleming, Irma D., Carla Tang, and Giavonni M. Lewis. "620 Outbreak of Carbapenem-Polymyxin-Quat-Resistant Acinetobacter Baumannii Associated with Mafenide Acetate shortages: An Interdisciplinary Approach to Eradication." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S164—S165. http://dx.doi.org/10.1093/jbcr/irab032.270.
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Abstract Introduction In the wake of Hurricane Maria, many US hospitals experienced massive drug shortages requiring substitution with alternative therapies. Our regional center experienced an increased incidence of Carbapenem-Polymyxin-Quat-Resistant Acinetobacter baumannii(CPQRA) infections, compared to a previous year of no infections. Here we describe a successful interdisciplinary approach to its eradication. Methods We conducted a retrospective review of CPQRA outbreaks for November and December 2018 in the burn ICU. De-identified data was collected and analyzed. In collaboration with the state’s department of health and epidemiology section, whole-genome sequencing was carried out on bacterial isolates. In addition, we instituted adenosine triphosphate (ATP) monitoring on all surfaces, a process of rapidly measuring actively growing microorganisms. Results Resistant Acinetobacter was isolated from five ICU patients, two of whom died with CPQRA bacteremia, producing a case-fatality rate of 40%. The two cases that died both suffered traumatic injuries with multiple fractures in addition to an average TBSA of 58%. Non-fatal cases suffered no other traumatic injuries and had an average TBSA of 51%.During this period, genitourinary irrigant (neomycin-Polymyxin B) and polymyxin ointment were the primary topical agents for wound care. Whole genome sequencing revealed a qacEdelta1 positive strain and identified the primary source as a patient that returned from a long-term care facility carrying the converted A. Baumannii infection. ATP testing also showed increased levels in patient rooms and surgical suite. Conclusions As a result of these findings, we achieved eradication by developing new and reinforcing traditional practices of infection control. This included UV light therapy to all ICU rooms and surgical suite, oversight of environmental services procedures, rigorous enforcement of hospital infection control procedures, auditing hand hygiene, increased efforts in antibiotic stewardship and discontinuing Polymyxin containing topicals. By January 2019 there were no new cases of CPQRA in the ICU. This study shows that the resistance and rapid spread of CPQRA can be controlled with the cooperation of hospital staff, environmental services, infection control, pharmacy, and the state’s department of health. With the coordinated efforts of all parties, we were able to successfully eradicate a virulent and fatal resistant A. baumannii strain.
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Fleming, Irma D., Carla Tang, Lois Remington, and Giavonni Lewis. "69 Outbreak of Carbapenem-polymyxin-quat-resistant Acinetobacter Baumannii Associated with Mafenide Acetate Shortages: An Interdisciplinary Approach to Eradication." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S45. http://dx.doi.org/10.1093/jbcr/iraa024.073.
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Abstract Introduction In the wake of Hurricane Maria, many US hospitals experienced massive drug shortages requiring substitution with alternative therapies. Our regional center experienced an increased incidence of Carbapenem-Polymyxin-Quat-Resistant Acinetobacter baumannii(CPQRA) infections, compared to a previous year of no infections. Here we describe a successful interdisciplinary approach to its eradication. Methods We conducted a retrospective review of CPQRA outbreaks for November and December 2018 in the burn ICU. De-identified data was collected and analyzed. In collaboration with the state’s department of health and epidemiology section, whole-genome sequencing was carried out on bacterial isolates. In addition, we instituted adenosine triphosphate (ATP) monitoring on all surfaces, a process of rapidly measuring actively growing microorganisms. Results Resistant Acinetobacter was isolated from five ICU patients, two of whom died with CPQRA bacteremia, producing a case-fatality rate of 40%. The two cases that died both suffered traumatic injuries with multiple fractures in addition to an average TBSA of 58%.Non-fatal cases suffered no other traumatic injuries and had an average TBSA of 51%.During this period, genitourinary irrigant (neomycin-Polymyxin B) and polymyxin ointment were the primary topical agents for wound care. Whole genome sequencing revealed a qacEdelta1 positive strain and identified the primary source as a patient that returned from a long-term care facility carrying the converted A. Baumannii infection. ATP testing also showed increased levels in patient rooms and surgical suite. Conclusions As a result of these findings, we achieved eradication by developing new and reinforcing traditional practices of infection control. This included UV light therapy to all ICU rooms and surgical suite, oversight of environmental services procedures, rigorous enforcement of hospital infection control procedures, auditing hand hygiene, increased efforts in antibiotic stewardshipand discontinuing Polymyxin containing topicals. By January 2019 there were no new cases of CPQRA in the ICU. This study shows that the resistance and rapid spread of CPQRA can be controlled with the cooperation of hospital staff, environmental services, infection control, pharmacy and the state’s department of health. With the coordinated efforts of all parties, we were able to successfully eradicate a virulent and fatal resistant A. baumannii strain. Applicability of Research to Practice Describe an approach to eradicating resistant organisms and provide a roadmap to characterize the source, implement control measures to terminate an outbreak, and institute preventive measures.
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Sheckter, Clifford C., David Perrault, Danielle H. Rochlin, Arhana Chattopadhyay, and Yvonne L. Karanas. "545 The Association of Plastic Surgery Facility Volume with Inpatient Burn Outcomes." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S111—S112. http://dx.doi.org/10.1093/jbcr/iraa024.173.
