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Zhang, Kairui, Michael W. Hast, Soutarou Izumi, Yu Usami, Snehal Shetye, Ngozi Akabudike, Nancy J. Philp, et al. "Modulating Glucose Metabolism and Lactate Synthesis in Injured Mouse Tendons: Treatment With Dichloroacetate, a Lactate Synthesis Inhibitor, Improves Tendon Healing." American Journal of Sports Medicine 46, no. 9 (June 21, 2018): 2222–31. http://dx.doi.org/10.1177/0363546518778789.
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Background: Tendon injuries are common problems among athletes. Complete recovery of the mechanical structure and function of ruptured tendons is challenging. It has been demonstrated that upregulation of glycolysis and lactate production occurs in wounds, inflammation sites, and cancerous tumors, and these metabolic changes also control growth and differentiation of stem and progenitor cells. Similar metabolic changes have been reported in human healing tendons. In addition, lactate production has increased in progenitors isolated from injured tendons after treatment with IL-1β. It is thought that the metabolic changes play a role in tendon healing after injury. Hypothesis: Glucose metabolism is altered during tendon injury and healing, and modulation of this altered metabolism improves tendon repair. Study Design: Controlled laboratory study. Methods: The authors used the tendon injury model involving a complete incision of the Achilles tendon in C57BL/6J female mice and studied alterations of glucose metabolism in injured tendons with [U-13C]glucose and metabolomics analysis 1 and 4 weeks after surgery. They also examined the effects of dichloroacetate (DCA; an indirect lactate synthesis inhibitor) treatment on the recovery of structure and mechanical properties of injured tendons 4 weeks after surgery in the same mouse model. Results: Significant changes in glucose metabolism in tendons after injury surgery were detected. 13C enrichment of metabolites and intermediates, flux through glycolysis, and lactate synthesis, as well as tricarboxylic acid cycle activity, were acutely increased 1 week after injury. Increased glycolysis and lactate generation were also found 4 weeks after injury. DCA-treated injured tendons showed decreased cross-sectional area and higher values of modulus, maximum stress, and maximum force when compared with vehicle-treated injured tendons. Improved alignment of the collagen fibers was also observed in the DCA group. Furthermore, DCA treatment reduced mucoid accumulation and ectopic calcification in injured tendons. Conclusion: The findings indicate that injured tendons acutely increase glycolysis and lactate synthesis after injury and that the inhibition of lactate synthesis by DCA is beneficial for tendon healing. Clinical Relevance: Changing metabolism in injured tendons may be a therapeutic target for tendon repair.
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Zhang, Jianying, Feng Li, Tyler Augi, Kelly M. Williamson, Kentaro Onishi, MaCalus V. Hogan, Matthew D. Neal, and James H. C. Wang. "Platelet HMGB1 in Platelet-Rich Plasma (PRP) promotes tendon wound healing." PLOS ONE 16, no. 9 (September 16, 2021): e0251166. http://dx.doi.org/10.1371/journal.pone.0251166.
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Platelet-rich plasma (PRP) is a widely used autologous treatment for tendon injuries in clinics. Platelets (PLTs) are a major source of high mobility group box1 (HMGB1) that is gaining attention as a chemoattractant that can recruit stem cells to the wound area to enhance healing of injured tissues; however, the contribution of PLT HMGB1 in wounded tendon healing remains unexplored. This study investigated the effect of PLT HMGB1 within PRP on tendon healing using PLT HMGB1 knockout (KO) and GFP mice. A window defect was created in the patellar tendons of both groups of mice, and wounds were treated with either saline, PRP isolated from PLT HMGB1-KO mice, or PRP isolated from GFP mice. Seven days post-treatment, animals were sacrificed and analyzed by gross inspection, histology, and immunostaining for characteristic signs of tendon healing and repair. Our results showed that in comparison to mice treated with PRP from PLT HMGB1-KO mice, wounds treated with PRP from GFP mice healed faster and exhibited a better organization in tendon structure. Mice treated with PRP from PLT HMGB1-KO mice produced tendon tissue with large premature wound areas and low cell densities. However, wounds of PLT HMGB1-KO mice showed better healing with PRP from HMGB1-KO mice compared to saline treatment. Moreover, wounds treated with PRP from GFP mice had increased extracellular HMGB1, decreased CD68, increased stem cell markers CD146 and CD73, and increased collagen III protein expression levels compared to those treated with PRP from PLT HMGB1-KO mice. Thus, PLT HMGB1 within PRP plays an important role in tendon wound healing by decreasing inflammation, increasing local HMGB1 levels, and recruiting stem cells to the wound area in the tendon. Our findings also suggest that the efficacy of PRP treatment for tendon injuries in clinics may depend on PLT HMGB1 within PRP preparations.
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Zhang, Ying, Jing Yu, Jiefeng Zhang, and Yongxin Hua. "Simvastatin With PRP Promotes Chondrogenesis of Bone Marrow Stem Cells In Vitro and Wounded Rat Achilles Tendon–Bone Interface Healing In Vivo." American Journal of Sports Medicine 47, no. 3 (January 22, 2019): 729–39. http://dx.doi.org/10.1177/0363546518819108.
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Background: Tendons and ligaments are joined to bone in a specialized interface that transmits force from muscle to bone and permits body movement. Tendon/ligament injuries always occur in the interface areas, and injured tendons/ligaments have a limited healing response because the insertion site is composed of a fibrocartilaginous zone. Purpose: To study the effect of simvastatin with platelet-rich plasma (PRP) on chondrogenesis of rat bone marrow stem cells (BMSCs) in vitro and wounded rat Achilles tendon–bone interface healing in vivo. Study Design: Controlled laboratory study. Methods: The in vitro model was performed by the culture of rat BMSCs with various concentrations of simvastatin (0, 10, 50, 100 nM) for 2 weeks. The effect of simvastatin on the chondrogenic differentiation of the BMSCs was examined by histochemical analysis and real-time quantitative reverse transcription polymerase chain reaction. The in vivo model was carried out by testing the healing effect of simvastatin with PRP on 12 wounded rat Achilles tendon–bone interfaces. Results: Simvastatin induced chondrogenic differentiation of rat BMSCs in a concentration-dependent manner as evidenced by histological staining and real-time quantitative reverse transcription polymerase chain reaction. The wounds treated with simvastatin alone or with simvastatin-containing PRP gel healed much faster than the wounds treated with saline alone or PRP alone. Histological analysis showed that higher percentages of healed tissues were positively stained with safranin O and fast green in wounds treated with simvastatin-containing PRP gel than in the other 3 groups. Immunohistochemical analysis further demonstrated these findings, as evidenced by more positively stained healed tissues with collagen I and II antibodies in the wound areas treated with simvastatin-containing PRP gel than the other 3 groups. Conclusion: The combination of simvastatin with PRP induced chondrogenesis of BMSCs in vitro and enhanced fibrocartilage formation in vivo. The simvastatin–PRP gel treatment promotes wounded tendon-bone interface healing in clinical treatment. Clinical Relevance: The combination of simvastatin with PRP may be a good clinical treatment for wounded tendon/ligament junction healing, especially for acute sports-related tendon/ligament injuries.
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Shafiq, Muhammad. "FREQUENCY, DISTRIBUTION AND TREATMENT OF ACUTE FLEXOR TENDON INJURIES IN ZONE V OF HAND." Gomal Journal of Medical Sciences 17, no. 1 (March 31, 2019): 11–14. http://dx.doi.org/10.46903/gjms/17.01.1857.
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Background: Flexor tendons injuries are common emergency procedures The objectives of this study were to determine the frequency, distribution and results of treatment of acute flexor tendon injuries in zone V of hand in our population. Material and Methods: This descriptive cross-sectional was conducted in the Department of Orthopedic, Gomal Medical College, D.I.Khan, Pakistan from January 2015 to December 2017. Sample size was 30, selected through consecutive technique. Patients having flexor tendon injuries in zone v, admitted through emergency department were included in this study. Demographic variable were sex and age-groups. The research variable were tendon involved, nerves involved, artery involved, mechanism of injury, wound size, duration of injury, season, type of injury, hand involved and results of treatment. All variables, being categorical were analyzed by frequency and percentages using SPSS version 16.0. Results: Out of 30 patients, 22(73.33%) were male. Twenty four (80%) patients were between 21 to 40 years age. Mechanism of injury was glass in 16(53.33%) cases, knife in 10(33.33%) cases. Twenty (66.66%) cases presented in summer. Flexor digitorum sublimus was injured in 21(70.0%), FCR in 11(36.66%), FPL in 8(26.66), FDP in 6(20.0%) and FCU in 4(13.33%) cases. Median nerve was involved in nine (30%) cases. Radial artery was involved in eight (26.66%) cases. Wound size was 2 cm in 24(80%) cases. Sixteen (53.33 %) cases came with self-inflicted injuries. Twenty (66.66 %) cases came after 12 hours. Twenty five (83.33%) patients achieved good to excellent results. Conclusion: Flexor digitorus sublimus was the most common tendon injured in non-dominant hand, especially in young males. Median nerve and radial artery were commonly injured structures mostly with glass. Majority patients presented more than 12 hours after injury, having wound size of 2cm. Mostly the injuries were self-inflicted and occurred in summer season.
