Journal articles on the topic 'Leg Wounds and injuries Treatment'
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1
Golubovic, Zoran, Vojkan Stanic, Srbobran Trenkic, Predrag Stojiljkovic, Goran Stevanovic, Aleksandar Lesic, Ivan Golubovic, Dragan Milic, Aleksandar Visnjic, and Stevo Najman. "Penetrating injury of the lungs and multiple injuries of lower extremities caused by aircraft bombs splinters." Vojnosanitetski pregled 67, no. 8 (2010): 688–93. http://dx.doi.org/10.2298/vsp1008688g.
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Introduction. Injuries caused by aircraft bombs cause severe damages to the human body. They are characterized by massive destruction of injured tissues and organs, primary contamination by polymorph bacterial flora and modified reactivity of the body. Upon being wounded by aircraft bombs projectiles a victim simultaneously sustains severe damages of many organs and organ systems due to the fact that a large number of projectiles at the same time injure the chest, stomach, head and extremities. Case report. We presented a patient, 41 years of age, injured by aircraft bomb with hemo-pneumothorax and destruction of the bone and soft tissue structures of the foot, as well as the treatment result of such heavy injuries. After receiving thoracocentesis and short reanimation, the patient underwent surgical procedure. The team performed thoracotomy, primary treatment of the wound and atypical resection of the left lung. Thoracic drains were placed. The wounds on the lower leg and feet were treated primarily. Due to massive destruction of bone tissue of the right foot by cluster bomb splinters, and impossibility of reconstruction of the foot, guillotine amputation of the right lower leg was performed. Twelve days after the wounding caused by cluster bomb splinters, soft tissue of the left lower leg was covered by Tirsch free transplantant and the defect in the area of the left foot was covered by dorsalis pedis flap. The transplant and flap were accepted and the donor sites were epithelized. Twenty-six days following the wounding reamputation was performed and amputation stump of the right lower leg was closed. The patient was given a lower leg prosthesis with which he could move. Conclusion. Upon being wounded by aircraft bomb splinters, the injured person sustains severe wounds of multiple organs and organ systems due to simultaneous injuries caused by a large number of projectiles. It is necessary to take care of the vital organs first because they directly threaten the life of the wounded patient. Despite adequate surgical treatment of war wounds of the feet, because of massive defect of bone and soft tissue, amputation may be the only rational solution of the treatment. The resection of the lung may be successful method for the severe destruction of the lung.
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Hamrahi, Victoria, Michael R. Hamblin, Walter Jung, John B. Benjamin, Kasie W. Paul, Alan J. Fischman, Ronald G. Tompkins, and Edward A. Carter. "Gram-Negative Bacterial Infection in Thigh Abscess Can Migrate to Distant Burn Depending on Burn Depth." Interdisciplinary Perspectives on Infectious Diseases 2012 (2012): 1–6. http://dx.doi.org/10.1155/2012/567140.
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Sepsis remains the major cause of death in patients with major burn injuries. In the present investigation we evaluated the interaction between burn injuries of varying severity and preexisting distant infection. We used Gram-negative bacteria (Pseudomonas aeruginosaandProteus mirabilis) that were genetically engineered to be bioluminescent, which allowed for noninvasive, sequential optical imaging of the extent and severity of the infection. The bioluminescent bacteria migrated from subcutaneous abscesses in the leg to distant burn wounds on the back depending on the severity of the burn injury, and this migration led to increased mortality of the mice. Treatment with ciprofloxacin, injected either in the leg with the bacterial infection or into the burn eschar, prevented this colonization of the wound and decreased mortality. The present data suggest that burn wounds can readily become colonized by infections distant from the wound itself.
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Weiss, Janet M. "Treatment of Leg Edema and Wounds in a Patient With Severe Musculoskeletal Injuries." Physical Therapy 78, no. 10 (October 1, 1998): 1104–13. http://dx.doi.org/10.1093/ptj/78.10.1104.
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Golubović, Ivan, Predrag Stojiljković, Mihailo Ille, Milan Radojković, Nemanja Jovanović, Milan Lazarević, Ivana Golubović, et al. "Disconnection of arterial collateral as the cause of lower leg amputation after conquassation caused by petrol tiller: A case report." Timocki medicinski glasnik 47, no. 2-3 (2022): 119–25. http://dx.doi.org/10.5937/tmg2202119g.
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Introduction. Leg conquassation caused by petrol tiller is one of the most severe injuries in bone and joint traumatology. Firm strokes by sharp tiller blades produce strong force that easily damages both soft tissues and bones. Since tillers are used in soil processing, the wounds are highly contaminated with dirt and fertilizers, hence the anaerobic spore-forming bacilli, such as tetanus and gas gangrene pathogens. Case report. This paper presents the treatment of a 69 years old man with chronic arterial insufficiency of the lower extremities who suffered severe injury of the lower leg (IIIB open tibial fracture according to Gustillo) by petrol tiller while performing agricultural work. Due to the absence of pulsations, Multislice CT angiography and arteriography were performed. Arteriography of the injured leg confirmed chronic occlusion of the anterior tibial artery and numerous stenotic lesions of the peroneal and posterior tibial arteries. Posterior tibial artery was chronically occluded in its distal part and connected to the foot with moderately developed collateral arteries which provided the viability of the injured leg. Despite undertaken basic principles of treatment of this serious injury (primary surgical treatment of wounds, external fixation, reconstruction of soft tissue, antibiotic and anti-tetanus prophylaxis) due to infection and gangrene the treatment ended with lower leg amputation. Conclusion. Leg amputation can be expected in this type of injuries in cases of extensive destruction of tissue in the field of existing chronic arterial insufficiency in elderly patients, even in the absence of injury of main blood vessels due to traumatic disconnection of collateral in such patients.
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Al Junaid, Abdulsalam Mohamed. "Peculiarities of treatment of patients with gunshot fractures of the leg in Yemen." N.N. Priorov Journal of Traumatology and Orthopedics 9, no. 2 (February 2, 2022): 80–83. http://dx.doi.org/10.17816/vto99823.
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Retrospective analysis of treatment of 232 wounded with gunshot crus fractures was presented. All patients were treated at Jemen Central Hospital ALTAWRA (Sana) from 1966 to 2000. Out of all patients 94% had missile wounds and 6%) comminuted wounds. All wounded were admitted to Hospital during 24 hours after injury. Peculiarities of wound treatment were the following: injured limb after application of author's stabilizing reposition device if necessary was washed by soap-saline solution. Primary debridement was more active compared to classic one and included removal of small osseous fragments and resection of large osseous fragment ends. In 66%) of wounded no complications were observed during postoperative period and healing by first intention was noted. In 8,4%) of patients healing by granulation occurred. In 15% of cases wound suppuration was limited by soft tissues. Osteomyelitis was diagnosed in 8,6% of patients. In 2% of cases crus gangrene followed by vascular thrombosis was developed.
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Lychagin, A. V., A. A. Gritsyuk, and V. S. Korytin. "Long-term complications of tibial injury." Grekov's Bulletin of Surgery 181, no. 1 (December 28, 2021): 80–87. http://dx.doi.org/10.24884/0042-4625-2022-181-1-80-87.
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The OBJECTIVE of the study, based on our own experience, was to determine the frequency, structure and specificity of long-term complications after replacement of soft tissue and leg bones defects, and to develop treatment tactics.METHODS AND MATERIALS. A retrospective study of the case of 53 patients who underwent treatment in the trauma department of the hospital for the period 2000 to 2008 was carried out. These patients had soft tissue wounds and circular defects of the tibial diaphysis because of severe open injuries of 17 (32.1 %) and gunshot wounds to the lower leg (36 (67.9 %). Patients underwent replacement of soft tissue and lower leg bones using the Ilizarov method and microsurgical reconstruction free flaps. The analysis of treatment results was carried out.RESULTS. After the end of inpatient treatment, patients were dynamic observation carried out. 39 (73.6 %) of 53 patients sought medical help, as for various complications, the average long-term follow-up was (42.2±5.5) months. The most frequent complications were relapses of soft tissue inflammation in 13.7 % and osteomyelitis in 24.5 % of cases, non-inflammatory complications were tibia fractures (5.7 %) and pseudarthrosis (7.6 %). The analysis of treatment methods of these complications is presented.CONCLUSION. Simultaneous replacement of extensive leg defects with a free vascularized flap and Ilizarov's distraction osteogenesis creates favorable conditions for wound healing and tibial restoration, however, in the long-term period there are complications in the form of recurrent osteomyelitis, tibia fractures and pseudarthrosis, which require specialized treatment based on a detailed analysis of the pathology and the previous treatment method.
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Herawati, Leli. "TINGKAT PENGETAHUAN PASIEN TENTANG PERAWATAN LUKA DIABETES MELITUS DI RUMAH SAKIT PTPN II BANGKATAN BINJAI TAHUN 2016." Jurnal Riset Hesti Medan Akper Kesdam I/BB Medan 1, no. 2 (December 1, 2016): 110. http://dx.doi.org/10.34008/jurhesti.v1i2.71.
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Diabetic wounds are injuries that occur in patients with diabetics involving disorders of the peripheral and autonomic nerves. Every year more than one million people with diabetes lose one of their legs as one of the complications of diabetes, this means that every 30 seconds one leg is lost due to diabetes somewhere in the world. The purpose of this study was to determine the level of knowledge of patients in the treatment of diabetes mellitus wounds in PTPN II Hospital Binjai Departure in 2016. The method of this study was descriptive observational. The population in this study were all patients treated at the Women's Room at PTPN II Bangkat Binjai Hospital, totaling 20 people. The sample in this study amounted to 10 people with accidental sampling techniques. The results of this study indicate that the Knowledge Level of Patients About Diabetes Wound Care in the Women's Room of PTPN II Hospital Binjai Departure in 2016 which is interpreted is good knowledge as many as 6 people (60%), enough as many as 2 people (20%) and less than 2 people (20%). 3. It is expected that patients will be able to prevent Diabetes Injuries by controlling blood glucose, using footwear, treating toenails, foot care and foot exercises. If Complications with Diabetes Injuries have occurred, the patient is expected to be able to treat diabetic wounds properly.Keywords: Patient Knowledge, Diabetes Melitus Wound Care
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Gonzalez, Gilberto A., Christopher Castagno, Jordan Carter, Brinda Chellappan, and Philippe Taupin. "Negative pressure wound therapy on complex extremity wounds requiring coverage with a meshed bilayer wound matrix: a retrospective analysis." Journal of Wound Care 31, Sup9 (September 1, 2022): S8—S15. http://dx.doi.org/10.12968/jowc.2022.31.sup9.s8.
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Objective: The treatment of complex extremity wounds is technically challenging. In this 5-year retrospective review, we compared the use of Integra Meshed Bilayer Wound Matrix (IMBWM; Integra LifeSciences, US) followed by a split-thickness skin graft (STSG) combined with negative pressure wound therapy (NPWT) versus IMBWM followed by STSG alone for the management of these wounds. Method: Data from patients undergoing management using IMBWM for a complex extremity wound coverage were collected. Results: Among the 109 patients studied, the wounds of 62 patients were managed using IMBWM and NPWT, and 47 were managed using IMBWM alone. The most common aetiology of these injuries was trauma. Wound size and location were similar for each group, ranging in size from 2–30cm2 and being primarily on the forearm, followed by the leg and arm. There was a significantly greater take of the IMBWM+STSG with NPWT (96.8%) compared to without NPWT (85.1%, p=0.03). There were significantly fewer reapplications of the dermal matrix required in the NPWT group (3.2%) versus the non-NPWT group (14.9%, p=0.03). There were significantly fewer postoperative complications, prior to STSG, in the NPWT group (3.2%) versus the non-NPWT group (14.9%, p=0.03). Conclusion: The combination of IMBWM with NPWT leads to a higher success rate, and can reduce the number of dermal matrix reapplications and postoperative complications, in the setting of complex extremity wounds. The use of IMBWM in combination with NPWT has the potential to improve both surgical procedures and patient outcomes in this setting.
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Golubovic, Ivan, Branko Ristic, Predrag Stojiljkovic, Milan Ciric, Ivana Golubovic, Zoran Radovanovic, Sladjana Petrovic, Nina Djordjevic, Zoran Golubovic, and Stevo Najman. "Results of open tibial fracture treatment using external fixation." Srpski arhiv za celokupno lekarstvo 144, no. 5-6 (2016): 293–99. http://dx.doi.org/10.2298/sarh1606293g.