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Abstract Introduction Acute burn care involves a spectrum of physicians, nurses, and allied health professionals. Similarly, burn surgeons have variable training backgrounds that originate from different specialties. Plastic surgery was founded on the core principles of reconstruction and offers the full spectrum of acute burn care and reconstructive surgery. Previous work has shown that variations in practice within burn surgery are partially driven by training background. We hypothesize that plastic surgery involvement and access to the full reconstructive paradigm will improve inpatient outcomes in the treatment of burn injuries. Methods Acute burn patients with known percent total body surface area (%TBSA) were extracted from the National Inpatient Sample (NIS) from 2012–2014 based on International Classification of Disease 9th Edition codes. Plastic surgery volume per facility for the entire NIS was determined based on ICD-9 codes for flap procedures, breast reconstruction, and complex hand reconstruction. Outcomes included odds of receiving a flap, patient safety indicators (venous thromboembolic event, sepsis, surgical bleeding, pneumonia, wound complications) and mortality. Regression models included the following variables: age, %TBSA, gender, inhalation injury, comorbidities, hospital size, and urban/teaching status. Results The weighted sample included 99,510 burn admissions with a mean age of 37.2 years (standard deviation [SD] 24.3) and mean %TBSA of 12.4% (SD 12.4%). The weighted median plastic surgery volume by facility was 245 cases per year (Interquartile range 115, 495). Compared to the lowest quartile, the upper three quartiles of plastic surgery volume were associated with an increased likelihood of undergoing a flap procedure during admission (p< 0.05). Plastic surgery volume was also associated with decreased likelihood of patient safety indicator events, whereby the highest quartile showed an OR of 0.71 (95% confidence interval 0.59–0.85, p< 0.001). Plastic surgery facility volume was not significantly associated with a difference in the likelihood of inpatient death. Conclusions Burn patients treated at high volume plastic surgery facilities were more likely to undergo flap procedures during their admission compared to low volume centers. High volume plastic surgery facilities were associated with lower likelihood of inpatient complications, although there were no differences in mortality. Applicability of Research to Practice Inform health systems design in the delivery of burn care to provide the best outcomes for burn survivors.
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Sajid, Soha, James Gill, Adrian Chojnowski, and Rohit Singh. "The Avocado Hand – the UK Experience of the Management of Avocado Hand Injuries." Journal of Hand Surgery (Asian-Pacific Volume) 25, no. 04 (October 28, 2020): 402–6. http://dx.doi.org/10.1142/s2424835520500423.
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Background: Avocados are increasingly being consumed due to the nutritional benefits they provide. Avocado related hand injuries reflect their increasing popularity. Most injuries occur in attempting to de-stone the fruit. This is a prospective cohort study reviewing hand injuries sustained from preparing the fruit. Methods: Data was prospectively collected from three centres across United Kingdom (UK) over a 4-year period. The data was analysed for patient demographics, nature and zone of injury and management required. Results: A total of 35 patients and 42 injuries were included in the study. The median age of patients presenting with these injuries was 33 years, with majority of injuries occurring in the 21–30 age group. Most (88%, n = 31) of patients were male. Majority (85%, n = 36) of injuries happened during the de-stoning of the fruit. All injuries occurred in the non-dominant hand, with 70%, (n = 30) of wounds being sustained in zone 3. All injuries required surgical management and needed between 1 to 6 follow up outpatient visits. Vital structures such as tendons, digital nerves, pulleys and joint capsule were frequently implicated and required exploration or repair. Conclusions: Avocado related hand wounds are serious injuries with an associated morbidity. They frequently sustained by young patients. They usually require surgical management and may need numerous outpatient attendances. Caution and public education should be advocated on the preparation of avocados. This is the largest study to date that has reviewed the surgical management of avocado hand injuries.
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Belokrylov, N. M., A. N. Belokrylov, I. S. Mukhamadeev, A. S. Denisov, V. N. Kiryakov, and K. I. Gorkovets. "Damage to the major limb vessels with complete disturbance of blood flow in children (results of clinical observations)." Genij Ortopedii 28, no. 1 (February 25, 2022): 7–11. http://dx.doi.org/10.18019/1028-4427-2022-28-1-7-11.
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Background Trauma with associated damage to major arteries and veins typically occurs in adults; reports on such injuries in children are rare. In the organization of their treatment, difficulties are encountered such as formation of teams that must include angiosurgeons. The issues of restoring limb function after injuries with damage to muscle, nerve trunks or complete amputation of the limb remain relevant in children, despite their high abilities to recover. Each particular case in health care institutions has its own characteristics and difficulties for treatment, which was the reason for this communication. Purpose To share our clinical experience and details of providing urgent medical care to injured children with complete impairment of the main arteriovenous blood flow. Materials and methods Three cases with complete damage to major arteries and veins, including their defects, were studied. We describe the details of tactics and features of their surgical management. All patients underwent clinical and laboratory examination; emergency assistance was provided by orthopedic traumatologists and angiosurgeons. All patients were admitted in a state of hemorrhagic shock in stage 2 or 3. Surgical aid was provided in patients with a critical, almost terminal condition. Results On admission 40 minutes after the injury, one patient was diagnosed with a deep cut wound on the posterior surface of the right thigh with damage to the flexor muscles of the leg, femoral artery and vein with their defects up to 3 cm, and a cut wound on the right lower leg. Combined plasty of vascular defects with grafts from the great saphenous vein of the thigh and muscle suture were performed. An excellent result was noted after 3 months. In the second patient, there was an injury with glass in the area of the left axillary fossa with a transverse cut of all nerves, brachial artery and vein, tendons of the biceps and triceps muscles of the shoulder. An excellent result of primary reconstruction was diagnosed 1.5 years later. In the third case, the patient was admitted with a complete traumatic amputation of the right forearm in the lower third due to the use of a mechanical wood splitter; replantation began 5 hours after the cut off. Replantation was successful. It included 4 stages of treatment; the 2nd one was repeated revision and suture of the vessels 16 hours after the onset of thrombosis following the 1st operation. The next two stages included combined plastic surgery of muscles and tendons, first on the extensor and then of the flexor surface of the forearm. Movements appeared 6 months after the injury during the restoration of sensitivity. A completely satisfactory result of treatment was obtained; the patient began to use his hand in everyday life and to write after one year. Conclusion Damage to the main arteriovenous formations requires urgent surgical treatment, aimed at preserving the limb, restoring blood supply, nerve formations, and bone integrity. In complete amputation, restoration of muscle-tendon formations may be postponed for subsequent stages. In primary care, one should consider the need for subsequent, sometimes long-term rehabilitation, the result of which directly depends on the restoration of neurotrophic and sensitive functions.