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Dinhane, Kandir Genesio Innocenti, Alexandre Leme Godoy-Santos, Alexandre Todorovic Fabro, Maria Regina Moretto, Igor Deprá, and Winston Bonetti Yoshida. "Short-term Changes After Corticosteroid Injections Into the Normal Tendons of Rabbits: A Controlled Randomized Study." American Journal of Sports Medicine 47, no. 3 (January 14, 2019): 721–28. http://dx.doi.org/10.1177/0363546518818819.
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Background: Corticosteroid injections in or around tendons for the treatment of athletic injuries are a common practice among orthopaedic surgeons and are apparently efficacious in the short term, although controversies persist related to local complications. Purpose: This study evaluated short-term (48 hours) biomechanical, biochemical, and histological alterations after a single injection of betamethasone into the normal tendons of rabbits. Study Design: Controlled laboratory study. Methods: A total of 72 New Zealand White rabbits were randomly divided into 2 groups: the test group—in which 36 animals underwent 1 intratendinous injection of betamethasone (1.4 mg / 0.2 mL) in the right calcaneal tendon; the control group—in which the right calcaneal tendon of 36 animals was injected with saline (placebo control group) and the left calcaneal tendon was left untreated for normal standards (normal control). Forty-eight hours later, animals were euthanized and tendons were harvested. Metalloproteinase (MMP1 and MMP2) and interleukin (IL1 and IL6) expression levels, biomechanical resistance (load × elongation parameters), and histomorphometry (hematoxylin and eosin and picrosirius red stains for collagen fibers, tenocytes, and inflammatory cells) were analyzed in the tendons. Results: The test group had a significant reduction in MMP2 expression as compared with the control groups ( P = .027). Regarding the other parameters, there were no additional significant differences between the groups. Conclusion: A single injection of corticosteroid into normal calcaneal tendons did not trigger acute local morphological, structural, or biomechanical injuries at 48 hours, but it did promote a significant decrease in MMP2 levels. Additional studies are needed with increased duration of follow-up, various doses, and multiple injections and in tendinopathic models. Clinical Relevance: Some previous studies demonstrated early structural changes in tendons after a single corticosteroid injection, which was not corroborated by the present study. Metalloproteinase decrease is usually associated with a reduction in collagen degradation, which would be protective for the healing process. More studies are necessary to confirm the possible beneficial effect of these results in the long term and for tendinopathies.
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Sung, Kun Yong, Seung Je Lee, and Hong Sil Joo. "Treatment Strategy for an Electrical Burn Patient with Multiple Fourth-Degree Wounds." Journal of Wound Management and Research 16, no. 2 (June 30, 2020): 121–24. http://dx.doi.org/10.22467/jwmr.2020.01032.
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Electrical burns, especially high-voltage burns, usually cause necrosis of the subcutaneous fat, fascia, muscle, and bone. The reconstruction of electrical injuries often involves multiple surgeries. We present the case of a 56-year-old man who was injured by a high-voltage current resulting in multiple soft tissue defects on the left ankle and plantar area. The wounds on the malleolar and lateral plantar areas had burned the muscle, tendon, and bone. Because the patient had multiple wounds and unstable vessels, we took the strategy of operating in stages. The primary aim of treatment was wound healing and maintaining the support structure for mobility. Several rounds of wide debridement and negative-pressure wound therapy, followed by application of acellular dermal matrix and split-thickness skin graft were performed as part of the first stage. At the 1-year follow-up, the patient could walk independently wearing a splint to prevent foot drop. A second reconstructive surgery is possible, if necessary.
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Khvisyuk, O. M., V. V. Pastukh, M. Yu Karpinsky, O. D. Karpinska, and I. A. Subbota. "An experimental study of the mechanical properties of the Achilles tendon in rabbits during its recovery after injury." TRAUMA 22, no. 1 (April 9, 2021): 12–19. http://dx.doi.org/10.22141/1608-1706.1.22.2021.226392.
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Background. The problem of treating patients with tendon injuries remains unresolved. Unsatisfactory results after surgical treatment, according to different authors, range from 15 to 62 %. The functional outcome after surgical repair of damaged tendons is difficult to predict because of the high risk of scar block formation, which prevents them from sliding freely. Adhesions compromise the extensibility of the tendons, which in turn affects their strength. The purpose was to experimentally investigate the strength properties of the Achilles tendons after their surgical restoration with the further use of various medications. Materials and methods. The mechanical properties of the Achilles tendons of rabbits were investigated, on which a model of their partial damage was created by crossing by 1/2 the diameter. The injured tendon was sutured with a tendon suture. Within the experiment, 5 groups of preparations of the Achilles tendons of rabbits with a heel bone were studied, 3 preparations in each group. Group 1 was a control one. After performing the tendon suture, the wound was sutured. The rabbits of group 2 were administered Noltrex around the tendon suture. Group 3 included the animals who were injected with a preparation of hyaluronic acid. Group 4 consisted of the animals who were injected with lidase. Group 5 included the animals with the normal values, preparations of non-operated Achilles tendons of intact animals. All animals were withdrawn from the experiment on day 60. According to the test results, the value of the elastic modulus and the ultimate strength of the preparation was calculated. Results. The greatest elongation under a tensile load of 30 N was achieved on preparations of unoperated Achilles tendons of rabbits — 2.96 ± 0.22 mm. The smallest elongation was obtained for the preparations of the control group — 0.83 ± 0.37 mm. The rest of the drug groups showed intermediate values. The Achilles tendon preparations of rabbits from the control group (0.216 ± 0.123 MPa) have the highest value of the elastic modulus. The smallest value of the modulus of elasticity was found in the study of non-injured preparations of the Achilles tendon (0.051 ± 0.004 MPa). The drugs of the control group had the greatest strength (the value of the maximum permissible load was 81.81 ± 0.34 N). The least strength was demonstrated by preparations of non-traumatized Achilles tendons of rabbits (the value of the maximum permissible load was 69.72 ± 0.18 N). Conclusions. Within the recovery of the Achilles tendon in rabbits after injury, an increase in the values of indicators characterizing the strength properties of tissues is observed — elastic modulus, maximum permissible load, and ultimate strength. The values of indicators characterizing the plastic properties of tissues decrease, which can be one of the reasons for the development of post-traumatic contractures. The best indicators in terms of tissue plasticity were observed in the group of preparations of the Achilles tendon of rabbits treated with hyaluronic acid. The worst ones were registered in the control group.
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Wang, Hai, and Ningning Liu. "Research on the Examination Value of High-Frequency Ultrasound in the Postoperative Rehabilitation Treatment of Sports Injury Achilles Tendon Rupture." Journal of Medical Imaging and Health Informatics 10, no. 4 (April 1, 2020): 918–22. http://dx.doi.org/10.1166/jmihi.2020.2954.
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The objective of the paper is to explore the examination value of high-frequency ultrasonography in the postoperative rehabilitation treatment of Achilles tendon injury occurred during sports events. The high-frequency ultrasound imaging technique was applied to examine the Achilles tendon injuries of patients. After the patients accepted Achilles tendon rupture repair surgeries, ultrasound imaging was applied to detect the rehabilitation conditions during the recovery processes. The diagnosis was mainly performed through the Achilles tendon sonograms examined 4 weeks, 6 weeks, 12 weeks, 24 weeks after the surgeries respectively; in addition, the changes in the American Orthopedic Foot and Ankle Score (AOFAS) and the elasticity modulus of repaired Achilles tendons were observed 8 weeks, 12 weeks, 24 weeks, and 48 weeks after the surgeries respectively. The results showed that the Achilles tendon was significantly improved after the postoperative rehabilitation, and the average AOFAS score was positively correlated with the elasticity modulus of the repaired Achilles tendon. In addition, the research results also indicated that the high-frequency ultrasound technology could accurately observe the thickness, area, and internal echo of the Achilles tendons of patients dynamically in real-time, which was convenient and quick. After the patient had undergone rehabilitation training, high-frequency ultrasound could be used to detect the postoperative rehabilitation conditions of patients, thereby the real-time rehabilitation conditions of the patients would be obtained.
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ANGERMANN, P., and M. LOHMANN. "Injuries to the Hand and Wrist. A Study of 50,272 Injuries." Journal of Hand Surgery 18, no. 5 (October 1993): 642–44. http://dx.doi.org/10.1016/0266-7681(93)90024-a.
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This study reports the causes, characteristics and treatment of injuries to the hand and wrist presented to five accident and emergency departments in a 2-year survey of 13% of the Danish population. The rate of injury to the hand or wrist was 28.6% of all injuries, or 3.7 per 100,000 inhabitants per year. 34% of the accidents were domestic, 35% were leisure accidents, 26% were occupational and 5% were traffic accidents. Only 2% of the patients were admitted to hospital for further treatment or observation and 13% were referred to a hospital as outpatients. The most frequent causes for admission were fractures (42%), tendon lesions (29%) and wounds (12%).