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Introduction. Open lower leg fractures are the most common open fractures of the locomotor system and their treatment is associated with a number of complications. Objective. The aim of the paper was to present the results of the treatment of 68 patients with open lower leg fractures, as well as the complications that accompany the treatment of these fractures. Methods. In the analyzed group, there were 45 (66.18%) men and 23 (33.82%) women. The majority of patients - 33 (48.53%) of them - were injured in motor vehicle accidents, whereas 24 (35.29%) patients sustained injuries due to falls from heights. In two (2.94%) patients the cause of open tibial fractures was gunshot injuries. In the analyzed group, there were 18 (26.47%) type I open fractures, 21 (30.88%) type II open fractures, 19 (27.94%) type IIIA open fractures, seven (10.29%) type IIIB open fractures, and three (4.41%) type IIIC open fractures. Results. The tibial shaft fracture healed without serious complications in 50 (73.53%) patients, whereas in 18 (26.47%) patients we observed some complications. Nonunion was found in 10 (14.71%) patients, osteitis in four (5.88), malunion in two (2.94%) patients. Milder complications such as soft tissue pin tract infection developed in 13 (19.12%) patients, infection of the open fracture wound soft tissue was observed in four (5.88%) patients. Conclusion. Basic principles in the treatment of open lower leg fractures in this study are thorough primary open fracture wound treatment followed by the delayed wound closure, stable fracture fixation using unilateral external skeletal device, proper antibiotic treatment and tetanus prophylaxis. The results correlate with similar studies.
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Samoylenko, G. E., S. O. Zharikov, and R. P. Klimanskyi. "The «Propeller»–technique in plastic surgery of the extensive wounds of distal leg and the foot." Klinicheskaia khirurgiia 86, no. 3 (February 28, 2019): 27–31. http://dx.doi.org/10.26779/2522-1396.2019.03.27.
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Objective. To increase the efficacy of plastic surgery in treatment of the extensive soft tissue defects, applying “sparing” resection of the lower third of the shin and foot for consequences of mechanical and/or thermal trauma or infectious–necrotic processes.
Materials and methods. We conducted a retrospective evaluation of the “Propeller”–technique application for the elevation of the skin islet flaps on sural neurovascular pedicle in 11 patients, who underwent surgery between 2014 and 2017. The task for investigation was to eliminate the shin and foot defects, developed due to large–scale tissue damage. The Group 1 was organized for patients with the mine–blast trauma and the coal mine occupational injuries (2 patients followed in each category). Management of purulent–necrotic wounds (Group 2) was required in cases of amputation and resection of the foot due to either osteomyelitis (3 patients followed) or frostbites (4 patients followed).
Results. All the patients had an adequate vascular supply of the affected limbs, even in 3 patients from the Group II, who had only one artery preserved. In all cases a secondary surgical debridement, necrectomy and the soft tissue defect repair were performed during the same operation.
Conclusions. Using of the tegument tissues mobilization complex “Propeller”– technique is an effective instrument for sealing of deep complex defects of different etiology, localized in distal part of the lower extremity.
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Spitnale, Michael J., Candler G. Mathews, Allen J. Barnes, Zachary T. Thier, and J. Benjamin Jackson. "Epidemiology of Lower Leg Soft Tissue Injuries in High School Athletes." Foot & Ankle Orthopaedics 7, no. 1 (January 2022): 247301142110578. http://dx.doi.org/10.1177/24730114211057886.
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Background Annually there are an estimated 4.5 million sports- and recreation-related injuries among children and young adults in the United States. The most common sports-related injuries are to the lower extremities, with two-thirds occurring among children and young adults (age range 5-24 years). The objective is to describe the epidemiology of lower leg injuries across 27 high school (HS) sports over a 3-year period. Methods The Datalys Center for Sports Injury Research and Prevention provided lower leg injury data for 27 sports in 147 high schools for 2011-2012 through 2013-2014 academic years from National Athletic Treatment, Injury and Outcomes Network (NATION) HS Surveillance Program. Results The overall rate of lower leg injuries over this 3-year period was 1.70 per 10 000 acute events (AEs) (95% CI, 1.59-1.82). In men, the highest number of lower leg injuries was in football (n=181), but indoor track had the highest rate of injury at 2.80 per 10 000 AEs (95% CI, 2.14-3.58). In women, the highest number of lower leg injuries and the highest rate of injury were in cross-country (n=76) at 3.85 per 10 000 AEs (95% CI, 3.03-4.81). The practice injury rate was 0.91 times the competition injury rate (95% CI, 0.78-1.07). Conclusion An improved understanding of the most common sports in which lower leg injuries are seen may help direct appropriate resource utilization. Our data would suggest efforts toward prevention of these overuse injuries, especially in football, track, and cross-country may have the greatest impact on the health of student athletes. Level of Evidence: Level IV, case series.
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Swoboda, Laura. "A Retrospective Analysis of Clinical Use and Outcomes Using Viable Placental Membrane Allografts in Chronic Wounds." Wounds : a compendium of clinical research and practice 33, no. 12 (December 10, 2021): 329–33. http://dx.doi.org/10.25270/wnds/2021.329333.
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Introduction. Viable placental membrane (vPM) has been shown to decrease time to healing, adverse wound events, and wound-related infections. Wound research exclusion criteria commonly exclude wound types other than diabetic foot ulcers and venous leg ulcers (VLUs), comorbidities including peripheral arterial disease (PAD) and uncontrolled diabetes mellitus (DM), and wounds with exposed bone or tendon. Objective. This retrospective research study evaluated the clinical use and outcomes of the vPM with living mesenchymal stem cells used in chronic wound management in the community hospital outpatient department setting with the goal of comparing real-world use and outcomes of the product with use and outcomes described in the chronic wound literature. Materials and Methods. A retrospective analysis on vPM treatments at a Wisconsin academic health system’s community hospitals. Participants included all patients who received vPM therapy between July 1, 2016, and August 21, 2019. Results. A total of 89 patients received vPM treatment during the study period (mean age, 70 years; 69% male [n = 61], 31% female [n = 28]). Wound types were 54% diabetic or neuropathic foot ulcers (n = 48), 17% VLUs (n = 15), 7% pressure injuries (n = 6), and 22% atypical wounds (n = 20). The average wound duration prior to vPM initiation was 104 days. Average wound size at presentation was 6.9 cm2. Of study participants 54% had PAD (n = 48), 63% had DM (n = 56), 33.7% had DM and PAD (n = 30), and 17% had exposed bone or tendon (n = 15). Average adjusted time to healing after initiation of vPM was 81.2 days. The percentage of wounds healed 12 weeks after initiation of vPM treatment was 57%. Conclusions. Effectiveness of vPM observed in controlled trials also was observed in this real-world study on vPM for multiple wound types, patients with comorbidities including PAD and uncontrolled DM, and wounds with exposed bone or tendon. Results of this study were not statistically different from those reported in the literature. More randomized controlled trials are needed to explore the efficacy of vPM on patient presentations common to wound healing centers.
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Shmatenko, A. P., Yu V. Rumyancev, O. M. Vlasenko, and O. V. Pleshkova. "Economic aspects of pharmacotherapy of servicemen with injury and wound of the brain." Farmatsevtychnyi zhurnal, no. 5-6 (August 14, 2018): 16–23. http://dx.doi.org/10.32352/0367-3057.5-6.17.02.
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The fighting in the area of the antiterrorist operation led to a large number of injuries among servicemen who are serving in the east of the country. Injuries and wound of the brain occupy about 35–40% among the total level of injury. and mortality in severe traumatic brain injury is 70%. All this has determined the relevance of the study of medical treatment of servicemen with injury and wound of the brain., Numerous pharmacotherapeutic schemes have been proposed for the treatment of victims with this pathology, aimed at preventing brain hypoxia, improving metabolic processes, normalizing life support functions and intracranial pressure, and the price range of pharmacotherapy of this pathology varies considerably, that’s why the aim of our work is to establish the cost indicators of the main directions of pharmacotherapy of affected servicemen with injury and wound of the brain.The main directions of the pharmacotherapy of injuries and wounds of the brain have been identified as a result of the analysis of the scientific literature and primary medical documentation, which include: normalization of life-supporting functions and brain metabolism; treatment of intracranial hypertension; restoration of microcirculation and cerebral circulation; elimination of excitation and convulsions; antibacterial, analgesic, anti-inflammatory, blood-resuscitating and symptomatic therapy.
Analysis of the dependence of the cost of treatment on the severity of the affected servicemen with injury and wound of the brain showed that the most expensive is the pharmacotherapy of severe injuries and wounds, the average cost of treatment of the affected is 139,98 UAH for 1 patient per day. The average cost of medicines for the treatment of servicemen with injuries and wounds of medium and mild severity was 67,23 and 42,26 UAH per day respectively
We analyzed the total costs spent on these directions of pharmacotherapy and found that the greatest cost is characterized by the costs of normalizing brain metabolism, the costs are 1 261,21 UAH per patient, this accounts for 38% of the total cost of medicines. Also, the most expensive directions are antibacterial – 649,27 UAH (19%) and analgesic therapy – 375,90 UAH (11%). The least expenses are expended on anti-inflammatory therapy, the cost of which is 19,96 UAH.
Analyzing the daily cost of one day of treatment of affected it was found that the most expensive are the first 7 days of treatment.
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Arkhipov, Dmitry Valerievich, Alexander Alekseevich Andreev, Dmitry Andreevich Atyakshin, and Anton Petrovich Ostroushko. "Oxygen Sorption Treatment in the Treatment of Soft Tissue Wounds." Journal of Experimental and Clinical Surgery 12, no. 4 (October 28, 2019): 248–53. http://dx.doi.org/10.18499/2070-478x-2019-12-4-248-253.
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Background. The number of patients with soft tissue wounds does not tend to decrease, which is largely due to the growth of patients with injuries, ulcerative defects, skin tumors, comorbid pathology, including diabetes mellitus, antibiotic-resistant strains and other causes. New methods of local treatment of wounds based on the application of the latest achievements of science are constantly being introduced into the work of surgical departments. High efficiency is demonstrated by the use of sorbents and oxygen, which enhance the reparative processes in wounds.The aim of the study was to study in experimental conditions the effectiveness of the method of surgical treatment of soft tissue wounds, based on the use of jet oxygen sorption treatment (SCS).Materials and methods. The study was performed on 150 white Wistar rats in 5 groups of animals. In the 1st control group treatment was not carried out. In the 2nd and 3rd control groups, the wound surface was treated with a jet of air and oxygen, respectively; in the 4th control group, sorbent was applied to the wound surface. In the 1st experimental group conducted scso wound surface. The study of the effectiveness of SCS was carried out using objective, planimetric, histological and histochemical research methods. Results. The use of sorbent (4th control group) and the method of jet oxygen sorption treatment (1st main group) led to the most pronounced positive changes-acceleration of relief of the studied symptoms by 1.1-1.3 times and 1.2 1.5 times, respectively, compared with the data obtained in the 1st control group. Treatment of wounds with oxygen jet (3rd control group) had practically no advantages in comparison with treatment with air jet (2nd control group).Conclusion. Indirectly, the highest activity of reparative processes during the observation period in the 4th control and 1st main groups was confirmed by the average optical density of RNA and SH-groups, and their desire to normalize to 10 days could indicate the completion of processes of stratification in the wound area. In total, the average area of wounds was minimal in the 1st experimental group, where this figure was by the 3rd and 10th days-74.0% and 99.5% compared to the baseline data.
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Zhang, Li, Simei Wang, Meihua Tan, Hongwei Zhou, Ying Tang, and Yan Zou. "Efficacy of Oxidized Regenerated Cellulose/Collagen Dressing for Management of Skin Wounds: A Systematic Review and Meta-Analysis." Evidence-Based Complementary and Alternative Medicine 2021 (August 4, 2021): 1–10. http://dx.doi.org/10.1155/2021/1058671.