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ANGERMANN, P., and M. LOHMANN. "Injuries to the Hand and Wrist. A Study of 50,272 Injuries." Journal of Hand Surgery 18, no. 5 (October 1993): 642–44. http://dx.doi.org/10.1016/0266-7681(93)90024-a.
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This study reports the causes, characteristics and treatment of injuries to the hand and wrist presented to five accident and emergency departments in a 2-year survey of 13% of the Danish population. The rate of injury to the hand or wrist was 28.6% of all injuries, or 3.7 per 100,000 inhabitants per year. 34% of the accidents were domestic, 35% were leisure accidents, 26% were occupational and 5% were traffic accidents. Only 2% of the patients were admitted to hospital for further treatment or observation and 13% were referred to a hospital as outpatients. The most frequent causes for admission were fractures (42%), tendon lesions (29%) and wounds (12%).
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Campbell, E., S. Pillai, SV Vamadeva, and GS Pahal. "Hand tendon injuries." British Journal of Hospital Medicine 81, no. 11 (November 2, 2020): 1–14. http://dx.doi.org/10.12968/hmed.2020.0141.
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This article provides a comprehensive overview of hand tendon injuries. It has been tailored towards healthcare professionals who will be the first to assess these injuries and instigate appropriate management. It discusses the essential hand anatomy to be aware of, how to assess tendon injuries, their initial management and also the definitive surgical interventions used, if required. Rehabilitation techniques are also discussed, as this is also key to good functional outcomes. Missed injuries, or delay in their diagnosis and referral to specialist hand surgeons, can cause a large amount of morbidity for patients and therefore it is important that they are picked up in a timely manner.
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Fan, Youfen, Yanyan Pan, Cui Chen, Shengyong Cui, Jiliang Li, Guoying Jin, Neng Huang, and Sida Xu. "Use of Composite Acellular Dermal Matrix-Ultrathin Split-Thickness Skin in Hand Hot-Crush Injuries: A One-Step Grafting Procedure." BioMed Research International 2022 (July 21, 2022): 1–12. http://dx.doi.org/10.1155/2022/1569084.
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Background. Hot-crush injuries to the hands can be devastating, and early debridement and coverage with skin autograft remains the golden standard of wound treatment. However, this type of treatment is not feasible or unlikely to succeed due to limited donor sites and wound characteristics of hot-crush injuries on hands. Thus, the composite grafting of acellular dermal matrix (ADM) and split-thickness skin graft (STSG) as a novel alternative method has been attempted. In this series, the results are presented to demonstrate the feasibility and effectiveness of the use of one-stage procedure for early reconstruction in hand hot-crush injuries. Methods. All consecutive patients with hand hot-crush injuries, who underwent one-stage procedure of ADM and ultrathin STSG for soft tissue coverage at our institution from December 2018 to November 2019, were retrospectively analyzed. Wound dressings were opened on 7 days after operation to examine graft survival and complications. Patients were followed up for at least 9 months to evaluate their hand profiles. Results. Samples of 14 patients with a total of 23 wounds were involved in the study. Thirteen of the 23 third–fourth-degree wounds had varying degrees of tendon exposure. On 7 days postoperation, the composite grafts survived in 12 patients with minimal focal graft losses and liquefaction and necrosis in 2 patients, which achieved successful healing following new coverage of ultrathin STSG. All the wounds healed with hospital stays ranging from 9 days to 32 days (median: 24.5 days). At the final follow-up (from 9 months to 20 months), all patients achieved excellent or good total active motion grade and good scar quality (Vancouver scar scale scored 1–3) with no revision surgery. Conclusions. One-stage composite grafting of ADM and ultrathin STSG is a reliable alternative for early reconstruction in hand hot-crush injuries, which delivers good functional outcomes and a good cosmetic appearance.
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Erçalik, Tülay, Füsun ŞŞahin, Cem ErÇalik, Beril DoĞĞu, Serap Dalgiç, and Banu Kuran. "Psychometric characteristics of Duruoz Hand Index in patients with traumatic hand flexor tendon injuries." Disability and Rehabilitation 33, no. 17-18 (January 2011): 1521–27. http://dx.doi.org/10.3109/09638288.2010.533244.
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Aryan, Henry E., Arun P. Amar, Burak M. Ozgur, and Michael L. Levy. "Gunshot Wounds to the Spine in Adolescents." Neurosurgery 57, no. 4 (October 1, 2005): 748–52. http://dx.doi.org/10.1227/01.neu.0000175728.93653.b1.
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ABSTRACT OBJECTIVE: The incidence of spinal instability after penetrating gunshot wounds to the spine in adolescents is unknown. We describe our experience over a 15-year period. METHODS: Hospital records were reviewed retrospectively. After injury and emergency care, patients were transferred to a rehabilitation facility. Examinations were completed using the American Spinal Injury Association and Frankel scales on admission, discharge, and 6 and 12 months after injury. Severity of injury was described by: 1) degree of neurological damage, 2) degree of preserved neurological function, and 3) presence of instability. RESULTS: Sixty patients were identified with a mean age 15.6 years (± 2.7 yr). Twelve patients had cervical, 31 thoracic, and 17 lumbosacral injuries. No operative treatments were used in their care. Thirty-four patients had complete neurological deficits. Mean acute hospitalization was 21.1 days (± 22.8 d), and mean rehabilitation stay was 86.3 days (± 48.9 d), for a total hospitalization of 107.4 days (± 65.9 d). At 1 year, 19 patients were ambulatory and 53 were autonomous. Despite the presence of bony involvement in all, no evidence of spinal instability was noted on follow-up dynamic imaging. Even in two patients with apparent two-column disruption, no instability was noted. At 1-year follow-up, significant (nonfunctional) improvement was noted in the neurological examination (P < 0.0001). Improvements were most notable in those patients with cervical injuries, followed by thoracic and lumbar injuries. CONCLUSION: After penetrating gunshot wounds to the spine, patients at 1-year follow-up examinations have evidence of significant, but nonfunctional, improvement. No evidence of spinal instability was noted in this study, and no surgical intervention was required.