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Esquivel, Esteban, Cameron Cox, Amanda Purcell, and Brendan MacKay. "Zone V Extensor Tendon Repair with a Palmaris Longus Tendon Autograft and Human Umbilical Membrane." Case Reports in Orthopedics 2020 (January 4, 2020): 1–5. http://dx.doi.org/10.1155/2020/2759281.
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Extensor tendon repairs, although common, can be difficult injuries to treat. Their treatment is tailored to the zone of the hand that is affected since varying biomechanical forces are applied to the tendon at each zone. Prompt treatment is necessary to prevent potential complications associated with these injuries. This is particularly true of Zone V extensor tendon injuries, as their mechanism is commonly a highly infectious human bite. We present the case of a human fight bite resulting in a Zone V extensor tendon injury. The delayed presentation of this case resulted in an untreated infection that caused an abscess with associated extensor tendon necrosis and rupture. Given the large gap length between the ends of the tendons, tendon repair was performed using a palmaris longus autograft. Even when these are done in a controlled setting, adhesions are common. The compromised wound bed caused irritation, erosion, and subsequent rupture of the extensor tendon of the hand. In an effort to avoid common complications such as adhesion, the repair was then wrapped with human umbilical membrane (AVIVE® Soft Tissue Membrane, AxoGen Inc., Alachua, FL) to separate adjacent tissue and reduce inflammation. Even without access to formal physical therapy, our patient had excellent functional outcomes at his final follow-up visit. The patient was able to make a loose composite fist, had no extensor lag at the MCP joints, and had extensor lag of 15 degrees at the PIP joints of digits 4-5.
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Martens, A., L. Bogaert, H. Wilderjans, and C. Mespoulhès-Rivière. "Factors affecting outcome of extensor tendon lacerations in the distal limb of horses." Veterinary and Comparative Orthopaedics and Traumatology 21, no. 04 (2008): 358–64. http://dx.doi.org/10.3415/vcot-07-07-0069.
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SummaryDistal limb lacerations are common injuries in horses, with a better prognosis reported for extensor tendons lacerations compared to flexor tendons lacerations. The objective of the present study was to determine the influence of type and location of injury, modalities of treatment and post surgical complications on the outcome of extensor tendon lacerations. The medical records of 156 horses surgically treated for extensor tendon lacerations over a 10-year period were analysed retrospectively. Information was obtained for 124 horses with a minimum of 18 months follow-up. Statistical analysis was performed on 129 horses (five horses were euthanatized during hospitalization) in order to determine factors affecting outcome. Seventy-four percent of the horses returned to soundness, 17% had moderate gait impairment and 9% remained lame. Approximately 60% of the sports horses returned to an equal or higher level of performance, and 17.5% returned to a lower level. In the multivariate statistical analysis, the only significant factor that favourably influenced outcome was complete suture of the wound. A significant association could not be detected between outcome and absence of a functional extensor tendon, The most important post-surgical complication was extensive scarring of the wound. The present results report outcome of extensor tendon lacerations in a large number of horses and outline the importance of primary wound healing in order to avoid major scarring with potential functional consequences.
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OTENE, Cletus I., Joyce E. IKUBOR, Odisi O. IDIAKHOA, and Christopher O. OTENE. "THE BURDEN OF HAND INJURIES IN DELTA STATE, NIGERIA." International Journal of Forensic Medical Investigation 2, no. 1 (March 31, 2016): 20. http://dx.doi.org/10.21816/ijfmi.v2i1.16.
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BACKGROUND: The hand is a very vital part of the human body in structure and function. Injuries to the hand can be very devastating affecting individual and national productivity because of inability of the usually active workforce to use their hands adequately. This study is therefore, to document the pattern of hand injuries and the disabilities from such injuries in our environment.METHODOLOGY: This was a retrospective review of patients who presented and were managed for hand injuries at the outpatient clinics of two tertiary hospitals in Delta State of Nigeria between January 2013 and December 2015. The admission and operation registers as well as case notes of patients treated at the units were the sources of the information. Ethical approval was obtained from the Ethics committee of the Teaching Hospital. The results were analysed using SPSS version 20. Descriptive statistics were used to represent frequency distribution. RESULTS: A total of 102 patients were managed in the 2 tertiary hospitals in the state in the study period. 63.7% were males and 36.3% females. The age range most commonly affected was the 20 – 29 years (35.3%) followed by 30 – 39 years and 10 – 19 years at 15.7% each. Majority were students (38.2%) followed by civil servants (19.6%). Commercial motorcyclists, artisans and machinery operators lumped together made up 15.7%. The commonest cause of injury was machete/ knife cuts and stab wounds (24.5%), followed by RTA (20.6%), burns (14.7%) and machinery accidents (13.7%). On the types of injuries sustained, deep lacerations (injuring tendons and nerves) were the commonest (33.3%). Contractures secondary to burn injuries were next (13.7%) whereas, 11.8% had crush injuries as well as another 11.8% with fractures/ dislocations. 61.8% of patients had good outcomes following treatment while 38.2% had outcomes adjudged as poor or fair.CONCLUSION: Hand injuries are disabling and may deny the citizenry and the nation of useful workforce and productivity. Hand trauma can be prevented by encouraging civil societies and providing safe home and workplace environments. KEY WORDS: Burden; pattern; hand injuries; disabilities.
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Mihara, Makoto, Hisako Hara, and Kazuki Kikuchi. "Lymph node transfer for refractory infectious sites caused by trauma." SAGE Open Medical Case Reports 5 (January 1, 2017): 2050313X1771163. http://dx.doi.org/10.1177/2050313x17711631.
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Objective: In this report, we placed focus on the immunological function of lymph nodes and performed lymph node transfer via a free flap to a site of refractory infection. Case and Results: Case 1 describes a 34-year-old male suffering from compound fractures with severe crush injuries and burns in the right ankle joint. A 20 × 15 cm skin defect was observed around the right malleolus medialis, along with denuded tendons with bacterial infection. After conservative treatment, we transferred a lymph-node-containing free superficial circumflex iliac artery perforator flap to the region, with minimum debridement. No recurrence of wound infection appeared. Case 2 describes a 73-year-old male patient suffering from extensive contused wound in the right crus. Despite conservative treatment, the tibia gradually became denuded with computed tomography and magnetic resonance imaging revealing degeneration of the tibial cortex. We performed a free superficial circumflex iliac artery perforator flap containing lymph nodes to the chronic infection area. The wound area healed successfully. Conclusion: In conclusion, lymph node transfer has a potential of treatment infection sites.
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Baumfeld, Daniel, Fernando Raduan, Caio Nery, Benjamim Macedo, Thiago Silva, and Tiago Baumfeld. "Early Postoperative Results of Endoscopic Transfer of Flexor Hallucis Longus for Chronic Achilles Rupture." Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0001. http://dx.doi.org/10.1177/2473011417s000112.
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Category: Ankle, Arthroscopy, Hindfoot Introduction/Purpose: Background Achilles tendon chronic rupture lead to proximal retraction of the tendon and have a greater tendency to show poorer functional outcomes than acute ruptures. Numerous surgical procedures have been described to treat this pathology. The transfer of the flexor hallucis longus is a well-established treatment option, usually performed as an open procedure. The aim of this paper is to report a case series of six patients with chronic Achilles tendon rupture treated with endoscopic transfer of FHL. Methods: Six patients with Achilles tendon chronic injuries or re-ruptures were treated with endoscopic FHL transfer. There were four man and two women, average of 50 years, with four left and two right tendons involved, and no bilateral cases. All lesions were at zone 2 (between 2-6 cm proximal to insertion). We describe the surgical technique and report our results at an average of a nine-month follow-up. Results: The average follow-up of the series was 9 months (range, 5–12 months). Three patients had an associate procedure at the Achilles tendon to repair the pre-existent gap, using a minimally invasive technique. On average, we expend 56 minutes to perform the surgery, ranging from 45 to 70 minutes. All patients had a major increase in ATRS score values postoperatively, with an average of 17.8 preoperatively and 83,3 postoperatively No major complications or wound healing problems were noted. Tiptoe stance was possible for all patients without limitation. None of the patients noticed functional weakness of the hallux during daily life activity. Conclusion: Endoscopic FLH transfer is a reliable option for patients with higher skin risk and soft tissue complications. Other studies are needed to compare this technique with the open procedure, gold standard by now, to ensure its safety and efficacy.
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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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DeFroda, Steven F., Benjamin S. Kester, Alexander C. Newhouse, Daniel M. Wichman, Sunikom Suppaiksorn, and Shane J. Nho. "Endoscopic Repair of the Proximal Hamstring." Video Journal of Sports Medicine 1, no. 2 (March 2021): 263502542110038. http://dx.doi.org/10.1177/26350254211003893.