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Objective. The purpose of this study was to evaluate the wound healing efficacy of oxidized regenerated cellulose (ORC)/collagen dressing and ORC/collagen/silver-ORC dressings compared to standard of care or control in treatment of chronic skin wounds such as diabetic foot ulcers (DFUs), venous leg ulcers (VLUs), and pressure injuries sore ulcers (PISUs). Methods. An electronic search was carried out in four popular databases PubMed, Scopus, Embase, and CENTRAL to identify thirteen included studies, comparing the clinical efficacy of ORC/collagen dressings when compared to control in management of chronic skin wounds, especially DFUs, VLUs, and PISUs, and skin graft donor site wounds. Results. Consolidated data from thirteen comparative clinical studies undertaken for management of DFUs, VLUs, and PISUs showed favorable outcomes towards use of ORC/collagen compared to other traditional and hydrocolloid foam dressings in terms of wound healing rate ( P = 0.02 ) and percentage wound relative reduction ( P = 0.003 ). The time taken to achieve complete wound healing in the included studies did not show any statistical significant difference ( P = 0.24 ). There was no significant difference in adverse events between ORC/collagen-treated group and comparative group ( P = 0.19 ). Conclusion. ORC/collagen wound dressings are beneficial in terms of improved wound healing rate and percentage wound relative reduction compared to already existing traditional standard of care with non-MMP, inhibiting biomaterials such as moistened gauze, autologous growth factors, hydrocolloid foam dressings, or ovine extracellular matrix.
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Carlin, Arthur M., James G. Tyburski, Robert F. Wilson, and Christopher Steffes. "Factors Affecting the Outcome of Patients with Splenic Trauma." American Surgeon 68, no. 3 (March 2002): 232–39. http://dx.doi.org/10.1177/000313480206800304.
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This is a report of 546 consecutive patients with penetrating and blunt splenic trauma seen over a 17½-year period (1980–1997). The etiology of the splenic injuries and the associated mortality rates were: blunt injuries 45 of 298 (15%), gunshot wounds 48 of 199 (24%), and stab wounds four of 49 (8%). The overall mortality rate was 97 of 546 (18%). The most significant risk factors for death were all associated with major blood loss: transfusion requirements ≤6 units of blood, low initial operating room blood pressure, associated abdominal vascular injuries, and performance of a thoracotomy. The two most important organs injured in conjunction with the spleen that were significant predictors of postoperative infectious complications were colon and pancreas. The need for splenectomy was most significantly correlated with higher grades of splenic injury especially grades IV and V. The evolution in management of blunt splenic trauma has led to a significant improvement in splenic preservation and avoidance of laparotomy for many patients. Operative splenic salvage is reduced in patients subjected to laparotomy who are candidates for nonoperative treatment. Improved results with splenic injury should be obtained by rapid control of bleeding. This may require more liberal criterial in selecting patients with splenic trauma for early operative treatment.
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Golubovic, Zoran, Goran Vidic, Srbobran Trenkic, Zoran Vukasinovic, Aleksandar Lesic, Predrag Stojiljkovic, Goran Stevanovic, Ivan Golubovic, Aleksandar Visnjic, and Stevo Najman. "Treatment of open tibial shaft fracture with soft tissue and bone defect caused by aircraft bomb: Case report." Srpski arhiv za celokupno lekarstvo 138, no. 7-8 (2010): 510–14. http://dx.doi.org/10.2298/sarh1008510g.
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Introduction. Aircraft bombs can cause severe orthopaedic injuries. Tibia shaft fractures caused by aircraft bombs are mostly comminuted and followed by bone defects, which makes the healing process extremely difficult and prone to numerous complications. The goal of this paper is to present the method of treatment and the end results of treatment of a serious open tibial fracture with soft and bone tissue defects resulting from aircraft bomb shrapnel wounds. Case Outline. A 26-year-old patient presented with a tibial fracture as the result of a cluster bomb shrapnel wound. He was treated applying the method of external bone fixation done two days after wounding, as well as of early coverage of the lower leg soft tissue defects done on the tenth day after the external fixation of the fracture. The external fixator was removed after five months, whereas the treatment was continued by means of functional plaster cast for another two months. The final functional result was good. Conclusion. Radical wound debridement, external bone fixation of the fracture, and early reconstruction of any soft tissue and bone defects are the main elements of the treatment of serious fractures.
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Radulovic, Svetozar, Branko Despot, Vladimir Papic, Branislava Pusac, and Nebojsa Trkulja. "War injuries of the blood vessels of the extremities." Vojnosanitetski pregled 59, no. 2 (2002): 153–56. http://dx.doi.org/10.2298/vsp0202153r.
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Treatment results of 200 injured with the lesions of 282 magisterial blood vessels were analyzed. All were combat injuries, and the majority was caused by the fragments of explosive device. The mechanism of such the injuries produced large defects of soft tissues as well as the high level of the wound contamination, which aggravated reconstructive procedures and increased the risk of infection. In the majority of cases anatomic reconstruction of the artery was performed, and the ligature was used only in the case of graft infection and in the injuries of one artery of the lower leg or the forearm. The majority of injuries was solved by lateral suture or patch plastic, since postoperative constriction caused by those methods did not cause greater hemodynamic disorders due to the size of venous lumen. The duration of ischemic interval was of the utmost importance for the favorable final result of the treatment, as well as the adequate debridement of the wound, good soft-tissue cover of the reconstructed blood vessel and precise a traumatic technique. Total percentage of amputations was 14.5%, and all were involving the lower extremities, and were mostly caused by popliteal artery lesion.
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Fomin, O. O., V. P. Kovalchuk, N. S. Fomina, M. D. Zheliba, Oleksandr Dobrovanov, and Karol Kralinsky. "Treatment of purulent-inflammatory complications in a combat gunshot trauma." Modern medical technologies 41 part 3, no. 2 (April 6, 2019): 34–39. http://dx.doi.org/10.34287/mmt.2(41).2019.37.
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Purpose of the study. Justification of the effective treatment tactics of the wounded with the gunshot fractures of the long bones.Materials and methods. The examination and treatment of 123 wounded with gunshot fractures were performed. All wounded were divided into 3 groups according to clinical observation. For the first clinical group the traditional treatment of the combat fractures with osteometallosynthesis out of injury zone was done. In the second group, treatment was added with negative pressure therapy. In the third clinical group Wounded got a VAC-associated therapy with the proposed of counter-drainage of wounds with the flow-washing irrigation with antiseptic solutions Decasan + 3% hydrogen peroxide. A bacteriological study of the wounds` exudates was carried out, and the sensitivity of microorganisms to antibiotics was determined.Results. The assay of microbiological investigation of the wounds of patients, which got explosive and mine-explosive injuries, demonstrated a predominance gram-negative microflora in the wound microbiocenoses such as Acinetobacter spp. (53% of cases) and Pseudomonas spp. (15% of cases). Gram-positive cocci were isolated from 22,2% of cases. The analysis of the antibiotic sensitivity data of gram-negative non-fermentative rods showed a high level of resistance to most antibacterial. All strains of acinetobacteria and pseudomonads were susceptible to polymyxin B and colistin, but resistant to unprotected and protected aminopenicillins (amoxicillin/clavulanate, ampicillin/sulbactam). Acceleration of regenerative processes in the wound under the influence of VAC-therapy (formation of healthy granulations, disappearance of edema) in patients with negative pressure suppression (II HS, III HS) led to a reduction of hospitalization period, which took in average 7,8 ± 1,2 days, that was 5,2 ± 0,8 days less than in a control group. In the third group of wounded, a mixture of Decasan and 3% hydrogen peroxide in the proportion of 3 : 1 was used for rinsing of wounds. On the third day tissue edema decreased in 94,45% of the wounded in that observation group, while in the second clinical group it was observed in 88,89% of patients. The duration of the hydration phase in the wound process was reduced to 5,7 days. The period of complete healing of the wounds was shorter for 2,5 days. The period of indoor stay of the wounded of this group in the hospital decreased from 14,97 to 10,8 days.Conclusions. Prevalence of gram-negative microorganisms in a gunshot wound and their high degree of resistance to antibiotics should be noticed when one takes a decision about empirical antibiotic therapy in the wounded. Observed clinical results of the proposed negative pressure therapy with counter-drainage of wounds by setting of flow-washing irrigation with a mixture of antiseptics Decasan and 3% hydrogen peroxide allow recommending this scheme for treatment of wounded with gunshot fractures of long bones.Keywords: Gunshot wound, antiseptics VAC-therapy.
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Osaiyuwu, Omokaro, and Anthony Osemwegie Osaguona. "Human Bite Injuries of the Orofacial Region: An Analysis of 26 Cases in Port Harcourt, Nigeria." Craniomaxillofacial Trauma & Reconstruction Open 5 (January 1, 2020): 247275122091266. http://dx.doi.org/10.1177/2472751220912660.
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Study Design: A retrospective study of 26 cases of human bite injuries at the Government Dental and Maxillofacial Hospital (now Maxillofacial unit, Rivers State University Teaching Hospital), Port Harcourt, within September 2011 and August 2016. Objective: To analyze the pattern, presentation, management, and complications of human bite injuries in the orofacial region. Methods: Information was extracted from hospital records of all victims of human bites to the face between the study period. Facial bites resulting from animals were excluded. Data such as age, gender, time lag between the injury and time of presentation in the hospital, nature and the circumstances of the injuries, site of injuries, and treatment outcomes and complications were collected and analyzed. Results: A total of 26 patients within the ages of 18 and 60 years were seen during the period of study. They were all related to fights, which were all resolved out of court. There was a preponderance of females, and the lower lip was the most affected site ( p < .05). In all, 14 patients presented within 24 hours of injury and all but 2 (7.6%) patients presented within 7 days of injury. No wound was overtly infected. Treatments of injuries were varied from simple wedge excision and primary closure to complex multistaged procedures and were uneventful with acceptable surgical outcomes. Conclusion: Human bite wounds reported in this study were all due to social conflicts without legal redress. Although human bite wounds are considered to be dirty or contaminated but with proper wound debridement, antimicrobial cover and primary or immediate surgical closure results in very favorable aesthetic outcomes in all cases.
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Chogan, Faraz, Yufei Chen, Fiona Wood, and Marc G. Jeschke. "Skin Tissue Engineering Advances in Burns: A Brief Introduction to the Past, the Present, and the Future Potential." Journal of Burn Care & Research 44, Supplement_1 (December 26, 2022): S1—S4. http://dx.doi.org/10.1093/jbcr/irac127.
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Abstract Burn injuries are a severe form of skin damage with a significant risk of scarring and systemic sequelae. Approximately 11 million individuals worldwide suffer burn injuries annually, with 180,000 people dying due to their injuries. Wound healing is considered the main determinant for the survival of severe burns and remains a challenge. The surgical treatment of burn wounds entails debridement of necrotic tissue, and the wound is covered with autologous skin substitutes taken from healthy donor areas. Autologous skin transplantation is still considered to be the gold standard for wound repair. However, autologous skin grafts are not always possible, especially in cases with extensive burns and limited donor sites. Allografts from human cadaver skin and xenografts from pig skin may be used in these situations to cover the wounds temporarily. Alternatively, dermal analogs are used until permanent coverage with autologous skin grafts or artificial skins can be achieved, requiring staged procedures to prolong the healing times with the associated risks of local and systemic infection. Over the last few decades, the wound healing process through tissue-engineered skin substitutes has significantly enhanced as the advances in intensive care ensuring early survival have led to the need to repair large skin defects. The focus has shifted from survival to the quality of survival, necessitating accelerated wound repair. This special volume of JBCR is dedicated to the discoveries, developments, and applications leading the reader into the past, present, and future perspectives of skin tissue engineering in burn injuries.
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Bangun, Seri Rayani, Mestiana Br Karo, Barce Inel Crevis Gulo, Anna Pefrianti Siburian, Fransiskanes Manurung, and Lisbeth L. Sihotang. "Perawatan Luka Penderita Kusta Dengan Daun Tetanus (Leea Aequata L) Pengobatan Tradisonal Suku Karo." JURNAL KREATIVITAS PENGABDIAN KEPADA MASYARAKAT (PKM) 4, no. 5 (October 1, 2021): 1103–8. http://dx.doi.org/10.33024/jkpm.v4i5.4212.