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Anderson, Jeffrey H., Qian Qiu, Anthony J. Deegan, Brianna Mills, Ruikang Wang, and Samuel P. Mandell. "93 Optical Coherence Tomography: A New Imaging Technique for Burn Injuries." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S61. http://dx.doi.org/10.1093/jbcr/iraa024.096.
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Abstract Introduction Accurate assessment of burn depth and healing time remains elusive. As a result, some patients may wait weeks, through painful wound care only to have surgery. Others may have early surgery on wounds that may have healed with a good outcome. Expert opinion remains the most common method of wound evaluation. We sought to evaluate if Optical Coherence Tomography (OCT) with Microangiography (OMAG) can predict burn wound healing. Methods We prospectively enrolled a cohort of 17 burned subjects whose attending physician initially evaluated the depth of the wound as indeterminate. Burn wounds were scanned on enrollment and weekly, until healed or grafted, using a clinical prototype swept source OCT with OMAG capability. Wounds were also assessed by the attending physician for depth of injury and healing time. Wounds were photographed at the time of each scan. OCT and OMAG scans were then used to quantitatively determine blood vessel depth and density within the wound. Univariate regression with clustering and panel effects evaluated the association with healing time. Photographs and scans of each wound from all time points were evaluated by 5 blinded assessors (four surgeons and an OCT engineer) for time to wound healing. Kappa was used to measure the interrater reliability between evaluators. Results The mean patient age was 46 years with a mean burn size of 10% body surface area. Fourteen patients ultimately healed their wounds. Three patients underwent excision and grafting. There was no significant association between vessel depth or density and healing time (Table). Similarly, vessel depth was not predictive of the need for surgery. However, vessel density £ 0.255 perfectly predicted the need for surgery. There was no agreement between evaluators regarding predicted healing looking at OCT and OMAG scans (Kappa 0.003). There was moderate agreement between evaluators predicting healing from photos (Kappa 0.047). Conclusions This preliminary data demonstrates that quantitative OCT/OMAG data shows promise in predicting which patients undergo surgical therapy. Variation of healing estimates from provider image assessment support the best use of this tool as a quantitative measure. Larger studies are needed to explore these findings and the role of this technology. Applicability of Research to Practice OCT/OMAG is a quantitative tool that shows promise in predicting which patients undergo surgical therapy.
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Marjanovic, Zoran, Maja Raicevic, Dragoljub Zivanovic, Danijela Djeric, and Nikola Bojovic. "Hand injuries in children and adolescents." Srpski arhiv za celokupno lekarstvo 149, no. 5-6 (2021): 311–15. http://dx.doi.org/10.2298/sarh181121016m.
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Introduction/Objective. The objective of the study was to determinate which groups in the population of children are most prone to hand injuries and to identify the causes of the injuries with the aim of further developing better means of severe injuries prevention that can lead to invalidity. Methods. A retrospective epidemiological study was carried out, and included all children with hand injuries admitted to our hospital between January 1, 2010 and December 31, 2017; The data were collected and analyzed statistically using SPSSR. Significance was defined as p < 0.05. Results. The total number of patients was 254, 202 boys and 52 girls, with a mean age for both sexes 10.13 years (range1?17). The majority of patients were from an urban population 56.7% and 43.3% were from a rural area. Regarding the month in the year when the injury occurred, there were two peaks, in January and in May. The right hand was more affected, 53.2%, than the left, 45.6%, and both hands were affected in 1.8% of cases. Isolated soft tissue injuries (skin, muscles, tendons) were present in 59% of cases, isolated bone injuries (phalangeal and metacarpal bone fractures) in 15.3%, and both soft tissue and bone injuries in 25.7% of cases. The little finger was the most affected, followed by the long finger and thumb, index and ring finger, respectively. The most serious injuries were from explosive wounds caused by firecrackers and handling agricultural tools and engines. Conclusion. Hand injuries in childhood are common and can have devastating consequences. Developing prevention program by raising awareness about this issue is of vital importance.
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HAESE, JULIA B. "Psychological Aspects of Hand Injuries their Treatment and Rehabilitation." Journal of Hand Surgery 10, no. 3 (October 1985): 283–87. http://dx.doi.org/10.1016/s0266-7681_85_80044-9.
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Psychological factors related to the treatment and rehabilitation of hand-injured patients were identified by interviewing of thirty patients under treatment. Findings were compared with those reported in the literature. Concern for inactivity, desire to return to work, and effort toward recovery were identified as significantly common factors; pain and fear of disfigurement were not. Patients perceived themselves as making the greatest effort toward recovery but not that this was the most important factor in the recovery process. Responsibility varied significantly among the early, middle, and final phases of treatment. The results of the investigation were discussed in relation to hand-rehabilitation and implications for counselling and occupational therapy.
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ROGACHEFSKY, R. A., C. G. MENDIETTA, P. GALPIN, and E. A. OUELLETTE. "Reverse Radial Forearm Fascial Flap for Soft Tissue Coverage of Hand and Forearm Wounds." Journal of Hand Surgery 25, no. 4 (August 2000): 385–89. http://dx.doi.org/10.1054/jhsb.2000.0410.
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Six patients with severe hand and forearm injuries involving open wounds and exposed structures were treated with reverse radial forearm fascial flaps and split-thickness skin grafts for soft tissue cover. There were five men and one woman aged between 16 and 36 years. Injuries included soft tissue avulsion on the dorsum of the hand and fingers, extensive flexor and extensor tendon damage, multiple phalangeal fractures, a grade IIIB open dislocation of the index to little carpometacarpal joints, a grade III open metacarpal fracture and a finger amputation. The average wound size was 9 cm in length and 7 cm in width. The mean duration of follow-up was 12 months (range, 5–20 months). All flaps healed well, and all patients were satisfied.