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Background: Proximal hamstring injuries are increasingly common. While open repair with suture anchors placed in the ischial tuberosity has long been the gold standard technique for surgical management, endoscopic techniques can allow for smaller incisions, reduced wound complications, and an expedited recovery. Indications: Patients with full-thickness 3-tendon proximal hamstring tears, 2-tendon tears with retraction >2 cm, or partial tears that remain symptomatic despite conservative management are considered for surgery. High-demand patients are often treated acutely, and low-demand patients may be offered surgery after a conservative management period. Technique Description: In the prone position, 2 arthroscopic portals are created in the gluteal fold. Fluoroscopy is used to verify safe portal placement, and the sciatic nerve is visualized along with the retracted tendon origin. The ischial tuberosity is identified, and the hamstring origin is debrided and decorticated. An accessory portal is created for suture anchor placement. Two double-loaded anchors are placed in the tuberosity, the sutures of which are used to repair the hamstring tendons using a horizontal mattress configuration. Patients undergo a stepwise postoperative physical therapy protocol. Results: An 85% return to sport rate can be expected following all hamstring repairs, with some studies reporting as high as 95% after endoscopic repair. Compared with nonoperative treatment, proximal hamstring repair overall results in higher patient satisfaction and return to sport. While large studies have yet to report on outcomes compared with the traditional open technique, the smaller incisions look to reduce wound complications and postoperative pain. Discussion/Conclusion: Recent advancements in endoscopic techniques have allowed for adequate visualization and robust repair of proximal hamstring avulsions. We present our endoscopic technique of the proximal hamstring, which, compared with the traditional open repair, can decrease perioperative complications and accelerate recovery.
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Bodendorfer, Blake M., David X. Wang, Brian P. McCormick, Austin M. Looney, Christine M. Conroy, Caroline M. Fryar, Joshua A. Kotler, William J. Ferris, William F. Postma, and Edward S. Chang. "Treatment of Pectoralis Major Tendon Tears: A Systematic Review and Meta-analysis of Repair Timing and Fixation Methods." American Journal of Sports Medicine 48, no. 13 (February 28, 2020): 3376–85. http://dx.doi.org/10.1177/0363546520904402.
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Background: Repair of torn pectoralis major tendons is generally considered superior to nonoperative management, but there is a paucity of comparative data to demonstrate ideal repair timing and fixation methods. Purpose/Hypothesis: The purpose was to compare the outcomes between acute and chronic repair and among the various methods of fixation (transosseous tunnels, cortical buttons, suture anchors, screws with washers, and direct repair). It was hypothesized that acute repair would have superior outcomes and there would be similar outcomes among the various methods of fixation. Study Design: Meta-analysis. Methods: In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review of the literature was completed through MEDLINE, SPORTDiscus, CINAHL, Cochrane, Embase, and Web of Science databases. English-language studies were included with a minimum of 6 months’ mean follow-up and 5 cases per study. MINORS (Methodological Index for Nonrandomized Studies) was utilized to assess the quality of the existing literature. Analysis of mechanisms of injury and meta-analysis of pooled outcomes were completed. Pooled effect sizes were calculated from random effects models. Continuous variables were assessed via mixed model analysis, with the individual study designated as a random effect and the desired treatment for comparison as a fixed effect. Bivariate frequency data were transformed through Freeman-Tukey log-linear transformation for variance stabilization and then assessed through a mixed model with a study-level random effect and subsequently back-transformed. Significance was set at P < .05. Results: Twenty articles with 384 injuries met the inclusion criteria for comparison. All patients were male, with 61.9% of injuries occurring during weight training, at a mean age of 31.53 years, and with a mean follow-up of 30.12 months. Included studies scored a mean (SD) 15.53 ± 4.26 (range, 7.0-23.3) by MINORS criteria. Acute repair was significantly superior to chronic repair, with a relative improvement of functional outcome by 0.85 ( P = .004) and satisfaction with cosmesis by 20.50% ( P = .003). There was a trend toward acute repair having a higher proportion of patients who were pain-free (34.47%, P = .064). There were no significant differences among the methods of fixation for repair. Conclusion: Acute repair of pectoralis major tendon tears resulted in significantly superior functional outcomes and cosmesis satisfaction with a trend toward a higher proportion of patients who were pain-free. There were no significant differences among the methods of fixation for repair.
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McIntyre, James Alexander, Ian A. Jones, Alla Danilkovich, and C. Thomas Vangsness. "The Placenta: Applications in Orthopaedic Sports Medicine." American Journal of Sports Medicine 46, no. 1 (April 4, 2017): 234–47. http://dx.doi.org/10.1177/0363546517697682.
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Background: Placenta has a long history of use for treating burns and wounds. It is a rich source of collagen and other extracellular matrix proteins, tissue reparative growth factors, and stem cells, including mesenchymal stem cells (MSCs). Recent data show its therapeutic potential for orthopaedic sports medicine indications. Purpose: To provide orthopaedic surgeons with an anatomic description of the placenta, to characterize its cellular composition, and to review the literature reporting the use of placenta-derived cells and placental tissue allografts for orthopaedic sports medicine indications in animal models and in humans. Study Design: Systematic review. Methods: Using a total of 63 keyword combinations, the PubMed and MEDLINE databases were searched for published articles describing the use of placental cells and/or tissue for orthopaedic sports medicine indications. Information was collected on placental tissue type, indications, animal model, study design, treatment regimen, safety, and efficacy outcomes. Results were categorized by indication and subcategorized by animal model. Results: Outcomes for 29 animal studies and 6 human studies reporting the use of placenta-derived therapeutics were generally positive; however, the placental tissue source, clinical indication, and administration route were highly variable across these studies. Fourteen animal studies described the use of placental tissue for tendon injuries, 13 studies for osteoarthritis or articular cartilage injuries, 3 for ligament injuries, and 1 for synovitis. Both placenta-derived culture-expanded cells (epithelial cells or MSCs) and placental tissue allografts were used in animal studies. In all human studies, commercial placental allografts were used. Five of 6 human studies examined the treatment of foot and ankle pathological conditions, and 1 studied the treatment of knee osteoarthritis. Conclusion: A review of the small number of reported studies revealed a high degree of variability in placental cell types, placental tissue preparation, routes of administration, and treatment regimens, which prohibits making any definitive conclusions. Currently, the clinical use of placenta is limited to only commercial placental tissue allografts, as there are no placenta-derived biological drugs approved for the treatment of orthopaedic sports medicine conditions in the United States. However, this review shows that the application of placental cells or tissue allografts appears to be safe and has potential to improve outcomes for orthopaedic sports medicine indications.
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Blome-Eberwein, Sigrid A., and Cassandra Pinataro. "548 Heterotopic Ossification or Dystrophic Calcinosis Cutis in Burn Scars - A Case Series." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S122—S123. http://dx.doi.org/10.1093/jbcr/irab032.198.
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Abstract Introduction Heterotopic ossification of large joints is a commonly seen and described entity in Burn survivors. We have observed a rather uncommon phenomenon in a series of 4 Burn survivors who presented to our Burn center for scar treatment and open wounds many years after their injuries. A chronic, small, splinter-like subcutaneous irritation led to open wounds and infections in their burn scars. A similar condition is known as dystrophic calcinosis cutis in the dermatologic literature, but caused by calcium metabolism changes in otherwise healthy skin. Methods The demographics and history of illness was documented in all 4 patients. A literature review was performed. The calcified bone-like irritant was removed surgically in all patients, sometimes in more than one location. Pathologic evaluation was performed on the removed specimen. Strategies leading to healing of the wounds were evaluated. Results Four publications were found addressing this phenomenon in Burn scars, all case reports. All of our patients had undergone curettage of the lesions by a dermatologist in the past without resolution. All lesions were excised surgically and proved to extend subcutaneously far more extensively than the visible skin lesion. X rays proved not helpful in preoperative assessment of the extent. All wounds healed after the irritant was removed. Conclusions All lesions appeared to have formed along tendon or fascia remnants underneath the burn scars, exerting pressure on the overlying epithelium which eventually led to breakdown and necrosis. This finding prompted the term “heterotopic cutaneous ossification”. Chronic tension and inflammation were assumed in the etiology, rather than calcium metabolism abnormalities or systemic connective tissue disease, which were not present in these patients. Research is needed to establish the prevalence, cause, and prevention of this condition in Burn survivors.
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Prysyazhnyuk, V. "The treatment of animals in Galicia in the middle ages." Scientific Messenger of LNU of Veterinary Medicine and Biotechnologies 22, no. 100 (December 23, 2020): 32–35. http://dx.doi.org/10.32718/nvlvet10006.