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ABSTRAK Kusta merupakan penyakit yang disebabkan oleh mycobacterium leprae. Penyakit kusta pada stadium lanjut sering disertai luka akibat terjadinya kerusakan saraf pada daerah kaki yang menimbulkan gangguan sensibilitas kelumpuhan otot dan luka penderita kusta sering infeksi dan sulit untuk disembuhkan karena pasien sering terlambat datang untuk berobat. Perawatan luka kusta dengan menggunakan agen topikal yang tepat merupakan faktor terpenting dalam penyembuhan Luka penderita Kusta . Tujuan dilakukannya penelitian ini diharapkan dapat meningkatkan pengetahuan masyarakat terhadap pentingnya perawatan luka pada penderita kusta di pusat Rehabilitasi kusta Desa Galang. Adapun kegiatan yang dilakukan yaitu berupa pemeriksaan kesehatan dan juga perawatan luka penderita kusta dengan menggunakan obat tradisional tambar tetanus (LEEA AEQUATA L). Penderita kusta yang mengikuti perawatan luka sebanyak 34 orang. Masyarakat sangat antusias dalam mengikuti perawatan luka yang dilaksanakan serta akan berupaya melaksanakannya secara mandiri dirumah untuk meningkatkan status kesehatan penderita kusta. Kata Kunci : Penderita Kusta, Luka , LEEA AEQUATA L. ABSTRACT Leprosy is a disease caused by mycobacterium leprae. Leprosy at an advanced stage is often accompanied by injuries due to nerve damage in the leg area which causes impaired sensibility, muscle paralysis, and leprosy wounds are often infected and difficult to heal because patients often come late for treatment. The treatment of leprosy wounds by using the right topical agent is the most important factor in the healing of leprosy wounds. The purpose of this research is expected to increase public knowledge of the importance of wound care for people with leprosy at the Leprosy Rehabilitation Center in Galang Village. The activities carried out are in the form of health checks and also the treatment of leprosy wounds using the traditional tambar tetanus medicine(LEEA AEQUATA L). The community is very enthusiastic about participating in the counseling that is carried out and will try to implement it independently which can improve the health status of leprosy sufferers. Keywords: Leprosy Patients, Wounds, LEEA AEQUATA L.
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DASTGIR, NABEEL, KAMRAN KHALID BUTT, and NAUSHEEN NABEEL. "MUSCULOSKELETAL INJURIES BY BONE SETTERS." Professional Medical Journal 19, no. 04 (August 7, 2012): 446–48. http://dx.doi.org/10.29309/tpmj/2012.19.04.2249.
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Objective: To highlight, evaluate and analyze the complications associated with the treatment of fractures, joint dislocations andlimb deformities by bone setters in a suburban population of district Kasoor. Study Design: Prospective descriptive study. Setting: This studywas conducted at the Department of Trauma & Orthopaedics, Central Park. Medical College based at Bhatti International Teaching Hospital,Kasoor. Methods: This was a six month prospective study involving eighty six (86) consecutive patients presenting with complications related totreatment of their musculoskeletal injuries by bone setters. Results: Eighty six patients with complications associated with previous treatmentby bone setters were seen 62.7 (%) were male while 37.2 (%) were female. The age range from 4 months to 76 years (mean 34 years). Out ofeighty six patients, 15(17.4 %) patients had non union, 21 (24.4%) had malunion, 9 (10.4%) had avascular necrosis, 15(17.4%) had chronicosteomyelitis, 4(4.6%) patients had gangrene, 8(9.3%) had contractures, 2(2.3%) had persistent dislocations, 4 (4.6%) had Leg ulcers and8(9.3%) had wound infections. The major reasons for going to bone setters were the perceived low cost of treatment (45%), pressure and advicefrom the elders and friends (38%), fear of surgery (5%) and assumption of faster healing by the bone setters (12%).The methods used by thebone setters include splintage, bandage, plaster, stretching, massage and suturing. Conclusions: Bone setters create very difficult problemsfor orthopaedic surgeons. Many patients develop complications and loose their limbs due to inappropriate treatments. Awareness programesregarding inadequate treatment given by bone setters are necessary and their Patronization should be discouraged to avoid these types ofcomplications.
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Gupta, Kalpna, Yunfang Li, Nicholas A. Mason, Tou S. Vang, Brett K. Levay-Young, Marna E. Erickson, and Robert P. Hebbel. "Opioid Receptors Stimulate Angiogenesis, Lymphangiogenesis and Neurogenesis in Ischemic Wounds in Sickle Mice." Blood 108, no. 11 (November 16, 2006): 1199. http://dx.doi.org/10.1182/blood.v108.11.1199.1199.
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Abstract Painful leg ulcers are a serious manifestation of sickle cell disease. We showed that topically applied opioids stimulate angiogenesis and promote wound healing in rats, and mice expressing sickle hemoglobin. We hypothesized that opioids orchestrate the normal healing process by stimulating angiogenesis, lymphangiogenesis and neurogenesis. Therefore, we examined mechanism(s) associated with opioid receptor-mediated wound repair using (a) ischemic wounds on transgenic sickle mice with medium severity (hBERK) and control mice expressing normal human hemoglobin (HbABERK), and (b) an in vitro model of skin repair using human epidermal keratinocytes (HEK) and dermal microvascular endothelial cells (HDMEC). We observed HEK secreted β-endorphin into the culture medium ‘immediately’ after injury (9.6±1.3 ng/ml and 2.87±0.37 ng/ml after 30 min of injury), declining to undetectable levels 60 min post-injury. Culture medium from ‘immediately’ injured HEK stimulated about 30% increase in HDMEC proliferation (p < 0.03 vs medium from intact HEK or medium from HEK 24h post-injury), which was completely antagonized by naloxone (1 μM), suggesting an opioid receptor-mediated effect. Furthermore, wounded monolayers of HDMEC incubated with ‘immediately’ injured HEK medium completely healed after 3 d as compared to 4 d with uninjured HEK medium. These data indicate endorphins secreted from skin keratinocytes upon injury stimulate endothelial proliferation, migration and angiogenesis via opioid receptors on endothelium. Therefore, we then examined wound scars from hBERK and HbABERK treated topically with either PBS/cream or morphine (3 mg/g cream) for 13 d. Z-series images were acquired using laser scanning confocal microscopy after immunostaining 100 micron thick wound cryosections for blood vessels, nerves and lymphatics, with anti-CD31, anti-PGP9.5 and anti-lymphatic vessel endothelium marker, respectively. PBS-treated hBERK wounds showed disorganized and stringy blood vessels, nerves and lymphatics, confined to the epidermis vs morphine-treated wounds showing normal architecture and their dermal as well as sub-epidermal localization, similar to that observed in HbA BERK wounds. Stereological quantitation revealed a significantly higher number of blood vessels and nerves in morphine vs PBS treated hBERK wounds (p<0.05). Blood flow estimated by measuring 86Rb uptake by wound scars after tail vein injection showed a 2-fold increase in blood flow in morphine vs PBS treated hBERK wounds (p<0.03), suggesting that opioids stimulate functionally normal vessels in the wounds. Opioid receptors (mu, delta and kappa) co-localized with blood vessels in both HbA and hBERK wounds but, the protein expression of only mu opioid receptor (MOR) was appreciably upregulated by morphine treatment of hBERK wounds as early as 3 d and also after 13 d as observed by Western immunoblotting. In HbABERK morphine-induced MOR upregulation occurred on 3 d but not 13 d. Wounds completely healed 13 d after morphine treatment in HbABERK but not in hBERK. Thus, MOR may be downregulated once the healing has occurred. These data suggest opioids, via their opioid receptors, stimulate endothelial proliferation and normal angiogenesis, lymphangiogenesis and neurogenesis. We speculate that in sickle cell disease where vasculopathy underlies the pathogenesis of painful leg ulcers, topically applied opioids may accelerate wound healing and may even provide pain relief.
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Naumenko, L. Y., T. O. Zub, and A. O. Mametyev. "Place of injuries of elbow joint in the structure of primary permanent disability among Ukrainian population." Medicni perspektivi 27, no. 3 (September 30, 2022): 167–72. http://dx.doi.org/10.26641/2307-0404.2022.3.266002.
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Despite the rapid development of orthopedics consequences of elbow injuries have a significant proportion of unsatisfactory treatment results until now. Owing to comprehend the sources of disability doctors could determine drawbacks of treatment and regulate rehabilitation program for patients with elbow injuries better. The purpose of the study was to investigate the structure of primary permanent disability due to elbow injuries among the Ukrainian population. The study was made on annual reports of Regional centers of medical and social expertise and the Center of medical and social expertise of the city of Kiev for 2018. During the reporting period a disability group due to upper extremity injuries was established totally for 1 211 patients in age over 18 years, among them 195 people had consequences of elbow traumas. That caused an intensive prevalence rate of 6.22 cases per 1 million of adults. Male patients (70.8%) and patients in working age (94.9%) prevailed among people with disability. 10.8% of patients were determined as people with disability without a revision period after the primary examination on medical and social expertise commission. The causes of primary permanent disability were domestic injuries (90.8%), occupational injuries (5.0%), injures during military service and battle injuries (2.1%) and disability since the childhood (2.1%). Structure according to disability groups showed the next distribution: 90.3% – the 3rd group, 9.2% – the 2nd group and 0.5% – the 1st group. Consequences of elbow injuries which led to primary permanent disability were caused by bone fractures (61.5%), elbow contractures and elbow ankyloses (19.0%), injuries of an ulnar nerve (8.7%), traumatic amputation at the elbow level (6.2%), forearm dislocations (3.1%), open wounds of elbow (1.0%), elbow ligaments ruptures (0.5%). Patients registered as disabled with a revision period during the first examination on commission had sufficient rehabilitation potential for restoration of elbow joint function and one of the upper limb in total.
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Magni, Giada, Francesca Tatini, Gaetano De Siena, Francesco S. Pavone, Domenico Alfieri, Riccardo Cicchi, Michele Rossi, et al. "Blue-LED-Light Photobiomodulation of Inflammatory Responses and New Tissue Formation in Mouse-Skin Wounds." Life 12, no. 10 (October 9, 2022): 1564. http://dx.doi.org/10.3390/life12101564.
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Background: Recent studies evidence that blue-LED-light irradiation can modulate cell responses in the wound healing process within 24 hours from treatment. This study aims to investigate blue-light (410–430 nm) photobiomodulation used in a murine wound model within six days post-treatment. Methods: A superficial wound was made in 30 CD1 male mice. The injuries were treated with a blue LED light (20.6 J/cm2), and biopsies were collected at 24, 72, and 144 hours. Histology, fluorescence analysis, and advanced microscopy techniques were used. Results: We can observe an increase in the cellular infiltrate response, and in mast-cell density and their degranulation index correlated to the expression of the major histocompatibility complex after 24 hours. Furthermore, after six days, the vessel density increases with the expression of the platelet-derived growth factor in the mast cells. Finally, collagen deposition and morphology in the treated wounds appear more similar to unwounded skin. Conclusions: Blue-light photobiomodulation stimulates several cellular processes that are finely coordinated by mast cells, leading to more rapid wound healing and a better-recovered skin morphology.
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Sanchez, Gonzalo Moreno, and Alwyn Louise Burridge. "Decision making in head injury management in the Edwin Smith Papyrus." Neurosurgical Focus 23, no. 1 (July 2007): 1–9. http://dx.doi.org/10.3171/foc-07/07/e5.
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✓The Edwin Smith Papyrus (circa 1650–1550 BC) is a didactic trauma treatise of major interest to neurosurgery, as it deals primarily with cranial and spine injuries. Information regarding the patient's condition is conveyed in the papyrus with sufficient clarity to allow a clinical assessment of each injury. The ancient Egyptian physician/teacher lists the key diagnostic elements in each case, and then pronounces his opinion of the treatment potential in one of three verdicts: 1) “a medical condition I can treat;” 2) “a medical condition I can contend with;” or 3) “a medical condition you will not be able to treat.” The structural organization of the text according to regional injuries of increasing severity permits analysis of sequential cases, and makes it possible to determine which clinical features led the ancient Egyptian physician to give the first or second verdict in the less severe injuries, but the third in the worst cases. Interestingly, the ancient physicians were not deterred from contending with injuries in the presence of basilar skull fractures, traumatic meningismus, skull perforation without overt neurological deficit, drowsiness, limited facial fractures, or closed head injuries without depressed fragments. Factors identified as determinant for the third verdict in head injuries are depressed skull fragments, dura laceration with exposed brain, infected cranial wounds/tetanus, major craniofacial fractures, deep skull–penetrating stab wounds, and aphasia. This study describes three case sequences of head injuries.