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MALIKOV, M. KH, K. P. ARTYKOV, G. D. KARIM-ZADE, A. A. DAVLATOV, D. D. DZHONONOV, and N. A. MAKHMADKULOVA. "DELAYED RECONSTRUCTIVE SURGERY FOR SEVERE HAND INJURIES." AVICENNA BULLETIN 24, no. 3 (2022): 404–12. http://dx.doi.org/10.25005/2074-0581-2022-24-3-404-412.
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Objective: To justify the use of delayed reconstructive interventions in severe complex hand injuries. Methods: The results of delayed reconstructive surgery in 22 patients with a severe complex hand injury for the period from 2010 to 2022 were analyzed. Most of the patients (81.8%) were admitted within 4 to 7 days after injury and received primary care in non-specialized institutions. The age of patients ranged from 17 to 45 years, with the mean age being 28.3 years. They had crush hand injuries with an incomplete avulsion of all fingers (3), II-V fingers (6), II-IV fingers (9), and II-III fingers (1), in three cases, an extensive wound defect of the hand was accompanied by complete amputation of II-III (1) and II-IV fingers (2). The concomitant defect of integumentary tissues had an extended character in case of damage by electric machines (101.2±3.6 cm2) and gunshot wounds (92.1±3.7 cm2). Results: The rationale for the use of delaying tactics was the severity of the injury, the time point of admission, and the decompensation of blood circulation in the fingers in 8 out of 16 admitted patients. All the patients underwent delayed necrosectomy with preservation of the maximum length of viable bone fragments. An extensive defect of the integumentary tissues was covered with a skin-fascial inguinal flap. The second stage performed was one-step directed nerve implantation with phalangization of the transplanted flap (6). For reinnervation, the superficial branch of the radial nerve was most often used as a donor’s nerve. The restoration of sensitivity was registered 3 months after the surgery. Conclusion: As a result of multi-stage complex reconstructive plastic surgery performed on a primary-delayed basis for severe complex hand and fingers injuries, followed by correcting operations to improve the sensory input of the residual segments; the adequate functional outcome was obtained with an improvement in the patient’s quality of life. Keywords: Severe hand injury, hand defects, hand reconstruction, flaps, neurotization.
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Coffey, Rebecca, and Rachel Penny. "556 The Use of a Concentrated Surfactant Based Gel to Promote Burn Wound Healing." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S126—S127. http://dx.doi.org/10.1093/jbcr/irab032.206.
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Abstract Introduction Strategies to remove necrotic tissue from burn wounds include excisional and non-excisional debridement. Alternative treatments could promote burn wound healing while minimizing patient discomfort and the need for surgery. We evaluated the usage of a concentrated surfactant gel (CSG) to promote burn wound healing in those with indeterminate depth and full thickness burn injuries. Methods An IRB approved retrospective study was conducted during a 10-patient new product trial period with enrollment between September and October 2019. Patients included in this study had indeterminate or full thickness burn wounds and were treated with a concentrated surfactant-based gel. Patients with non-burn diagnoses were excluded. Data collected included demographic information, injury descriptors, and additional burn wound characteristics. Results A total of 10 patients were included in this study as part of a new product trial. The subjects were 80% male with an average TBSA of 7.5%. 40% had indeterminate and 60% had full thickness burn wounds. Prior to initiation of the CSG, the burn wounds had been open for an average of 41 days. There were no infections or complications with usage of the CSG. 90% of patients reported less pain than the standard of care topical agents for burns. Average duration of treatment with the CSG until healing was 28 days. After usage of the CSG, no patients required surgery. Conclusions Our findings support the usage of a concentrated surfactant-based gel in patients with burn wounds. Patients reported decreased pain during dressing changes and ease of use compared to the standard topical agent in burn care. It also prevented surgical debridement in those with indeterminate and full thickness burn injuries.
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Zolotov, Aleksandr Sergeevich, Yu A. Zolotova, A. S. Zolotov, and Yu A. Zolotova. "Use of Vicrуl Rapide in Hand and Upper Extremity Surgery." N.N. Priorov Journal of Traumatology and Orthopedics 17, no. 4 (December 15, 2010): 80–83. http://dx.doi.org/10.17816/vto201017480-83.
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Quick-Absorbable Suture Vicryl Rapide was used at surgical treatment of 112 patients with various injuries and diseases of the hand and upper extremity for wounds closure. Wounds were closed by intradermal (34 patients) and external (78) sutures. Time of ligatures resorption and loss of strength as well as local response of tissues to suture material were analyzed in post-operative period. Complications that developed in 2 (1.8%) cases were not specific to Vicryl Rapide. External knots of intradermal suture were easily removed in all patients on day 14 after surgery. In 72 patients with external sutures complete loss of ligatures strength was noted during the period from 13th to 21st postoperative day (mean in 15.8±2.3 days). No local tissue reaction was observed. In external sutures the time of ligatures resorption and loss of strength was slightly higher than indicated in instruction. Use of Vicrуl Rapide in hand and upper extremity surgery is effective and safe.
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WATTS, A. M. I., M. GREENSTOCK, and R. P. COLE. "Outcome Following the Rehabilitation of Hand Trauma Patients." Journal of Hand Surgery 23, no. 4 (August 1998): 485–89. http://dx.doi.org/10.1016/s0266-7681(98)80128-9.
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Objective measures of hand function have been used to assess the outcome of rehabilitation following trauma. However, subjective assessments of function have been avoided by clinicians due to the difficulty in proving their validity and reliability. We have developed a subjective hand function scoring system (HFS), based on an activities of daily living assessment, which is used in planning and monitoring progress through rehabilitation. The HFS for 64 traumatic hand injuries were assessed on admission and discharge, and a significant improvement was found. There was a positive correlation between the HFS on admission and both the severity of injury, and the length of time off work. This scoring system is not validated, but this study illustrates the use of subjective functional scoring systems in the planning, delivery and evaluation of rehabilitation.