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Surgical diseases. At head injuries was carried out bloodletting from the jugular vein and infusion into the nasal cavity of chopped horseradish and citrus, mixing with wine, to cause nasal discharge, the outflow of which had a positive influence on the course of the disease. Surgical procedures in the oral cavity of a horse. Sharp teeth are blunted if you insert an iron bar between them. When chewing a bar, the horse must break its sharp ends. Wolf teeth or fangs can be removed with a chisel. The salivary glands under the tongue was called tuberculosis which in some cases were removed surgically. The wounds of the tongue were called “mucus”, lubricated with quicklime, mercury, honey. In cases of laminitis, the reasons for which could be wind, rye, water, treatment was based on blood from the jugular vein, tail, cheeks, limbs or from the veins of the palate, with the simultaneous use of herbal remedies such as asparagus, laxatives (cleansers), and bathing the limbs in cold water. When sitting (something like steaming from the saddle) were used wraps with vinegar, clay or washing with the above means. In cases of abdominal edema were used wet and warm compresses using a harness. When the scapula was damaged, a massage with rubbing a mixture of bean oil, turpentine and olive oil was effective. If there were cracks in the bone, the place on the other side of the crack was burned with hot iron, and in addition to wrapping with the roots of plants, leaves and bread, a bandage of thin boards and a bandage was applied. In case of a broken bone – a calm horse was given a permanent bandage and a bandage with pre-lubrication of the limbs with fat. Disease of shuttle bones. Were burned with iron and covered with herbs, or lubricated with ointment, consisting of resin, vegetable oil and bean oil. Phlegmons and congestive edema of the extremities were treated by wrapping a mixture of poppy oil, including bloodletting from this limb, or massage with the simultaneous use of substances such as: nettle root or cumin, ground with honey and flour. Inflammation of the tendons was called a clogged vein, wrapping a mixture of onions and garlic was recommended for medicinal purposes. The pile (lump) “called a dog's hair” has been treated with human feces for two centuries. Dislocations and subdislocations. After directing the bone to the starting position, a mixture of vinegar, honey and tire was used. Rub, peel off the hoof (mutilation of the hoof, resulting from the attack of one limb on the other). After cutting the mutilated (wounded) place and cleaning the wound by rinsing with oil or vinegar it is necessary to cover the damage with melted wax, fat or resin. Cut the damaged horn especially when there is suppuration. When a horseshoe nail is driven deep into the hoof during shoeing, the horseshoe must be removed, open the sole in the area of the disease, and in order to allow the leakage of pus (exudate) to wash the wound with oil. To prevent further contamination of the wound, fill it with resin. Penetration of alien bodies into the hoof from below. This can happen when a horse steps on a sharp object. Were treated as described above. The so-called Spartan shoes were put on the hoof, which is still in common use today. When there was a suspicion that there was exudate in the wall of the hoof, to determine where, you need to moisten the horn of the hoof with water. The place that became dry the fastest due to the rising temperature was the most suitable for opening and the possibility of exudate. The curvature that most often occurs in barefoot unshod horses, the horn was removed with a knife up to the soft tissues of the hoof, the wound was tapenaded by wetting the tampons with vinegar, honey, or impregnate them with salt or lime, it is impossible to use alum in the final period of treatment. Granulation tissue exacerbation was treated with caustic agents such as copper green or ferrous sulfate. Ulcers were opened with steamed iron or accelerated their natural opening with the help of Spanish flies. After opening, they were covered with powdered sulfur or bread with salt. Lubricate the edema with wine yeast or grated burdock root, and knife wounds were tamponade with a saturated mixture of resin, sulfur, vinegar. Bruises on the body of animals were lubricated the damaged areas with ointment from nettle root and fat, and the removal of exterior bodies from gunshot wounds was carried out by induction of wound suppuration with mercury ointment, alkali. Iron particles embedded in the wound, tried to remove with a magnet. Cluster of hair – caused acceleration ointment, consisting of roundworms, bees and oil, and the intensive molting was facilitated by smearing the horse's fur with his own blood. White spots, varieties on the corresponding horse hair were treated through burns of this place with hot dough mixed with mustard and strong vinegar. It should be noted that one of the most common surgical procedures was bloodletting and it is from the various veins of the horse's body. Not only for internal or surgical diseases, but also as a means of disease prevention was used. Eye diseases, namely: swollen eyes with flowing tears, under this name should be understood as a series of inflammatory conditions of both eyes and eyelids. Treatment – blood from a vein over the orbits, as well as well-washed eyes with well water. In endosperm, it was recommended to inject powdered substances such as feces, pepper, ginger, feathers, lard, alum into the eye.
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Borodai, O. M., and Yu V. Kas. "FEATURES OF CLINICAL MANIFESTATIONS OF POST-TRAUMATIC NEUROPATHIES AND PLEXOPATHIES RESULTED FROM GUNSHOT AND NON-GUNSHOT INJURIES OF EXTREMITIES." International Medical Journal, no. 3 (September 16, 2020): 45–48. http://dx.doi.org/10.37436/2308-5274-2020-3-9.
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The number of traumatic injuries to nerve stems and plexuses is steadily increasing in peacetime during armed conflicts and terrorist acts. In wartime, peripheral nerve injuries are much more common, and a great deal of the knowledge about peripheral nerve damage and repair is based on combat experience. The study of the clinical course of post−traumatic neuropathies and plexopathies contributes to the development of clinical and neurological criteria and compensatory−restorative responses in traumatic lesions of the peripheral nervous system, helps to assess the functional significance of various parts of the nervous system when compensating a damaged functional unit. To study the features of clinical manifestations of post−traumatic gunshot and non−gunshot neuropathies and plexopathies, 63 patients underwent clinical and neurological examination with topical and clinical diagnoses, collection of detailed anamnesis and complaints, electroneuromyography and ultrasound examination. Movement disorders, characterized by peripheral paresis or plegia of the corresponding muscle group and accompanied with a reduced or lost tendon and periosteal reflexes, were common. Sensitivity disorders were a combination of prolapse (anesthesia, hypoesthesia) and irritation (paresthesia, hyperpathy, hyperesthesia). Autonomic disorders (vascular, secretory and trophic) in traumatic neuropathies differ depending on the clinical individuality of peripheral nerves. Vascular disorders were more often detected with partial damage to nerve structures and were accompanied by local edema. Of the secretory disorders, the most constant sign of impaired nerve conduction was sweating disorder. In the clinical picture of the pain syndrome, i.e. causalgia, the pain sensations by type of burning dominated. The intensity of the pain syndrome in severe cases was very high, in some cases the pain was exacerbated by irritation of the senses. The clinical picture of causalgia is characterized by an increased pain when warming the injured limb and it reduced when cooled, that is a "symptom of a wet rag." Knowledge of clinical features allows the detection of the peripheral nervous system lesions at the early stages of pathology, performance of dynamic clinical and neurological observation and treatment, timely use of modern additional research methods to address further treatment tactics that restore limb function, improve quality of life. Key words: post−traumatic neuropathy and plexopathy, peripheral nervous system, gunshot wounds of nerves and plexuses.
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Zhang, Jianying, Daibang Nie, Kelly Williamson, Jorge L. Rocha, MaCalus V. Hogan, and James H.-C. Wang. "Selectively activated PRP exerts differential effects on tendon stem/progenitor cells and tendon healing." Journal of Tissue Engineering 10 (January 2019): 204173141882003. http://dx.doi.org/10.1177/2041731418820034.
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To understand the variable efficacy with platelet rich plasma (PRP) treatments for tendon injury, we determined the differential effects of proteinase-activated receptor (PAR)1- or PAR4-activated PRP (PAR1-PRP, PAR4-PRP) from humans on human patellar tendon stem/progenitor cells (TSCs) and tendon healing. We show that PAR1-PRP released VEGF, whereas PAR4-PRP released endostatin. Treatment of TSCs with PAR1-PRP increased collagen I expression and matrix metalloproteinase-1 (MMP-1), but cells treated with PAR4-PRP increased less collagen I and higher MMP-2 expression. The wound area treated with PAR4-PRP formed tendon-like tissues with well-organized collagen fibers and fewer blood vessels, while PAR1-PRP treatment resulted in the formation of blood vessels and unhealed tissues. These findings indicate that differential activation of PRP leads to different effects on TSCs and tendon healing. We suggest that based on acute or chronic type of tendon injury, selective activation of PRP should be applied in clinics in order to treat injured tendons successfully.
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Maffulli, Nicola, Alessio Giai Via, and Francesco Oliva. "Chronic Achilles Tendon Rupture." Open Orthopaedics Journal 11, no. 1 (July 31, 2017): 660–69. http://dx.doi.org/10.2174/1874325001711010660.
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Background:The Achilles tendon, the largest and strongest tendon in the human body, is nevertheless one of the tendons which most commonly undergoes a complete subcutaneous tear. Achilles tendon ruptures are especially common in middle aged men who occasionally participate in sport. Even though Achilles tendon ruptures are frequent, up to 25% of acute injuries are misdiagnosed, and present as chronic injuries.Methods:This is a review article about diagnosis and management of chronic Achilles tendon ruptures. Minimally invasive Achilles tendon reconstruction is discussed.Results:The optimal surgical procedure is still debated, however, less invasive peroneus brevis reconstruction technique and free hamstring autograft provide good functional results.Conclusion:The management of chronic ruptures is more demanding than acute tears, because of the retraction of the tendon ends, and the gap makes primary repair impossible. Wound complications and infections are frequent after open procedures. Minimally invasive treatments provide good functional results and lower complications rate.