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Pallud, Johan, Giorgia Antonia Simboli, Alessandro Moiraghi, Alexandre Roux, and Marc Zanello. "Neurosurgical developments of Thierry de Martel (1875–1940), French neurosurgery pioneer, during World Wars I and II." Neurosurgical Focus 53, no. 3 (September 2022): E6. http://dx.doi.org/10.3171/2022.6.focus22241.
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Following France’s entry into World War I on August 3, 1914, Thierry de Martel (1875–1940), the French neurosurgery pioneer, served on the front line and was wounded on October 3, 1914. He was then assigned as a surgeon in temporary hospitals in Paris, where he published his first observations of cranioencephalic war wounds. In 1915, de Martel met Harvey Cushing at the American Hospital in Neuilly, where de Martel was appointed chief surgeon in 1916. In 1917, he published with the French neurologist Charles Chatelin a book (Blessures du crâne et du cerveau. Clinique et traitement) with the aim to optimize the practice of wartime brain surgery. This book, which included the results of more than 5000 soldiers with head injuries, was considered the most important ever written on war neurology at that time and was translated into English in 1918 (Wounds of the Skull and Brain; Their Clinical Forms and Medical and Surgical Treatment). In this book, de Martel detailed the fundamentals of skull injuries, classified the various craniocerebral lesions, recommended exploratory craniectomy for cranioencephalic injuries, recommended the removal of metal projectiles from the brain using a magnetic nail, and advocated for the prevention of infectious complications. Between the World Wars, de Martel undertook several developments for neurosurgery in France alongside neurologists Joseph Babinski and Clovis Vincent. Following France’s entry into World War II on September 3, 1939, de Martel took over as head of the services of the American Hospital of Paris in Neuilly. He updated his work on war surgery with the new cases he personally treated. Together with Vincent, de Martel presented his new approach in "Le traitement des blessures du crâne pendant les opérations militaires" ("The treatment of skull injuries during military operations") on January 30, 1940, and published his own surgical results in April 1940 in "Plan d’un travail sur le traitement des plaies cranio-cérébrales de guerre" ("Work Plan on the Treatment of Cranio-Cerebral Wounds of War"), intended for battlefield surgeons. On June 14, 1940, the day German troops entered Paris, de Martel injected himself with a lethal dose of phenobarbital. Thierry de Martel played a central role in establishing modern neurosurgery in France. His patriotism led him to improve the management of wartime cranioencephalic injuries using his own experience acquired during World Wars I and II.
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Hemmo-Lotem, Michal, Claudia Jinich-Aronowitz, Liri Endy-Findling, Michal Molcho, Michal Klein, Yehezkel Waisman, Yehuda L. Danon, and Joav Merrick. "Child Injury in Israel: Emergency Room Visits to a Children's Medical Center." Scientific World JOURNAL 5 (2005): 253–63. http://dx.doi.org/10.1100/tsw.2005.32.
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The object of this study was to provide data for policy making and prevention program planning in Israel. The study examined all visits to the Department of Emergency Medicine at the Schneider Children's Medical Center in 1996 (41,279 visits in total). Approximately 22.6% of the emergency room patients were admitted following injury. Most (97%) were unintentional injury. Approximately 42% of the patients were less than 4 years old and about 20% were 2 years old. In all age groups, the rate of boys was double. Approximately 92% were Jews. Despite this low rate of non-Jewish patients, however, they constituted 20% of later hospitalizations. The main injuries recorded were bruises and wounds from blunt objects, falls, motor vehicle–related accidents, and sport injuries. The most commonly injured body parts were the head and upper and lower limbs. In 82%, medical treatment was reported and 7% were hospitalized. In examining injuries over the year, there were no significant differences between the different months, but there were clusters of injuries around various holidays—bicycle and skateboard accidents at Rosh Hashanah, Yom Kippur, and Succoth; pedestrian accidents around Lag BaOmer; burns on Purim, Hannukkah, and Passover; and accidental poisoning around Passover. The findings gave an indication of the nature of the injured population groups. These data could be useful for prevention strategy, both on the level of physical injury as well as on the level of the times of the year, when the risk was higher. The data collected very strongly raise the urgent need for establishing a national surveillance system, which would allow tracking injury-related data with respect to young people throughout the country.
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Nnachi, Ijem Anya, Benjamin Chinonso Okeanya, and Hope Chinwe Ezinwa. "Maggot debridement therapy and innovation from myiasis - A review." Bio-Research 20, no. 3 (November 25, 2022): 1721–29. http://dx.doi.org/10.4314/br.v20i3.9.
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Maggot debridement therapy is the introduction of live and disinfected fly larvae in a wound in order to aid cleaning and healing. This technique was discovered as a beneficial effect of colonization of human tissue by fly larvae (myiasis). This discovery was made during the World War I when it was observed that injured soldiers whose wounds were infested with maggots healed faster than their counterparts whose wounds were free from maggots. In this therapy, the larvae of Blow fly (Lucilia sericata) are used because they feed exclusively on dead tissues. There are two different ways through which these maggots are applied into the wound, namely, free range dressing and biobag dressing. The mechanism of action of the maggots during debridement involves secretion of digestive enzymes which breakdown the dead tissues, liquidizing it before ingesting the liquefied contents of the wound. They also secrete antimicrobials which inhibit microbial growth in the wound, thereby disinfecting it. This therapy has been successfully used in the treatment of leg ulcers, deep and diabetic wounds in humans. The advantages of maggot debridement therapy are enormous. The cost of using it is relatively low, it quickens healing of wounds, and it is painless. However, the patient may experience irritation and itching at the wound site which is associated with larval movement in the wound. The adoption of this therapeutic wound management is advocated as practical evidence show that it has proven effective in the management of diabetic wounds more than conventional medical practices.
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Isaev, I. A., A. Sh Mammadov, and I. I. Matiev. "Surgical Treatment of Closed Fractures of Long Bones of Extremities with Polytrauma." Ukraïnsʹkij žurnal medicini, bìologìï ta sportu 7, no. 3 (July 2, 2022): 134–38. http://dx.doi.org/10.26693/jmbs07.03.134.
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The purpose of the study was to improve the functional results of treatment of patients with closed fractures of long bones of the extremities with polytrauma. Materials and methods. The results of treatment of 95 patients with fractures of long bones of the extremities with polytrauma were analyzed. Among them there were 70 (73.9%) men and 25 (26.1%) women. The victims had one or more closed fractured of the long bones of the limbs. Persons of young and able-bodied age from 31 to 50 years old prevailed – 47 (48.9%) patients. Results and discussion. Active restorative treatment was started on the second and third days after the operation at the beginning of passive movements in the joints then, as the postoperative wound healed, on the sixth and seventh days, it was active. Depending on the nature of the fractures various implants were used, in most cases, low-contract ones, which in a particular case allow achieving maximum anatomical reposition and achieving stable fixation of fragments, which provides the possibility of an early start in the development of the joint. In the immediate postoperative period in 11 patients with open fracture type B3, superficial suppuration of the soft tissues around the pins was noted, which was easily dealt with using a device for injecting drugs into the infected pin channel. Four patients with granulating wounds of the lower leg underwent autodermoplasty with a free skin graft, all 100% were healed. Phlebothrombosis developed in three patients with hip fractures: they underwent an urgent operation by angiosurgeons – vessel plexization. Long term results of treatment in terms of 8 months to 5 years were studied in 76 patients. Treatment outcomes were assessed with some criteria (union, neuro vascular disorder, varus or valgus, rotation, shortening of the limb, movement in the knee and hip joint, pain, walking hanging activity). Four patients developed chronic osteomyelitis, they underwent seguestrectomy with sub segment recovery. Delayed consolidation was noted in six patients with complex fractures (type C). Two patients developed a defect in the bones of the lower leg up to 5 sm, they subsequently underwent lengthening of the segment. Post-traumatic contracture was noted in four patients. Three patients had persistent leg edema, chronic post-traumatic thrombophletitis, equinus deformity of the feet, significant chromate – the result was rated as “poor”. According to the results of ratings as “excellent”, “good”, “satisfactory” and “poor”, quantitative designations were assigned as 5, 4, 3, 2 points, respectively. In the 76 patients studied, the long-term results were assessed as follows: in 24 (31.6%) patients the result was regarded as excellent (5 points), in 37 (48.7%) patients it was good (4 points), in 12 (15.8%) %) – satisfactory (3 points), in 3 (3.4%) – poor (2 points). Conclusion. As a result of the use of low-contact on-bone plates in the osteosynthesis of complex comminuted fractures of long bones, with combined injuries, 90.3% gave excellent and good functional results. With a combined chest injury, intramedullary osteosynthesis with a pin with reaming is contraindicated, due to the risk of developing fat embolism. In these patients, it is necessary to operate with bone plates
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Aljuboori, Zaid. "Surgical removal of a spinal intrathecal projectile led to a significant improvement of cauda equina syndrome." Surgical Neurology International 11 (August 1, 2020): 227. http://dx.doi.org/10.25259/sni_434_2020.
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Background: Penetrating gunshot wounds of the spine are common and can cause severe neurological deficits. However, there are no guidelines as to their optimal treatment. Here, we present a penetrating injury to the lower thoracic spine at the T12 level that lodged within the canal at L1, resulting in a cauda equina syndrome. Notably, the patient’s deficit resolved following bullet removal. Case Description: A 29-year-old male sustained a gunshot injury. The bullet entered the right lower chest, went through the liver, entered the spinal canal at T12, fractured the right T12/L1 facet, and settled within the canal at the L1 level. The patient presented with severe burning pain in the right leg, and perineum. On exam, he had right-sided moderate weakness of the iliopsoas and quadriceps femoris muscles, a right-sided foot drop, decreased sensation throughout the right leg, and urinary retention. Computed tomography myelography showed the bullet located intrathecally at the L1 level causing compression of the cauda equina. The patient underwent an L1 laminectomy with durotomy for bullet removal. Immediately postoperatively, the patient improved; motor power returned to normal, the sensory exam significantly improved; and he was left with only mild residual numbness and burning pain in the right leg. Conclusion: With gunshot injuries, there is a direct correlation between the location/severity of the neurological injury and the potential for recovery. In patients with incomplete cauda equina syndromes, bullet extraction may prove beneficial to neurological outcomes.
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Hobara, Hiroaki, Koh Inoue, and Kazuyuki Kanosue. "Effect of Hopping Frequency on Bilateral Differences in Leg Stiffness." Journal of Applied Biomechanics 29, no. 1 (February 2013): 55–60. http://dx.doi.org/10.1123/jab.29.1.55.
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Understanding the degree of leg stiffness during human movement would provide important information that may be used for injury prevention. In the current study, we investigated bilateral differences in leg stiffness during one-legged hopping. Ten male participants performed one-legged hopping in place, matching metronome beats at 1.5, 2.2, and 3.0 Hz. Based on a spring-mass model, we calculated leg stiffness, which is defined as the ratio of maximal ground reaction force to maximum center of mass displacement at the middle of the stance phase, measured from vertical ground reaction force. In all hopping frequency settings, there was no significant difference in leg stiffness between legs. Although not statistically significant, asymmetry was the greatest at 1.5 Hz, followed by 2.2 and 3.0 Hz for all dependent variables. Furthermore, the number of subjects with an asymmetry greater than the 10% criterion was larger at 1.5 Hz than those at 2.2 and 3.0 Hz. These results will assist in the formulation of treatment-specific training regimes and rehabilitation programs for lower extremity injuries.
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Korkmaz, H. Ibrahim, Magda M. W. Ulrich, Gülbahar Çelik, Wessel N. Van Wieringen, Paul P. M. Van Zuijlen, Paul A. J. Krijnen, and Hans W. M. Niessen. "NOX2 Expression Is Increased in Keratinocytes After Burn Injury." Journal of Burn Care & Research 41, no. 2 (September 7, 2019): 427–32. http://dx.doi.org/10.1093/jbcr/irz162.