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BULSTRODE, N. W., N. BURR, A. L. PRATT, and A. O. GROBBELAAR. "Extensor Tendon Rehabilitation a Prospective Trial Comparing Three Rehabilitation Regimes." Journal of Hand Surgery 30, no. 2 (April 2005): 175–79. http://dx.doi.org/10.1016/j.jhsb.2004.10.016.
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Forty-two patients with 46 complete extensor tendon injuries were prospectively allocated to one of three rehabilitation regimes: static splintage; interphalangeal joint mobilization with metacarpophalangeal joint immobilization or; the “Norwich” regime. All 42 patients were operated on by one surgeon and assessed by one hand therapist. At 4 weeks the total active motion in the static splintage group was significantly reduced but by 12 weeks there was no difference between the regimes. There was no difference in total active motion between the repaired and uninjured hand at 12 weeks, with all patients achieving good or excellent results. However, grip strength at 12 weeks was significantly reduced compared to the uninjured hand after static splintage. There was no difference in hand therapy input between the regimes.
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Obradovic-Tomasev, Milana, Mladen Jovanovic, Nada Vuckovic, and Aleksandra Popovic. "Fungal infections in corn picker hand injury." Srpski arhiv za celokupno lekarstvo 144, no. 1-2 (2016): 52–55. http://dx.doi.org/10.2298/sarh1602052o.
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Introduction. Hand injuries caused by corn pickers are relatively rare but in most cases extensive, with massive tissue destruction. Severe wounds sustained during agricultural work are contaminated, with high incidence of infection. Objective. The aim of the study was to determine the frequency and type of fungal infection in corn picker injuries and their impact on the course and outcome of treatment. Methods. Corn picker hand injuries for the period 2006-2012 were analyzed. After setting up clinical suspicion, direct examination of repeated swabs and histopathological analysis of biopsy material were done in order to detect fungi. Results. From the total number of 60 patients, there was a fungal infection in nine of them (which makes 15% of the total number of patients). Aspergillus spp. was isolated in seven patients, Candida spp. in three, and Mucor spp. in one patient. None of the patients had increased risk factors for developing a fungal infection. In most cases, there was loss of graft and tissue necrosis in previously normally looking wound, after seven or more days. All patients were treated with repeated surgical debridement and concomitant parenteral and topical application of appropriate antifungal agents. There was no need for reamputation in any patient. Conclusion. A high degree of suspicion and a multidisciplinary approach are needed for early diagnosis of fungal infection. Confirmation of diagnosis and the initiation of surgical and appropriate antifungal therapy are essential for a successful outcome.
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OTENE, Cletus I., Joyce E. IKUBOR, Odisi O. IDIAKHOA, and Christopher O. OTENE. "THE BURDEN OF HAND INJURIES IN DELTA STATE, NIGERIA." International Journal of Forensic Medical Investigation 2, no. 1 (March 31, 2016): 20. http://dx.doi.org/10.21816/ijfmi.v2i1.16.
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BACKGROUND: The hand is a very vital part of the human body in structure and function. Injuries to the hand can be very devastating affecting individual and national productivity because of inability of the usually active workforce to use their hands adequately. This study is therefore, to document the pattern of hand injuries and the disabilities from such injuries in our environment.METHODOLOGY: This was a retrospective review of patients who presented and were managed for hand injuries at the outpatient clinics of two tertiary hospitals in Delta State of Nigeria between January 2013 and December 2015. The admission and operation registers as well as case notes of patients treated at the units were the sources of the information. Ethical approval was obtained from the Ethics committee of the Teaching Hospital. The results were analysed using SPSS version 20. Descriptive statistics were used to represent frequency distribution. RESULTS: A total of 102 patients were managed in the 2 tertiary hospitals in the state in the study period. 63.7% were males and 36.3% females. The age range most commonly affected was the 20 – 29 years (35.3%) followed by 30 – 39 years and 10 – 19 years at 15.7% each. Majority were students (38.2%) followed by civil servants (19.6%). Commercial motorcyclists, artisans and machinery operators lumped together made up 15.7%. The commonest cause of injury was machete/ knife cuts and stab wounds (24.5%), followed by RTA (20.6%), burns (14.7%) and machinery accidents (13.7%). On the types of injuries sustained, deep lacerations (injuring tendons and nerves) were the commonest (33.3%). Contractures secondary to burn injuries were next (13.7%) whereas, 11.8% had crush injuries as well as another 11.8% with fractures/ dislocations. 61.8% of patients had good outcomes following treatment while 38.2% had outcomes adjudged as poor or fair.CONCLUSION: Hand injuries are disabling and may deny the citizenry and the nation of useful workforce and productivity. Hand trauma can be prevented by encouraging civil societies and providing safe home and workplace environments. KEY WORDS: Burden; pattern; hand injuries; disabilities.
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Eftekhary, Nima, Kenneth Nwosu, Eric McCoy, Dudley Fukunaga, and Kevin Rolfe. "Overutilization of bracing in the management of penetrating spinal cord injury from gunshot wounds." Journal of Neurosurgery: Spine 25, no. 1 (July 2016): 110–13. http://dx.doi.org/10.3171/2015.12.spine151022.