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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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Lisa, Andrea Vittorio Emanuele, Leonardo Galtelli, Valeriano Vinci, Alessandra Veronesi, Luca Cozzaglio, Ferdinando Carlo Maria Cananzi, Federico Sicoli, and Marco Klinger. "Adoption of a Newly Introduced Dermal Matrix: Preliminary Experience and Future Directions." BioMed Research International 2020 (October 16, 2020): 1–5. http://dx.doi.org/10.1155/2020/3261318.
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Introduction. Acellular dermal matrix (ADM) products are adopted in the management of injuries to soft tissues. ADMs have been increasingly employed for their clinical advantages, and they are acquiring relevance in the future of plastic surgery. The aim of our study is to evaluate the application of ADMs in our patients who could not undergo fast reconstruction. Materials and Methods. We performed a retrospective study on 12 patients who underwent ADM placement for scalp and limb surgical reconstructions at the Humanitas Research Hospital, Rozzano (Milano), Italy. Wounds resulted from 9 tumor resections and 3 chronic ulcers. The ADM substrate used to treat these lesions was PELNAC™ (Gunze, Japan), a double-layered matrix composed of atelocollagen porcine tendon and silicon reinforcement. All patients underwent a second surgical operation to complete the treatment with a full-thickness skin graft to cover the lesion. Results. In this study, 12 patients were treated with PELNAC™: 11 out of 12 patients showed a good attachment over a median time of 21.3 days (range 14-27). After almost 23 days, all patients were ready to undergo a full-thickness skin grafting. Conclusion. This study assesses the benefits of PELNAC™ and proposes this method as an alternative to traditional approaches, especially in situations where the latter techniques cannot be applied.
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Huang, Songya, Xi Xiang, Li Qiu, Liyun Wang, Bihui Zhu, Ruiqian Guo, and Xinyi Tang. "Transfection of TGF-β shRNA by Using Ultrasound-targeted Microbubble Destruction to Inhibit the Early Adhesion Repair of Rats Wounded Achilles Tendon In vitro and In vivo." Current Gene Therapy 20, no. 1 (June 24, 2020): 71–81. http://dx.doi.org/10.2174/1566523220666200516165828.
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Background: Tendon injury is a major orthopedic disorder. Ultrasound-targeted microbubble destruction (UTMD) provides a promising method for gene transfection, which can be used for the treatment of injured tendons. Objective: The purpose of this study was to investigate the optimal transforming growth factor beta (TGF-β) short hairpin RNA (shRNA) sequence and transfection conditions using UTMD in vitro and to identify its ability for inhibiting the early adhesion repair of rats wounded achilles tendons in vivo. Methods: The optimal sequence was selected analyzing under a fluorescence microscope and quantitative real-time reverse transcription polymerase chain reaction in vitro. In vivo, 40 rats with wounded Achilles tendons were divided into five groups: (1) control group, (2) plasmid group (3) plasmid + ultrasound group, (4) plasmid + microbubble group, (5) plasmid + microbubble + ultrasound group, and were euthanized at 14 days post treatment. TGF-β expression was evaluated using adhesion scores and pathological examinations. Results: The optimal condition for UTMD delivery in vitro was 1W/cm2 of output intensity and a 30% duty cycle with 60 s irradiation time (P < 0.05). The transfection efficiency of the plasmid in group 5 was higher than that in other groups (P < 0.05). Moreover, the lowest adhesion index score and the least expression of TGF-β were shown in group 5 (P < 0.05). When compared with the other groups, group 5 had a milder inflammatory reaction. Conclusion: The results suggested that UTMD delivery of TGF-β shRNA offers a promising treatment approach for a tendon injury in vivo.
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Fedoseev, A. V., V. V. Lapin, D. S. Lobanov, A. V. Fedoseev, V. V. Lapin, and D. S. Lobanov. "Assessment of Treatment in Injuries of Finger Flexor Tendons." N.N. Priorov Journal of Traumatology and Orthopedics 10, no. 2 (June 15, 2003): 64–66. http://dx.doi.org/10.17816/vto200310264-66.
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The system of evaluation of treatment outcomes of finger flexor tendons are presented. The system is based on the restoration of total range of active movement only in intrafalangeous joints taking into account the contractures in functionally disadvantageous position. Using this system it is possible to evaluate the treatment outcomes in case of simultaneous injury of superficial and deep flexor tendons, isolated injury of deep flexor tendons of II-V fingers as well as long flexor tendon of the thumb.
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Sсherbak, Sergey G., Stanislav V. Makarenko, Olga V. Shneider, Tatyana A. Kamilova, and Alexander S. Golota. "Regenerative Rehabilitation in Injuries of Tendons." Physical and rehabilitation medicine, medical rehabilitation 3, no. 2 (July 5, 2021): 192–206. http://dx.doi.org/10.36425/rehab70760.
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The mechanical properties of tendons are thought to be affected by different loading levels. Changes in the mechanical properties of tendons, such as stiffness, have been reported to influence the risk of tendon injuries chiefly in athletes and the elderly, thereby affecting motor function execution. Unloading resulted in reduced tendons stiffness, and resistance exercise exercise counteracts this. Transforming growth factor-1 is a potent inducer of type I collagen and mechanosensitive genes encoding tenogenic differentiation markers expression which play critical roles in tendon tissue formation, tendon healing and their adaptation during exercise. In recent years, our understanding of the molecular biology of tendons growth and repair has expanded. It is probable that the next advance in the treatment of tendon injuries will result from the application of this basic science knowledge and the clinical solution will encompass not only the the best postoperative rehabilitation protocols, but also the optimal biological modulation of the healing process.
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Rasool, Altaf, Sheikh Adil Bashir, Prince Ajaz Ahmad, Akram Hussain Bijli, Umer Farooq Baba, Mir Yasir, and Adil Hafeez Wani. "Management of Wounds with Exposed Bones or Tendons in Children by Vacuum-Assisted Closure Therapy: A Prospective Study." Indian Journal of Plastic Surgery 53, no. 01 (March 2020): 097–104. http://dx.doi.org/10.1055/s-0039-3400192.
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Abstract Background The management of complex soft tissue defects with exposed bones/tendons is always a challenging task for the surgeon and the problem becomes more pronounced when it comes to the management of these wounds in children. Though flap procedures are considered the standard for managing the complex soft tissue defects with exposed bones/tendons yet small blood vessels for anastomosis, long operative period, increased chances of perioperative thrombosis, and difficult perioperative management in children add to the difficulty in performing flap procedures in children. The vacuum-assisted closure (VAC) therapy has emerged as a novel modality for the management of the difficult wounds with added advantages, especially in children. Objective To evaluate the efficacy of VAC in the management of wounds with exposed bones/tendons in children. Patients and Method Forty-six children of complex wounds with exposed bones/tendons were included in the study from July 2016 to June 2018. Results Out of 46 patients, 31 were male; the patients had a mean age of 8.4 years. Road traffic accident was the most common mode of injury (54%), with most of the wounds located over extremities. The mean duration of VAC therapy was 12 days. More than 90% coverage of the exposed structure was seen in 89% of patients. The wounds were definitively managed by split-thickness skin graft in 89% of patients and flap cover in 6.5% of patients. The mean cost of the VAC therapy at our government run hospital was 187 Indian rupees per day. No significant major complications were seen during the treatment. Conclusion VAC therapy is an efficient, safe, and cost-effective modality of treatment for the management of complex wounds in the pediatric population.
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Ecker, Jeff, Courtney Andrijich, Karolina Pavleski, Nicole Badur, and Bruno E. Crepaldi. "Outcome of primary tendon grafts for open Zone 3 extensor tendon injuries." Journal of Hand Surgery (European Volume) 45, no. 10 (September 9, 2020): 1045–50. http://dx.doi.org/10.1177/1753193420950655.
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Open injuries of the extensor mechanism in Zone 3 (dorsum of the proximal interphalangeal joint) have poor outcomes. We retrospectively analysed the outcomes of treating 19 Zone 3 extensor tendon injuries in 17 patients. The treatment comprised wound excision and debridement, primary tendon graft to reconstruct the damaged/missing extensor tendon, skeletal fixation when required, local flaps to vascularize the zone of injury and immediate short arc motion therapy. Using the criteria defined by Geldmacher et al., the outcome was predicted to be poor in nine, satisfactory in seven and good in three cases. In this study the outcomes were excellent in 10, good in six and satisfactory in three cases. Mean range of motion was 75° (range 25°–115°) at the proximal interphalangeal joint. We conclude that using the protocol described there should no longer be the perception of a dismal outcome for these complex Zone 3 extensor tendon injuries. Level of evidence: IV
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Kaufman, Howard H. "Treatment of head injuries in the American Civil War." Journal of Neurosurgery 78, no. 5 (May 1993): 838–45. http://dx.doi.org/10.3171/jns.1993.78.5.0838.