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Abstract Reepithelialization is crucial for effective wound repair in burn wounds. Reactive oxygen species (ROS) have shown to be important in this. Recent studies suggest that NOX proteins produce ROS in keratinocytes. In the present study, we have studied NOX proteins in burn wounds, including the effect of C1-esterase inhibitor (C1inh) hereon, which is the endogenous inhibitor of complement activity whereof we have shown previously that it also increased the rate of reepithelialization in burn wounds. Skin tissue derived from healthy control Wistar rats (n = 6) were compared with burn-injured rats, with (n = 7) or without C1inh treatment (n = 7). After 14 days, rats were terminated. From the burn-injured rats, the entire wound and nonburned skin from the hind leg, that is, internal control was excised. From the control rats, dorsal skin was excised. In these skin samples, NOX2 and NOX4 were analyzed immunohistochemically. In nonburned rats, NOX2 was found in keratinocytes in both the basal layer and suprabasal layer of the epidermis; and the number of NOX2-positive keratinocytes was 367/mm2 (254–378). In burned rats, the number of NOX2-positive keratinocytes was significantly increased in the newly forming epidermis in the burned area to 1019/mm2 (649–1172), especially in the suprabasal layer, but significantly decreased in remote nonburned skin to 22/mm2 (6–89). C1inh treatment counteracted these changes in epidermal NOX2 expression in burned rats, both in the burned area as in remote nonburned skin. No NOX4 expression was found in the epidermis in none of the groups. NOX2 expression was increased in keratinocytes in newly forming epidermis after burn injury. C1inh, a drug that increases the rate of reepithelialization, counteracted this effect. These results suggest a role for NOX2 in the reepithelialization of burn wounds.
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Peng, Bo, Shuo Liu, Lei Xu, and Zhen He. "Triaged Treatment-Based Conventional Weapon Combat Wound Classification Code Design and Injury Spectrum Statistical Analysis." Military Medicine 185, no. 11-12 (November 1, 2020): e2032-e2038. http://dx.doi.org/10.1093/milmed/usaa221.
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Abstract Introduction We create an expandable combat wound classification coding system and a stratified standardized combat wound injury spectrum to support triage according to the treatment echelon and to provide the basis for the rapid and efficient classification of combat casualties. The coding system simultaneously assists in identifying injuries with a high incidence of fatality that require emergency treatment, and provides a framework for the triage of combat wounds in mass casualty situations. Materials and Methods The three-tiered treatment echelon consisting of battlefield on-site first aid, emergency treatment, and early treatment was used to design an expanded combat wound classification coding system according to the differential needs of combat wound treatment. The Herfindahl−Hirschman Index (HHI) index was used as the key indicator for injury spectrum ranking and was applied to select the key anatomical structures that require the highest priority treatment in the three treatment echelons. The combat wound classification codes were based on the results of consultations with selected experts and results from the HHI index calculations. The use of the classification codes at the battlefield on-site first aid stage and emergency treatment stage was evaluated in exercises to test and compare the effectiveness of the classification codes against current classification systems. Results We obtained exhaustive combinations from the vast number of combat wound factors in combat wound classification codes, constructed injury spectrum frameworks within the different treatment echelons, and identified injuries with a high-incidence of fatality in each of the treatment echelons. Compared with traditional methods, the time spent on coding was reduced and classification accuracy was improved when using the new classification codes, which led to improved efficiency of classification and a reduced workload for hospital staff. Conclusions The combat wound classification codes that were established through the HHI index and expert consultations achieved good results in terms of having higher classification speed and accuracy than traditional methods. This means they could be used to identify injuries with a high-incidence of fatality and provide guidance to improve the efficiency of treatment among all treatment echelons in the army.
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Ankin, Mykola L., Taras M. Petryk, Oleksander A. Radomski, Viktoria A. Ladyka, Іryna V. Кerechanyn, Larysa Y. Fedoniuk, and Mykhailo P. Sas. "LONG-TERM RESULTS OF TREATING PATIENTS WITH OPEN FRACTURES OF LOW-LEG BONES." Wiadomości Lekarskie 75, no. 4 (2022): 803–8. http://dx.doi.org/10.36740/wlek202204110.
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The aim: To analyse long-term results of treating patients with open fractures of low-leg bones within a specific time period and to describe concomitant problems. Materials and methods: A retrospective study was carried out to evaluate the results of the final treatment of patients after one year and after five years. Patients were divided into two groups. Group I included 47 (61.84%) patients for whom the treatment method was changed from external fixation to internal fixation. Group II included 29 (38.16%) patients for whom the final treatment of an open fracture was performed with an external fixation device without changing the method. The study exclusion criteria were patients under 18 years old and patients with gunshot fractures of the lower leg bones. Results: Patient treatment included initial surgical debridement and fracture stabilization with external fixation devices. In all patients, wound healing occurred within 30 days (on average, 24 ± 4.5 days). When evaluating the treatment of patients in group I, 32 (68.09%) of them underwent a one-stage removal of an external fixation device and osteosynthesis of fragments during the first 7-10 days. In 3 (20.0%) patients, osteosynthesis was performed with an intramedullary locking nail, in 12 (80.0%) patients – with a plate. The decision to change the fixation method was made taking into account clinical and laboratory parameters. It is noted that the treatment of patients with type III open fractures of the lower leg bones according to the Gustilo-Andersen classification, provided that the method of external fixation is replaced with an internal one, gives better results compared to osteosynthesis with external fixation devices. Conclusions: Treatment of patients with high-energy injuries of the lower leg bones is a long-term process. It is possible to improve the therapy efficiency by changing the fixation method from external to internal one. In this regard, the main evaluative characteristics are such indicators as uncomplicated wound healing combined with the absence of laboratory and clinical signs of inflammation.
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SHAH, TAJAMMAL ABBAS, USMAN LATIF, and QUDDUS-UR REHMAN. "COVERAGE OF EXPOSED TIBIA." Professional Medical Journal 17, no. 01 (March 10, 2010): 44–49. http://dx.doi.org/10.29309/tpmj/2010.17.01.1977.
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The alarming rise in road traffic accident has resulted in increased incidence of degloving lower limb injuries requiring some sortof cover for exposed bones e.g tibia. Objective: To study and compare the rate of wound infection & decreased morbidity in degloving injuriesof lower limb following early bone coverage by various surgical methods of bone coverage. Design: Comparative, prospective study, Place& duration of study. Allied Hospital SU II Faisalabad. Period: From January 2002 to October 2004. Material & Methods: Thirty (30) patientsdivided into four groups, muscle & musculocutaneous flaps for 15 patients, local rotational flaps for 05 patients, cross leg flaps & decorticationfor 05 patients. The patients in each group were divided unequally because of unavailability of patients. Patients were also examinedpostoperatively for 06 weeks. Results: The patients underwent surgery for degloving injury of leg. Most of them were young malesbetween 5-45 years of age resulting mainly from different types of accidents. 2 out of 15(13.3%) patients having, musculocutaneous flapsdeveloped wound infection. 1 out of 5(20%) with local rotational flaps, 2 out of 5 (40%) with cross leg flaps & 3 out of 5(60%) with decorticationdeveloped wound infection. 14 out of 15(93.3%) patients with muscle & musculocutaneous flaps while 4 out of 5(80%) with local rotational flapsrecovered within 3 weeks. Patients with cross leg flaps recovered after one month while patients with decortication recovered after forty fivedays. 13 out of 15 regained full function (86%) with muscle & musculocutaneous flaps while patients having local rotational flaps regained 100%full function. 4 out of 5(80%) regained full function with cross leg flaps & 1 out of 5(20%) regained full function with decortication. Conclusions:Muscle & musculocutaneous flaps for exposed tibia is safe and effective method of treatment having low rate of wound infection with widercoverage & decreased morbidity.
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MACEDO, JEFFERSON LESSA SOARES, SIMONE CORRÊA ROSA, DANIEL LOBO BOTELHO, CLENDES PEREIRA DOS SANTOS, MURILO NEVES DE QUEIROZ, and TABATHA GONÇALVES ANDRADE CASTELO BRANCO GOMES. "Lower extremity reconstruction: epidemiology, management and outcomes of patients of the Federal District North Wing Regional Hospital." Revista do Colégio Brasileiro de Cirurgiões 44, no. 1 (February 2017): 9–16. http://dx.doi.org/10.1590/0100-69912017001003.
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ABSTRACT Objective: to evaluate the management of lower limbs complex traumatic injuries by analyzing their characteristics, types, conduct and evolution, with emphasis on surgical treatment. Methods: we conducted a prospective study of patients treated by Plastic Surgery at a regional hospital of the Federal District during a one-year period. We collected data through serial evaluations and telephone contact records. Results: we studied 40 patients, with a mean age of 25.6 years, predominantly male (62.5%). The most frequent wounds were of the distal third of the lower limb (37.5%). Bone or tendon exposures occurred in 55% had and there was a 35% rate of exposed lower limb fractures. The treatments employed were skin grafting (57.5%), local fasciocutaneous flap (15%), muscle flap (12.5%), cross-leg fasciocutaneous flap, reverse sural flap (12.5%) and microsurgical flap (2.5%). Short-term evaluation showed that 35 patients had excellent or good results (87.5%), four had a regular result (10%), and one had an unsatisfactory result (2.5%). In the long term, of the 18 patients who answered the questionnaire, ten resumed walking, even with support, in the first three months after surgery (55.6%). Conclusion: young men involved in motorcycle accidents during leisure time represented the profile of patients with lower limb trauma requiring surgical reconstruction; the distal third of the leg was the most affected region. Grafting was the most used technique for reconstruction and postoperative functional evaluation showed that, despite complex lesions, most patients evolved with a favorable healing process and successful functional evolution.
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Sonikpreet, Sonikpreet, Gulshan Oberoi, and Sarwan Kumar. "Case Report: Maggots' Infestation As a Predisposing Condition for Heparin-Induced Thrombocytopenia, a Newest Entity." Blood 124, no. 21 (December 6, 2014): 5021. http://dx.doi.org/10.1182/blood.v124.21.5021.5021.
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Abstract Introduction Thromobocytopenia is a well-recognized complication of heparin with risk of venous or arterial thrombosis. Heparin induced thrombocytopenia, Type I (HIT-I) is a self-limiting, nonautoimmune, and most common form of thrombocytopenia. Heparin induced thrombocytopenia, Type - II (HIT-II) is an immune mediated and serious adverse drug reaction caused by formation of heparin-platelet factor 4 (PF4) complex antibodies. Its incidence ranges from 0.2% – 5.0% in patients exposed to heparin for more than 4 days and 0.2% for those treated with unfractionated heparin (UFH) for less than 4 days. HIT-II is referred as HIT in this abstract. Maggots' therapy is used in clinical centers all over the world for the treatment of chronic wounds, such as leg ulcers, pressure sores, diabetic and necrotic ulcers, as well as infected surgical wounds, burns and trauma injuries. Maggots' therapy has core beneficial effects on a non-healing wound by mechanisms of debridement, disinfection and enhanced healing. In the last decade, maggots have been used to treat wounds of thousands of patients worldwide, so clinicans have recognized maggots' therapy as an important adjunct to conventional medicine. Despite its widespread usage, the relationship between maggots and heparin-induced thrombocytopenia is undiscovered and unexplored. We are reporting a first ever case of heparin-induced thrombocytopenia where maggots predisposed to this medical condition. Case Patient is a 50-year-old morbidly obese (body mass index 68) male with medical history significant for diabetes mellitus-2 and hypertension presented in the hospital with left lower leg pain, which was sharp, 6/10, non-radiating, with no aggravating, and relieving factors. On presentation, he was hemodynamically stable. Physical examination revealed bilateral lower extremity hyper-pigmentation, chronic stasis changes and a superficial posterior malodorous ulcer of the left leg infested with 5-6 maggots. Rest of the examination was unremarkable. Maggots were removed, started antibiotics and he received subcutaneous heparin as thromboprophylaxis. His platelets dropped from 108X109/L to 66X109/L after a single dose of subcutaneous unfractionated heparin. 4 T score revealed high pre-test probability. Laboratory results showed positive heparin-PF4 antibody. Imaging studies were negative for any venous or arterial thrombi/emboli. Heparin was discontinued immediately and argatroban was begun. There was noticeable rise in his platelet count. He was discharged upon symptomatic improvement of his leg pain along with normalization of his platelet counts. Discussion Heparin-induced thrombocytopenia is a clotting disorder where antibodies like IgG, IgM, and IgA are provoked by heparin, and highly immunogenic complex of heparin-PF4. Then, heparin-PF4-antibody complex binds to an activated platelet surface, binding of this immune complex to endothelial cell surfaces and tissue factor leads to thrombosis. Genetic and patient-specific interactions may also have an impact on HIT. Maggots have been extensively studied in the wound healing process and various mechanisms of actions have been described in the literature. Maggots combat clinical infection by exudate production, ingestion of wound bacteria and secreting potent bactericidal agents. Maggots form granulation tissue by complex interactive healing process. Upon maggots’ exposure, growth factors, such as platelet-derived growth factor (PDGF), epidermal growth factor (EGF), fibroblast growth factor (FGF) and transforming growth factor (TGF), are produced and released from the wound site to rapidly recruit inflammatory cells via cytokines and chemokines to an injured area. These factors increase the capillary permeability to the wound site. Also, these growth factors are formed, stored and released from platelets, as is platelet factor 4 complex. Hence, maggots activate platelets, release immunogenic PF-4 complex and initiate the whole cascade of heparin-induced thrombocytopenia. We need further studies to validate the interrelation of maggots’ therapy or infestation and heparin-induced thrombocytopenia. Disclosures No relevant conflicts of interest to declare.