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OBJECTIVE Penetrating gunshot wounds (GSWs) to the spinal column are stable injuries and do not require spinal orthoses or bracing postinjury. Nonetheless, a high number of GSW-related spinal cord injury (SCI) patients are referred with a brace to national rehabilitation centers. Unnecessary bracing may encumber rehabilitation, create skin breakdown or pressure ulcers, and add excessive costs. The aim of this study was to confirm the stability of spinal column injuries from GSWs and quantify the overutilization rate of bracing based on long-term follow-up. METHODS This retrospective cohort study was performed at a nationally renowned rehabilitation center. In total, 487 GSW-related SCI patients were transferred for rehabilitation and identified over the last 14 years. Retrospective chart review and telephone interviews were conducted to identify patients who were braced at the initial treating institution and determine if late instability, deformity, or neurological deterioration resulted in secondary surgery or intervention. In addition, 396 unoperated patients were available for analysis after 91 patients were excluded for undergoing an initial destabilizing surgical dissection or laminectomy, thereby altering the natural history of the injury. All of these 396 patients who presented with a brace had bracing discontinued upon reaching the facility. RESULTS In total, 203 of 396 patients were transferred with a spinal brace, demonstrating an overutilization rate of 51%. No patients deteriorated neurologically or needed later surgery for spinal column deformity or instability attributable to the injury. All patients had stable injuries. The patterns of injury and severity of neurological injury did not vary between patients who were initially braced or unbraced. The average follow-up was 7.8 years (range 1–14 years) and the average age was 25 years (range 10–62 years). CONCLUSIONS The incidence of brace overutilization for penetrating GSW-related SCI was 51%. Long-term follow-up in this study confirmed that these injuries were stable and thus did not require bracing. No patients deteriorated neurologically, whether or not they were initially braced. The unnecessary use of spinal orthoses increases costs and patient morbidity. Reeducation and dissemination of this information is warranted.
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Carter, Jeffrey E., James H. Holmes, Kevin N. Foster, David J. Smith, and Jeffrey W. Shupp. "537 Autologous Skin Cell Suspension for the Treatment of Small (≤10% TBSA) Mixed-Depth Burns." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S116—S117. http://dx.doi.org/10.1093/jbcr/irab032.187.
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Abstract Introduction Split-thickness skin grafts (STSGs) have been the standard of care for many decades. Despite their widespread use, STSGs frequently fail. Autologous skin cell suspension (ASCS) is an FDA approved point of care regenerative medicine technology that reduces donor skin requirements without compromising clinical outcomes. ASCS allows for early treatment and less donor skin harvested that may be useful for hard-to-treat anatomical locations, in compromised patients that have risks for impaired wound healing, or elderly patients with thinner skin. We examined ASCS treatment as an adjunct to meshed autografts in adults with small mixed-depth/full-thickness burns. Methods We obtained IRB-approval for a prospective, multi-center, uncontrolled observational study that allowed continued access to ASCS before FDA approval (ClinicalTrials.gov Identifiers: NCT03333941). Subjects with mixed-depth/full-thickness injuries that required skin grafting with a minimum treatment area of 320 cm2 and burns ranging from 5–50% TBSA were eligible for study enrollment. Our analyses included only patients >18 years of age and ≤10% TBSA mixed-depth/full-thickness injuries that had completed the trial. All subjects had ≥1 burn wounds treated with meshed autografts (2:1–4:1) in combination with ASCS. Healing outcomes were accessed following ASCS treatment by direct visualization of each individual wound and included healing, scar outcomes, and safety data. Results Analyses included 20 subjects older than 18 years of age with ≤10% TBSA mixed-depth/full-thickness injuries. Of these, compromised wound healing was seen in 50.0% of subjects. Burn wounds with ≥90% re-epithelialization increased over time, with 62%, 80%, and 100% of wounds achieving closure at Weeks 1, 2, and 8, respectively. Similar results were seen in subjects with comorbidities known to affect wound healing and in elderly subjects despite their risks for impaired healing. Total POSAS patient (37.8 and 35.4) and observer scores were comparable (23.3 and 18.4) at Weeks 12 and 24. Safety events were typical for this patient population, and no serious adverse events occurred for any of the wounds. Conclusions This analysis provides additional information supporting the use of ASCS for the treatment of small, mixed-depth/full-thickness acute thermal burn injuries in adults, notably those with risk factors for impaired wound healing.
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AL-ANI, S. A., D. MOHAN, and A. J. PLATT. "Hand Surgery on Patients Who Are “High Risk” For Blood-Borne Viruses." Journal of Hand Surgery 31, no. 4 (August 2006): 426–31. http://dx.doi.org/10.1016/j.jhsb.2006.03.172.
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There is a risk of transmission of blood-borne viruses (BBV) to health-care workers when performing hand surgery on intravenous drug abusers and other patients known to have BBV. This review summarises methods and procedures that may be employed to help reduce this risk to a minimum. High-risk patients should be identified early and a non-invasive procedure considered. Only experienced staff should scrub and appropriate clothing should be worn. Sharp instrument use should be kept to a minimum and only instrument retraction and suturing should be employed. When possible, wounds should be closed with staples, glue or absorbable sutures. Appropriate steps must be taken to reduce the risk of injuries from sharp bone ends, K-wires and splash exposure during irrigation.
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Arcos Vera, Brenda, Felipe Alejandro López Silva, and Héctor Adolfo Morales Yépez. "Management and Treatment of Wounds by Projectile from a Firearm in Hand in the Plastic and Reconstructive Surgery Service of the Central Military Hospital in Two Years." Journal of Clinical Surgery and Research 2, no. 3 (July 29, 2021): 01–07. http://dx.doi.org/10.31579/2768-2757/016.
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Introduction: Gunshot wounds are a major cause of morbidity and lead to serious socioeconomic problems. Wounds often causing severe functional sequelae. Therefore, it is vitally important to provide proper management of these wounds. OBJECTIVES: Define the treatment of gunshot wounds at the Central Military Hospital in the period from March 2019 to March 2021. Material and Methods: It is a descriptive, retrospective, observational study, RESULTS: Patients who fulfilled the diagnosis presented 3 metacarpal fractures (27.27%), 2 metacarpal and phalangeal fractures (18.18%), 2 fractures of phalanges (18.18%), 1 carpal + metacarpal fractures (9.09%), 3 with injury only to skin cell tissue without evidence of fractures (27.27%). Therapeutic management: 3 patients received external fixator, 2 ORIF, 1 external fixator + ORIF + inguinal flap + bone graft, 1 external fixator + bone graft + ORIF, 0 wound closure, 4 management with wet therapy, CONCLUSIONS: The wounds By firearm in hand are frequent injuries, which merit immediate treatment. This depends on the complexity of the injury for a speedy recovery and integration into the workplace.