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✓ At the time of the American Civil War (1861–1865), a great deal was known about closed head injury and gunshot wounds to the head. Compression was differentiated from concussion, but localization of lesions was not precise. Ether and especially chloroform were used to provide anesthesia. Failure to understand how to prevent infection discouraged physicians from aggressive surgery. Manuals written to educate inexperienced doctors at the onset of the war provide an overview of the advice given by senior surgeons. The Union experiences in the treatment of head injury in the Civil War were discussed in the three surgical volumes of The Medical and Surgical History of the War of the Rebellion. Wounds were divided into incised and puncture wounds, blunt injuries, and gunshot wounds, which were analyzed separately. Because the patients were not stratified by severity of injury and because there was no neuroimaging, it is difficult to understand the clinical problems and the effectiveness of surgery. Almost immediately after the war, increased knowledge about cerebral localization and the development of antisepsis (and then asepsis) permitted the development of modern neurosurgery.
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Sajid, Soha, James Gill, Adrian Chojnowski, and Rohit Singh. "The Avocado Hand – the UK Experience of the Management of Avocado Hand Injuries." Journal of Hand Surgery (Asian-Pacific Volume) 25, no. 04 (October 28, 2020): 402–6. http://dx.doi.org/10.1142/s2424835520500423.
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Background: Avocados are increasingly being consumed due to the nutritional benefits they provide. Avocado related hand injuries reflect their increasing popularity. Most injuries occur in attempting to de-stone the fruit. This is a prospective cohort study reviewing hand injuries sustained from preparing the fruit. Methods: Data was prospectively collected from three centres across United Kingdom (UK) over a 4-year period. The data was analysed for patient demographics, nature and zone of injury and management required. Results: A total of 35 patients and 42 injuries were included in the study. The median age of patients presenting with these injuries was 33 years, with majority of injuries occurring in the 21–30 age group. Most (88%, n = 31) of patients were male. Majority (85%, n = 36) of injuries happened during the de-stoning of the fruit. All injuries occurred in the non-dominant hand, with 70%, (n = 30) of wounds being sustained in zone 3. All injuries required surgical management and needed between 1 to 6 follow up outpatient visits. Vital structures such as tendons, digital nerves, pulleys and joint capsule were frequently implicated and required exploration or repair. Conclusions: Avocado related hand wounds are serious injuries with an associated morbidity. They frequently sustained by young patients. They usually require surgical management and may need numerous outpatient attendances. Caution and public education should be advocated on the preparation of avocados. This is the largest study to date that has reviewed the surgical management of avocado hand injuries.
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Close, Graeme L., Craig Sale, Keith Baar, and Stephane Bermon. "Nutrition for the Prevention and Treatment of Injuries in Track and Field Athletes." International Journal of Sport Nutrition and Exercise Metabolism 29, no. 2 (March 1, 2019): 189–97. http://dx.doi.org/10.1123/ijsnem.2018-0290.
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Injuries are an inevitable consequence of athletic performance with most athletes sustaining one or more during their athletic careers. As many as one in 12 athletes incur an injury during international competitions, many of which result in time lost from training and competition. Injuries to skeletal muscle account for over 40% of all injuries, with the lower leg being the predominant site of injury. Other common injuries include fractures, especially stress fractures in athletes with low energy availability, and injuries to tendons and ligaments, especially those involved in high-impact sports, such as jumping. Given the high prevalence of injury, it is not surprising that there has been a great deal of interest in factors that may reduce the risk of injury, or decrease the recovery time if an injury should occur: One of the main variables explored is nutrition. This review investigates the evidence around various nutrition strategies, including macro- and micronutrients, as well as total energy intake, to reduce the risk of injury and improve recovery time, focusing upon injuries to skeletal muscle, bone, tendons, and ligaments.
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Newlands, Shawn D., Sreedhar Samudrala, and W. Kevin Katzenmeyer. "Surgical Treatment of Gunshot Injuries to the Mandible." Otolaryngology–Head and Neck Surgery 129, no. 3 (September 2003): 239–44. http://dx.doi.org/10.1016/s0194-5998(03)00481-9.
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OBJECTIVES: Our goal was to review and identify risk factors for complications from treatment of mandible fractures due to gunshot wounds. STUDY DESIGN AND SETTING: We conducted a retrospective review of treatment outcomes in 90 patients with gunshot wounds to the mandible treated over a 10-year period at 2 tertiary care centers. RESULTS: Our series of 90 patients with mandibular injuries due to gunshot wounds included 68 patients who underwent surgical procedures on the mandible. There were 14 complications in this group. Complications were more common in patients whose mandibles were rigidly fixated; however, these patients' injuries were more severe. Complications were significantly increased in patients who lost a segment of mandible in the injury. CONCLUSIONS: Complications were related to severity of injury and independent of treatment modality. SIGNIFICANCE: The complication rate for patients with gunshot injuries can be very high, particularly if bone is missing. Stabilization of remaining mandibular segments with potentially multiple subsequent reconstructive procedures is often required to restore mandibular continuity in these patients.
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Parekh, Selene, and Jay Shah. "Epidemiology and Outcomes of Achilles Tendon Ruptures in the National Football League." Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0003. http://dx.doi.org/10.1177/2473011417s000314.
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Category: Ankle, Sports Introduction/Purpose: While much less common than ankle sprains and other sports injuries, Achilles tendon ruptures have represented unexpected and potentially career-altering injuries for professional football athletes in the National Football League (NFL). Over the past decade, the technique for surgical repair of the ruptured Achilles tendon has evolved. Mini-open and percutaneous techniques have become more common, allowing for the minimization of wound complications and expediting the rehabilitation of athletes. Therefore, the objectives of this study were to update the epidemiology of Achilles tendon ruptures in the NFL, and to analyze how recovery and post-injury performance of professional football players with this injury have progressed in the last two decades. Methods: Several online sources including NFL news and injury reports, player registries, and player statistic databases were cross-referenced to conduct a retrospective identification of all NFL players sustaining complete Achilles tendon ruptures during the 2010-2015 NFL seasons. Yearly player performance statistics were also obtained and recorded for both offensive and defensive players. A power rating formula and “approximate value” algorithm, commonly used to evaluate player production, were borrowed to calculate yearly Offensive and Defensive performance metrics for each injured player. These calculated measurements were used to quantify both offensive and defensive player performance up to 3 seasons before and after their respective Achilles tendon rupture injuries, allowing for each player to serve as his own control. Results: 78 Achilles tendon ruptures were identified in professional football players during the 2010-2015 NFL seasons. 58% of these injuries occurred during the preseason. Of those that suffered an Achilles tendon rupture, 26% did not ever return to play in the NFL. Players who did return to play in the NFL took an average of 9 months to recover after the date of injury. Across all positions, there was a net decrease in power ratings by 22% and a net decrease in approximate value by 23% over 3 years following player return after Achilles tendon rupture. Across all positions, running backs saw the biggest decrease in production with a 78% decrease over 3 years post-injury in both power ratings and approximate value. Conclusion: While the incidence of Achilles tendon ruptures in NFL players, especially in the preseason, has increased substantially, more players are returning to play after injury and with better post-injury performance as compared to the previous two decades. These injuries should still be considered potentially career-altering as 26% of players never return to play after Achilles tendon ruptures and there is still a net decrease in power-ratings by 22% for those who do return. However, these numbers optimistically suggest that advancements in treatment protocol and rehabilitation are resulting in faster recovery and improved performance after Achilles tendon ruptures in NFL players.
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de Girolamo, Laura, Luiz Felipe Morlin Ambra, Carlotta Perucca Orfei, John P. McQuilling, Kelly A. Kimmerling, Katie C. Mowry, Kimberly A. Johnson, Amy T. Phan, Jessica L. Whited, and Andreas H. Gomoll. "Treatment with Human Amniotic Suspension Allograft Improves Tendon Healing in a Rat Model of Collagenase-Induced Tendinopathy." Cells 8, no. 11 (November 8, 2019): 1411. http://dx.doi.org/10.3390/cells8111411.
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Treatment of tendon injuries is challenging, with neither conservative nor surgical approaches providing full recovery. Placental-derived tissues represent a promising tool for the treatment of tendon injuries. In this study, human amniotic suspension allograft (ASA) was investigated in a pre-clinical model of Achilles tendinopathy. Collagenase type I was injected in the right hind limb of Sprague Dawley rats to induce disease. Contralateral tendons were either left untreated or injected with saline as controls. Seven days following induction, tendons were injected with saline, ASA, or left untreated. Rats were sacrificed 14 and 28 days post-treatment. Histological and biomechanical analysis of tendons was completed. Fourteen days after ASA injection, improved fiber alignment and reduced cell density demonstrated improvement in degenerated tendons. Twenty-eight days post-treatment, tendons in all treatment groups showed fewer signs of degeneration, which is consistent with normal tendon healing. No statistically significant differences in histological or biomechanical analyses were observed between treatment groups at 28 days independent of the treatment they received. In this study, ASA treatment was safe, well-tolerated, and resulted in a widespread improvement of the tissue. The results of this study provide preliminary insights regarding the potential use of ASA for the treatment of Achilles tendinopathy.