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Vercammen, Yasmine, Dieter Dauwe, Greet De Vlieger, Sabrina Houthoofd, Lars Desmet, and Michael P. Casaer. "Povidone Iodine Disinfection Associated with Hypothyroidism and Potentially Contributing to Prolonged Kidney Failure." Case Reports in Critical Care 2021 (June 24, 2021): 1–8. http://dx.doi.org/10.1155/2021/5528210.
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Objectives. To report a case of povidone-iodine (PVP-I, Iso-Betadine®) disinfection of lower leg fasciotomy wounds resulting in iodide absorption and possibly contributing to hypothyroidism and prolonged kidney injury. Design. Case report. Setting. Pediatric intensive care unit (PICU), university hospital. Patients. A 13-year-old patient presenting with prolonged oligoanuric kidney failure and unexplained primary hypothyroidism three weeks after severe abdominal sepsis with multiple organ dysfunction and major rhabdomyolysis due to bilateral lower leg compartment syndrome, necessitating moderate size fasciotomies, disinfected daily with PVP-I. Interventions. Interruption of PVP-I exposure and initiation of thyroid hormone substitution. Measurements and Main Results. Hypothyroidism was revealed during diagnostic work-up for persistent hypertriglyceridemia. Thyroxine (T4) (4.0 mg/L) and tri-iodothyronine (T3) (64 ng/L) were moderately low, yet thyroid stimulating hormone (TSH) (16.8 mIU/L) was fourfold the maximal normal range value. This pattern, atypical for prolonged critical illness-related hypothyroidism, prompted interruption of PVP-I exposure and initiation of thyroid hormone substitution. Urinary production and creatinine clearance recovered during the following days, and one week later, intermittent renal replacement therapy could be terminated, suggesting that PVP-I toxicity and/or hypothyroidism may have contributed to the persistent renal failure three weeks after resolved septic shock and rhabdomyolysis. Elevated serum and urinary anion gap normalized simultaneously, but this evolution of rather nonspecific indices could be multifactorial. Conclusion. PVP-I is a commonly used broad-spectrum antimicrobial agent for prevention and treatment of wound infections. Toxic complications due to PVP-I absorption, after disinfection of extended thermal injuries larger than 20% of the body surface, have been described. In critically ill children, however, toxic effects of PVP-I may occur due to repeated disinfection of less extended wounds. Proposed screening strategies include: monitoring of the volumes of PVP-I applied daily; of the thyroid function, the serum, and/or urinary anion gap and the urinary iodide concentrations. These strategies, however, remain to be validated. This case report should be a wake-up call for daily integration of wound management in the clinical evaluation of critically ill patients.
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Matthews, Marc R., Emily Helmick, Christopher Mellon, Danielle Thornburg, Areta Kowal-Vern, William H. Tettelbach, and Kevin N. Foster. "552 Limb Salvage: Amputations Prevented with Dehydrated Human Amnion/Chorion Membrane Allografts (dHACM) Used in Combination with Decellularized Human Collagen Matrix (dHCM)." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S124—S125. http://dx.doi.org/10.1093/jbcr/irab032.202.
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Abstract Introduction Burn and traumatic limb injuries with exposed bone/tendon typically require surgical flaps or amputations for healing. Some burn patients are not candidates for these invasive techniques. Placental amniotic membrane has been used as a wound dressing for more than 100 years and may offer an alternative to flaps and/or amputations. Processed dehydrated human amnion/chorion membrane (dHACM), from human placental tissue, contains type 1 human collagen as well as non-viable cells and 285 identified regulatory proteins including growth factors, chemokines, cytokines, metalloproteinases, and other tissue growth and inflammatory mediators. dHACM has been successfully used as a dressing for wound ulcers, burns, donor sites, & surgical debridement. This study reports the use of dHCAM as a limb salvage tool in four patients with severe injuries. Methods This is a retrospective case series of patients suffering severe lower extremity injury with bone/tendon exposure that had applied dHACM/dHCM over or packed (depending on wound depth), then covered with 3% bismuth tribromophenate petrolatum dressing & glycerol/ hydroxyethylcellulose lubricant. Negative pressure wound therapy (NPWT) was initiated; wound re-evaluation occurred in seven days. dHACM/dHCM was reapplied if required (bone still exposed). Results There were 3 males and 1 female with three burns and one NSTI. The mean±sd (median) age was 58±23 (61) years; % total burn surface area 3±3 (2); length of hospital stay 48±30 (40) days; number of tangential excisions & debridements 6.5±1 (6.5); days from admission to product application 49±47 (34) and discharge 24±19 (19) days; negative pressure wound therapy (NPWT) 53±6 (56) days. All four patients continued treatment upon discharge with clinic visits and home NPWT. All recovered with good results and no complications. Treatment may be continued with NPWT therapy at home or in a skilled nursing facility. Patients healed after two to three dHACM/dHCM applications and did not require leg or foot amputations. Conclusions In select limb salvage cases, dHACM/HCM may be a promising alternative to extremity amputations, tissue transfer flaps or other techniques for secondary intention healing of wounds with bone/tendon exposure.
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Sihotang, Martin Gabe Tua, Anak Agung Ngurah Ronny Kesuma, I. Komang Agus Krisna Saputra, and I. Komang Mahendra Laksana. "Osteomielitis kronis pada pasien anak laki-laki setelah cakaran kucing: laporan kasus." Intisari Sains Medis 13, no. 2 (August 30, 2022): 591–94. http://dx.doi.org/10.15562/ism.v13i2.1314.
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Background: Chronic osteomyelitis is still an important problem in the orthopedic field, especially in developing countries. Cat's claws contain many harmful microorganisms and can cause significant morbidity ranging from infection of skin tissue, muscle, and even deeper to bone tissue (osteomyelitis). The aim of this study was to report that injuries caused by cat-scratches and not receiving proper treatment can develop into chronic osteomyelitis. Case presentation: A 14-year-old boy came to the orthopedic polyclinic of Wangaya General Hospital with complaints of a left leg wound that had not healed since 2 years ago after got cat-scratches. The wound was oozing pus, tenderness, and the ankle area was found to be difficult to move because the patient's leg felt stiff. On physical, laboratory, and radiographic examination were found to be suggestive of chronic osteomyelitis. Conclusion: In general, cat scratch injuries are simple and harmless wounds, but if left untreated can lead to infection and morbidity in the future. Persistent symptoms and unrelieved wound conditions should be important indications for patients and practitioners of the possibility of infection that extends to soft tissue or bone tissue. A good understanding of acute wound management is very important in preventing serious infections. Latar belakang: Osteomielitis kronik masih merupakan masalah penting di bidang ortopedi terutama di negara berkembang. Pada cakaran kuku kucing mengandung banyak mikroorganisme berbahaya dan dapat menyebabkan morbiditas yang signifikan mulai dari infeksi jaringan kulit, otot, bahkan lebih dalam sampai mengenai jaringan tulang (osteomielitis). Tujuan dari penelitian ini adalah untuk melaporkan cidera yang disebabkan oleh cakaran kucing dan tidak mendapatkan pengobatan dengan baik dapat berkembang menjadi osteomielitis kronis. Laporan kasus: Seorang anak laki-laki berusia 14 tahun datang ke poliklinik ortopedi RSUD Wangaya dengan keluhan luka kaki kiri yang tidak kunjung sembuh sejak 2 tahun yang lalu, luka mengeluarkan nanah, nyeri tekan, serta pada daerah ankle ditemukan sulit untuk digerakkan yang dikarenakan kaki pasien terasa kaku. Pada pemeriksaan fisik dan laboratorium ditemukan mengarah pada osteomielitis kronis. Simpulan: Pada umumnya cidera cakaran kucing hanya luka sederhana dan tidak berbahaya, tetapi jika diabaikan dapat menyebabkan infeksi dan morbiditas dikemudian hari. Gejala yang menetap dan kondisi luka yang tidak membaik harus menjadi indikasi penting bagi penderita dan praktisi terhadap kemungkinan infeksi yang meluas ke jaringan lunak ataupun jaringan tulang. Pemahaman yang baik tentang penanganan luka akut menjadi sangat penting dalam mencegah terjadinya infeksi yang serius.
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Pankevych, V. V., U. D. Matolych, S. V. Ushtan, Z. P. Putko, and Yu B. Dmytryshyn. "Characteristics of Muscle Recovery under Experimental Post-Traumatic Contracture." Ukraïnsʹkij žurnal medicini, bìologìï ta sportu 6, no. 5 (October 27, 2021): 110–15. http://dx.doi.org/10.26693/jmbs06.05.110.
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The frequency of traumatic injuries of the maxillofacial area and the degree of their severity, have been increasing in recent years. The introduction of modern methods of treatment made it possible to improve the results of treatment and shorten its duration. Myogenic contractures develop as a complication after facial injuries, soft tissue injuries, in particular, masticatory muscles. The gastrocnemius muscle of a rat has the same striated structure as the pterygoideus medialis muscle of a person. The purpose of the work is to study the regeneration of striatal muscles with post-traumatic contractures on the basis of combined treatment of laboratory rats. Materials and methods. The study was carried out on 45 sexually mature 12 months old outbred white male rats, which weighed 180-200 g. In animals, reflex post-traumatic muscle contractures (traumatic myositis) resulting from the slaughter of calf muscles (without violating the integrity of muscle tissue) were simulated on the posterior left leg. The rats were divided into two groups. Group 1 included 21 animals that did not receive treatment and whose wounds healed by secondary intention. Group 2 included 24 rats that received combined treatment: on the 2nd day after surgery – general (oral) administration of the drug with the active substance cyclobenzaprine hydrochloride – 0.15 mg, once a day with daily procedures of magnetic laser therapy on the affected hind limb. Results and discussion. Depending on the signs of pain behavior (changes in behavior, restriction of movement, increased sensitivity, pain), the intensity of myogenic pain syndrome was assessed (low, moderate, high, very high). It was found that the use of combined treatment (magnetic laser therapy and the use of cyclobenzaprine hydrochloride) led to the normalization of behavioral and motor reactions by the 28th day: 56% of rats didn’t feel any pain and 44% had a low level of pain. The animals with the same trauma, which weren’t treated, showed a high and moderate level of pain. On the 28th day these animals could lean on their hind limbs while they were moving. However, they could not fully move due to a sharp restriction of their left hind limb function. The obtained results are the basis for the development of new approaches to improving the methods of prevention and rehabilitation treatment of contractures using magnetic laser therapy and central muscle relaxants. Conclusion. It was found that the use of magnetic laser therapy and cyclobenzaprine hydrochloride inhibited the development of an acute inflammatory reaction in the damaged muscle tissue of the hind limb of animals, accelerated and optimized reparative processes, which prevented excessive, functionally significant growth of connective tissue
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Agotegaray, Juan Ignacio, Ignacio Comba, Luciana Bisiach, and María Emilia Grignaffini. "Vascular Complications in Arthroscopic Repair Of Posterior Cruciate Ligament." Orthopaedic Journal of Sports Medicine 5, no. 1_suppl (January 1, 2017): 2325967117S0001. http://dx.doi.org/10.1177/2325967117s00019.