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Hongaiah, Deepak, Dinesh Kumar Sathanantham, and Spurthi Sanganbhonia. "Angry young man syndrome: anger based dominant hand injuries." International Surgery Journal 5, no. 12 (November 28, 2018): 3986. http://dx.doi.org/10.18203/2349-2902.isj20185031.
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Background: The incidence of self-inflicted anger related upper extremity injuries due to punching glass, involving dominant hand has increased in recent years even in our rural population of less than 1.5 million in District of Kolar, Karnataka, India. Although hospital stay is short, these patients require long term follow up, physiotherapy and occupational rehabilitation.Methods: This study is a case series involving a a retrospective analysis from June 1, 2015, to July 31, 2017. Our study involved only glass cut injury following an angry intention.Results: This study included 9 eligible patients who were all young male aged between 18 to 28 years (median age: 23.4 years) who had triggering factor before punching the glass pane. All patients had tendon injuries, flexors (n=4), extensor (n=3), both (n=2), muscle injuries (n=1), median nerve (n=2), radial artery (n=3). All injuries required operative intervention. Mean hospital stay was 5.2 days. Mean rehabilitation period was 5.2 months.Conclusions: These types of injuries can be prevented by regular counseling for stress/anger management as a part of rehabilitation to prevent further recurrences.
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Helito, Camilo Partezani, Daniel Kamura Bueno, Pedro Nogueira Giglio, Marcelo Batista Bonadio, José Ricardo Pécora, and Marco Kawamura Demange. "NEGATIVE-PRESSURE WOUND THERAPY IN THE TREATMENT OF COMPLEX INJURIES AFTER TOTAL KNEE ARTHROPLASTY." Acta Ortopédica Brasileira 25, no. 2 (April 2017): 85–88. http://dx.doi.org/10.1590/1413-785220172502169053.
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ABSTRACT Objective: To present an experience with negative-pressure wound therapy (NPWT) in the treatment of surgical wounds in patients treated for infections after total knee arthroplasty (TKA) with or without dehiscence and prophylaxis in wounds considered at risk of healing problems. Methods: We prospectively evaluated patients with TKA infection with or without surgical wound dehiscence and patients with risk factors for infection or surgical wound complications treated with Pico(r) device for NPWT in addition to standard treatment of infection or dehiscence in our institution. We considered as an initial favorable outcome the resolution of the infectious process and the closure of the surgical wound dehiscences in the treated cases and the good progression of the wound without complicating events in the prophylactic cases. Results: We evaluated 10 patients who used Pico(r) in our service. All patients had a favorable outcome according to established criteria. No complications were identified regarding the use of the NPWT device. The mean follow-up of the patients after the use of the device was 10.5 months. Conclusion: The NPWT can be safely used in wound infections and complications following TKA with promising results. Long-term randomized prospective studies should be conducted to prove its effectiveness. Level of Evidence IV, Case Series.
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Abbas, Paulette, Mia Choe, Elika Ridelman, Beth A. Angst, Justin D. Klein, and Christina M. Shanti. "737 Treadmill Friction Hand Injuries in the Pediatric Patient." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S200—S201. http://dx.doi.org/10.1093/jbcr/iraa024.320.
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Abstract Introduction Pediatric friction hand injuries are prevalent, likely due to the increasing presence of home exercise equipment. While friction injuries often appear deeper on initial assessment, not all are treated surgically during the acute phase. We sought to characterize our experience with outcomes based on acute (< 30 days) surgical intervention compared to delayed intervention. Methods Patients were queried from a single institution, verified pediatric burn center database. A retrospective chart review of pediatric patients (< 18 years) over a 5 year period was performed. Data collected included demographics, treatment methods (acute vs. delayed), dressing type, scar management, and follow-up. Outcomes included additional surgical and non-surgical adjuncts to treat the sequela of injury. Results Our institution treated 23 treadmill hand injuries over the 5-year period. There was a slight predominance of female (n=13, 57%) vs. male (n=10, 43%) patients. Median age at injury was 2 years (IQR 1–3). Thirteen patients (57%) sustained an injury equivalent to a second degree burn and ten (43%) to third degree. Injuries were initially treated with silvadene (n=14) and/or xeroform (n=21). Involvement of left and right hands were equally divided and all injuries involved the digits. The median number of digits involved was 2 (range 1–4). The most commonly injured digits were the middle and ring fingers (19 each). Average length of stay was 14 hours. All but one patient followed-up with a median number of 4 clinic visits. All of these patients were reported as healed at time of last follow-up. Median time to healing was 31.5 days (IQR 29 – 58). Overall, 4 patients (17%) underwent acute surgical intervention with a median of 7 days from injury (IQR 1.75–13.5). Of these 4 patients, 2 (50%) required additional operations for scar management and 2 (50%) required non-surgical management. Of the 19 (83%) who did not undergo early surgical management, only 1 patient (6%) required a Z-plasty, 12 (63%) were managed with non-surgical intervention and 6 (31%) needed no further treatment after healing. Conclusions Pediatric friction hand injuries often affect multiple digits and lead to a median of 4 clinic visits. Our data suggest that early surgical intervention in this cohort did not minimize future surgical procedures or non-surgical management. Rather, delayed intervention appears to allow for fewer surgical procedures and similar non-surgical management. Larger studies are required to validate this finding; however, this data suggests that continued initial management with a combination of silvadene and xeroform may be a safe option. Applicability of Research to Practice Our study provides guidance in the evaluation and treatment of pediatric treadmill friction injury. This data supports delaying surgical interventions on these seemingly deep hand injuries.