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Introduction: Posterior cruciate ligament is the primary stabilizer of the knee. Among the potential complications in arthroscopic repair of this ligament, there are vascular lesions, due to laceration, thrombosis and injury of the intima of the popliteal artery. We used one case to show the vascular complications that may arise in arthroscopic repair of the posterior cruciate ligament, how to handle it and the results. Methods: One patient, 33 years old, with a history of traffic accident. In a physical exam the patient shows pain and swelling of the knee, positive posterior drawer test and positive Godfrey test. X-rays on the knee show posterior tibial translation and MRI a complete fibers rupture at the middle third of the posterior cruciate ligament. An arthroscopic repair surgery was scheduled three weeks after trauma, with PCL reconstruction using simple band technique.After surgical intervention, hemostatic cuff was released, no peripheral pulse, paleness and coldness of the member was confirmed. An arteriography was carried out, which confirmed absences of distal vascular filling in the popliteal artery. An urgent referral was carried out with Vascular Surgery Services, who had been informed of the surgery previously (a notification that is part of our routine for this kind of interventions). Arteriorrhaphy and venorrhaphy of the popliteal arteries was fulfilled 12 hours later, with a leg fasciotomy. Daily monitoring was performed, and after 72 hours, muscle necrosis is seen with wound drainage, analysis shows presence of gram-negative bacilli, Proteus Mirabilis-Pseudomonas spp and the lab results showed leukocytes: 8.700/ml, ESR: 58, CRP: 48. A new surgery is performed with complete resection of the anterior external compartment of the leg, and a system of continuous cleansing is applied with physiological saline solution and boric acid for 14 days until drainage is eliminated. Vancomycin and ceftazidime EV was indicated for 14 days and, after a good evolution of the wounds, patient is discharged from hospital with Sulfamethoxazole/trimethoprim 160mg/800mg to be taken orally for 14 days. Results: After treatment with oral antibiotic is completed, wounds progress positively. Foot in equinus position, has positive distal pulses with distal sensibility. Use of a thermoforming brace is indicated for movement. Vascular Surgery Services are currently following patient’s evolution. An ankle arthrodesis surgery is evaluated for the future. Conclusion: Combined injuries that result in a posterior tibial translation over 15 mm and, those that come along with injuries in the anterior cruciate ligament or posterior lateral structures of the knee, should be repaired through surgery. Vascular lesion caused by laceration, thrombosis or injury of the intima of the popliteal artery, mainly during perforation and preparation of tibial tunnel, is a serious lesion. Although these vascular lesions during arthroscopy are complications relatively rare, a potential risk should be considered, with consequences that could be fatal for the extremity and for patient’s life when bleeding is involved. In those cases, urgent treatment is imperative, that is the reason we believe it is safe to coordinate with Vascular Surgery Services before the surgery is carried out.
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Hewett, Timothy E., Kevin R. Ford, Yingying Y. Xu, Jane Khoury, and Gregory D. Myer. "Effectiveness of Neuromuscular Training Based on the Neuromuscular Risk Profile." American Journal of Sports Medicine 45, no. 9 (April 25, 2017): 2142–47. http://dx.doi.org/10.1177/0363546517700128.
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Background: The effects of targeted neuromuscular training (TNMT) on movement biomechanics associated with the risk of anterior cruciate ligament (ACL) injuries are currently unknown. Purpose/Hypotheses: To determine the effectiveness of TNMT specifically designed to increase trunk control and hip strength. The hypotheses were that (1) TNMT would decrease biomechanical and neuromuscular factors related to an increased ACL injury risk and (2) TNMT would decrease these biomechanical and neuromuscular factors to a greater extent in athletes identified as being at a high risk for future ACL injuries. Study Design: Controlled laboratory study. Methods: Female athletes who participated in jumping, cutting, and pivoting sports underwent 3-dimensional biomechanical testing before the season and after completing TNMT. During testing, athletes performed 3 different types of tasks: (1) drop vertical jump, (2) single-leg drop, and (3) single-leg cross drop. Analysis of covariance was used to examine the treatment effects of TNMT designed to enhance core and hip strength on biomechanical and neuromuscular characteristics. Differences were also evaluated by risk profile. Differences were considered statistically significant at P < .05. Results: TNMT significantly increased hip external rotation moments and moment impulses, increased peak trunk flexion, and decreased peak trunk extension. Athletes with a high risk before the intervention (risk profile III) had a more significant treatment effect of TNMT than low-risk groups (risk profiles I and II). Conclusion: TNMT significantly improved proximal biomechanics, including increased hip external rotation moments and moment impulses, increased peak trunk flexion, and decreased peak trunk extension. TNMT that focuses exclusively on proximal leg and trunk risk factors is not, however, adequate to induce significant changes in frontal-plane knee loading. Biomechanical changes varied across the risk profile groups, with higher risk groups exhibiting greater improvements in their biomechanics.
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Sánchez-Machado, Dalia I., Jaime López-Cervantes, Diana M. Martínez-Ibarra, Ana A. Escárcega-Galaz, and Claudia A. Vega-Cázarez. "The use of chitosan as a skin-regeneration agent in burns injuries: A review." e-Polymers 22, no. 1 (January 1, 2022): 75–86. http://dx.doi.org/10.1515/epoly-2022-0011.
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Abstract Chitosan is an amino-polysaccharide, traditionally obtained by the partial deacetylation of chitin from exoskeletons of crustaceans. Properties such as biocompatibility, hemostasis, and the ability to absorb physiological fluids are attributed to this biopolymer. Chitosan’s biological properties are regulated by its origin, polymerization degree, and molecular weight. In addition, it possesses antibacterial and antifungal activities. It also has been used to prepare films, hydrogels, coatings, nanofibers, and absorbent sponges, all utilized for the healing of skin wounds. In in vivo studies with second-degree burns, healing has been achieved in at least 80% of the cases between the ninth and twelfth day of treatment with chitosan coatings. The crucial steps in the treatment of severe burns are the early excision of damaged tissue and adequate coverage to minimize the risk of infection. So far, partial-thickness autografting is considered the gold standard for the treatment of full-thickness burns. However, the limitations of donor sites have led to the development of skin substitutes. Therefore, the need for an appropriate dermal equivalent that functions as a regeneration template for the growth and deposition of new skin tissue has been recognized. This review describes the properties of chitosan that validate its potential in the treatment of skin burns.
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Kim, Myung-Sun, Yong-Ick Cho, Min-Suk Kook, Sang-Chul Jung, Young-Hyun Hwang, and Byung-Hoon Kim. "Effect of 660 nm Light-Emitting Diode on the Wound Healing in Fibroblast-Like Cell Lines." International Journal of Photoenergy 2015 (2015): 1–9. http://dx.doi.org/10.1155/2015/916838.
Full textAbstract:
Light in the red to near-infrared (NIR) range (630–1000 nm), which is generated using low energy laser or light-emitting diode (LED) arrays, was reported to have a range of beneficial biological effects in many injury models. NIR via a LED is a well-accepted therapeutic tool for the treatment of infected, ischemic, and hypoxic wounds as well as other soft tissue injuries in humans and animals. This study examined the effects of exposure to 660 nm red LED light at intensities of 2.5, 5.5, and 8.5 mW/cm2for 5, 10, and 20 min on wound healing and proliferation in fibroblast-like cells, such as L929 mouse fibroblasts and human gingival fibroblasts (HGF-1). A photo illumination-cell culture system was designed to evaluate the cell proliferation and wound healing of fibroblast-like cells exposed to 600 nm LED light. The cell proliferation was evaluated by MTT assay, and a scratched wound assay was performed to assess the rate of migrating cells and the healing effect. Exposure to the 660 nm red LED resulted in an increase in cell proliferation and migration compared to the control, indicating its potential use as a phototherapeutic agent.
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Thombare, Nupur, Gunjan Shende, Tejaswini B. Fating, Pratik Phansopkar, Neha Chitale, and Om C. Wadhokar. "Essentials of physiotherapy after degloving injury in a 45-year-old male." Journal of medical pharmaceutical and allied sciences 11, no. 2 (March 30, 2022): 4560–63. http://dx.doi.org/10.55522/jmpas.v11i2.1246.
Full textAbstract:
Injuries are most often caused by road traffic collisions and manufacturing accidents. They emerge from a large rotational force from the underlying fascia, which avulses the skin and subcutaneous tissue. The lower extremities are involved in the majority of such injuries. The patient was a 45-year-old visited Surgery department with complaints of pain on right foot and wound over dorsal aspect of the foot and ankle since day 1 with a history of crush injury to right leg and foot by machine(conveyer) in a factory. Patient developed pain which was sudden in onset and gradually progressive which was aggravated by movement and relieved by medication. investigations showed grade 3 medial malleolus fracture and 1st metatarsal fracture right side. Lacerated wound present over distal 1/3rd and distal 1/4th of right leg along with neovascular deficit. Patient undergone open reduction and k wire fixation with debridement and VAC application under spinal anaesthesia. After which he was referred to physiotherapy department for rehabilitation. This case study shows that proper plan for management is very necessary in order to make patient independent following degloving injury. The exercises and mobility improve patient’s quality of life. Physiotherapy treatment protocol was given for about 6 months, patient was again reassessed and then prognosis was made. Now he is able to perform activities of daily living. He is now able to walk. Keywords: Degloving injury, Crush injury, Rehabilitation.
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An, Seungwon, Xiang Shen, Khandaker Anwar, Mohammadjavad Ashraf, Hyungjo Lee, Raghuram Koganti, Mahmood Ghassemi, and Ali R. Djalilian. "Therapeutic Potential of Mesenchymal Stem Cell-Secreted Factors on Delay in Corneal Wound Healing by Nitrogen Mustard." International Journal of Molecular Sciences 23, no. 19 (September 29, 2022): 11510. http://dx.doi.org/10.3390/ijms231911510.
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Ocular surface exposure to nitrogen mustard (NM) leads to severe ocular toxicity which includes the separation of epithelial and stromal layers, loss of endothelial cells, cell death, and severe loss of tissue function. No definitive treatment for mustard gas-induced ocular surface disorders is currently available. The research was conducted to investigate the therapeutic potential of mesenchymal stem cell-conditioned media (MSC-CM) in NM-induced corneal wounds. NM was added to different types of corneal cells, the ocular surface of porcine, and the ocular surface of mice, followed by MSC-CM treatment. NM significantly induced apoptotic cell death, cellular ROS (Reactive oxygen species), and reduced cell viability, metabolic gene expression, and mitochondrial function, and, in turn, delayed wound healing. The application of MSC-CM post NM exposure partially restored mitochondrial function and decreased intracellular ROS generation which promoted cell survival. MSC-CM therapy enhanced wound healing process. MSC-CM inhibited NM-induced apoptotic cell death in murine and porcine corneal tissue. The application of MSC-CM following a chemical insult led to significant improvements in the preservation of corneal structure and wound healing. In vitro, ex vivo, and in vivo results suggest that MSC-CM can potentially provide targeted therapy for the treatment of chemical eye injuries, including mustard gas keratopathy (MGK) which presents with significant loss of vision alongside numerous corneal pathologies.
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Renemann, Horst H. "Rescue Mission Following the Hi-Jacking of the Lufthansa 737, “Landshut”." Journal of the World Association for Emergency and Disaster Medicine 1, no. 2 (1985): 199–200. http://dx.doi.org/10.1017/s1049023x00065584.
Full textAbstract:
At 15:15 hrs on 17 October 1977, the Lufthansa Medical Service in Frankfurt was notified about the hijacking of a 737 Boeing aircraft. At 15:30 hrs the Crisis Management Staff (CMS) asked me if I would accompany a stand-by crew on the rescue mission. The intention of the CMS was to come to an agreement with the hijackers to exchange the crew of the hijacked plane for a stand-by crew accompanied by an airline physician. I agreed. Medicines and medical equipment for the treatment of injured and sick passengers were packed by medical assistants. At 16:30 hrs highly confidential information was received from CMS—GSG 9 that the Border Patrol Special Commando led by Commander Wegner would accompany the rescue mission which would henceforth be termed “Special Mission”. The hijacked plane was to be followed and seized. It was likely that in the course of this operation an unpredictable number of burns, gunshot wounds and other serious injuries could occur. In a very short time, medical assistants packed further huge crates full of first-aid packs, Macrodex infusions, analgesics, and so forth. I asked Dr. Straub, a medical colleague, and Mr. Reiser, a nursing assistant, both employees of the Lufthansa Medical Service, to accompany me as volunteers, and they agreed. At 16:45 hrs the CMS approved the medical team and the medical equipment.