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Dursun, Gözde, Mersedeh Tohidnezhad, Bernd Markert, and Marcus Stoffel. "Effects of uniaxial stretching on tenocyte migration behaviour." Current Directions in Biomedical Engineering 4, no. 1 (September 1, 2018): 313–17. http://dx.doi.org/10.1515/cdbme-2018-0076.
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AbstractIt is widely known that tendon tissues are subjected to repeated cyclic mechanical load which influences cellular processes. The involvement of principles of mechanics in tissue engineering contributes to the investigations of the connection between mechanical and biological parameters in cellular processes and as well as to the development of new approaches for specific treatment methods. The healing process of injured tendons includes tenocyte migration which occurs from intact regions of tendon into the wound site. The aim of the present study is to investigate and enhance the migration characteristics of tenocytes under uniaxial mechanical stretching using an in-house tensile bioreactor system. Uniaxial mechanical stretching is applied to tenocyte-seeded silicone as well as collagen membranes, which possess different material properties. Tenocyte-seeded silicone membranes were investigated under three different loading conditions, including unstimulated (control), 3% and 5% strain, at frequency of 0.5 Hz. Tenocyte-seeded collagen membranes were investigated using three different frequencies, including unstimulated (control), 0.1 Hz and 0.5 Hz at strain of 4%. The main finding in this study is that uniaxially mechanical stretching at 3% strain enhances the cell migration more than 5% strain on silicone membranes.
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Georgieva, Gordana, Tomislav Jovanoski, Zana Aliu, and Djorgje Djokic. "Diagnosis and Surgical Principles in the Treatment of Acute Injuries of the Flexor Tendons of the Hand." Albanian Journal of Trauma and Emergency Surgery 5, no. 2 (March 24, 2021): 869–73. http://dx.doi.org/10.32391/ajtes.v5i2.226.
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Injuries to the flexor tendons of the wrist are a separate chapter in wrist surgery. Flexor tendon injuries still remain a challenge to ensure the patient's optimal outcome.
A special problem in the exploration of hand injuries is the accurate assessment of whether there is an injury to one or more tendons, at what height the injury is, and whether it is accompanied by injury to other elements of the hand.
On the volar side of the hand, both flexors of the fingers, superficial and deep, or just one of them, maybe injured. If the lesion is in the first zone depending on the severity of the injury, reinsertion or direct tenography is required.
In the second zone, there are still ambiguous views on the reconstruction of the deep and superficial flexor, ie. whether the surface flexor needs to be reconstructed. Injury to the flexor tendons in the third zone requires careful exploration for possible injury to the neurovascular elements, and the fourth zone often requires the release of the carpal tunnel.
In the most proximal zone of the flexor tendons, the fifth zone, injury to the main blood vessels of the hand and the nerves responsible for sensitive and motor innervation of the hand is possible.
Each injury should be approached with careful preoperative examination, appropriate operative technique as well as postoperative rehabilitation in order to fully restore the function of the hand.
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Chierice, João, Geraldo Figueiredo, Moyses Lima-Filho, Igo Lago, Rodrigo Costa, and José Marin-Neto. "Hybrid interventional and surgical treatment of complex traumatic cardiac dagger wounds." Journal of Transcatheter Interventions 29 (July 1, 2021): 1–5. http://dx.doi.org/10.31160/jotci202129a20210008.
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Penetrating injuries to the heart are usually devastating and few patients survive the initial trauma. The most frequent penetrating injuries are caused by projectile injuries and less commonly by melee weapons. Most of these injuries involve chamber free walls and a small percentage can affect the interventricular septum. We report a case in which an emergency surgical procedure was successful in controlling cardiac tamponade, and repairing a right ventricular laceration caused by multiple stab wounds. Subsequently, a successful interventional occlusion of a large interventricular septal defect, associated with significantly augmented pulmonary flow was performed.
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Hippensteel, K. J., Jeffrey Johnson, Jeremy McCormick, and Sandra Klein. "A Comparison of Wound Complications With Surgical Treatment of Achilles Tendon Conditions Using 2 Surgical Approaches." Foot & Ankle Orthopaedics 4, no. 1 (January 1, 2019): 247301141881400. http://dx.doi.org/10.1177/2473011418814004.
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Background: Wound complications are a concern with the open treatment of Achilles tendon conditions. The location of the incision may impact the risk of wound complications because of its relationship to the blood supply to the skin. There is no consensus as to the safest incision location. The purpose of this study was to evaluate and compare the rates of sural nerve injury and wound complications including superficial or deep infections and wound dehiscence between posterior midline and posteromedial surgical incision locations. Methods: 125 patients with Achilles tendon rupture or Achilles tendinopathy were treated with open surgery through a longitudinal posterior midline or posteromedial incision. An L-shaped incision was used in the posteromedial group for cases of insertional repair. Postoperative complications including sural nerve injuries, superficial wound complications, superficial infections, deep wound infections, return to the operating room, and need for soft tissue coverage were recorded and rates were compared between the groups. Results: No significant differences were detected between the posteromedial and posterior incision groups in rates of sural nerve injuries, superficial infection, or deep wound infection. The posterior incision group had significantly fewer wound complications. The wound complications in the posteromedial group primarily occurred when an L-shaped incision was used for insertional repair. No patients in either group required debridement or soft tissue/flap coverage. Conclusion: The posterior incision location had significantly fewer wound complications. The use of an L-shaped incision was likely responsible for the wound complications in this group rather than the location of the incision. The use of a medial incision was not found to decrease the rate of sural nerve injury. Level of Evidence: Level III.
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Lin, Zen-Pin, Yi-Hung Chen, Fan Chia, Huey-June Wu, Lawrence W. Lan, and Jaung-Geng Lin. "Episodes of Injuries and Frequent Usage of Traditional Chinese Medicine for Taiwanese Elite Wrestling Athletes." American Journal of Chinese Medicine 39, no. 02 (January 2011): 233–41. http://dx.doi.org/10.1142/s0192415x11008774.
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Wrestling normally places extreme demands on the body and thus may cause various kinds of injuries. An in-depth understanding of the episodes of injured sites, types, timings, and treatment modalities would help participants be aware of wrestling-related injury occurrences so as to develop effective preventive measures. Therefore, this study aims to investigate the gender-specific injuries among elite wrestling athletes. Subjects were selected from the 2009 Taiwanese National Wrestling Sport Championship. Participants were adolescent wrestling athletes, ages 16–18, who must have received at least one bronze medal at national level tournaments in 2008. A total of 118 respondents, 96 males and 22 females, completed and returned the questionnaire in which demographic data and information about the types, sites, and timings of injuries suffered and treatment modalities adopted were elicited. The data were analyzed with independent t-tests. The questionnaire results revealed a significantly higher injury rate for males than for females. The top three injured sites for males were waist (11.1%), ankle joint (10.1%) and finger (9.6%); while for females were ankle joint (13.6%), knee (12.5%) and waist (11.3%). Contusions were the most frequent type of injury: for males (73.5%) and for females (70.6%); followed by tendon inflammation for males (10.7%) and accumulated injuries for females (15.2%). During training and matching periods, the frequency of injuries for males (69.0%) is lower than that for females (81.8%). Traditional Chinese medicine (TCM) with acupuncture and moxibustion was the most common treatment modalities used for males (51.8%) and for females (68.0%); followed by orthopedics: for males (29.5%) and for females (18.0%). The present study contributed as the first effort to reveal the potency of using TCM with acupuncture and moxibustion in wrestling competitions. To prevent possible brain and body injuries in wrestling, safety education, skills and rules, and scoring systems may require further revision. Increased training of wrestling health professionals and advanced research and development of auxiliary training devices and protective equipment for wrestling athletes are also recommended.
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Lepp??niemi, Ari K., and Norman M. Rich. "Treatment of Vascular Injuries in War Wounds of the Extremities." Techniques in Orthopaedics 10, no. 3 (1995): 265–71. http://dx.doi.org/10.1097/00013611-199501030-00019.
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Melandri, Davide, Francesco Marongiu, Andrea Carboni, Corrado Rubino, Sergio Razzano, Valeria Purpura, Paola Minghetti, and Elena Bondioli. "A New Human-Derived Acellular Dermal Matrix for 1-Stage Coverage of Exposed Tendons in the Foot." International Journal of Lower Extremity Wounds 19, no. 1 (November 4, 2019): 78–85. http://dx.doi.org/10.1177/1534734619884422.
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The closure of wounds associated with soft tissue defects is surgically challenging, frequently requiring extensive plastic surgery and free flaps. The combination of ADM and STSG is an innovative method used to cover such wounds. The human-derived ADMs (H-ADMs) are the most described in the literature but according to European legislations, Companies H-ADMs outside the EC are not allowed to commercialize them in Europe, H-ADMs being “human products” and not “medical devices”, so being ruled by European legislations on transplants. The Skin Bank of the Bufalini Hospital (Cesena, Italy) obtained in 2009 the approval for the production and distribution of the first human cadaver-donor derived ADM from the Italian National Transplant Center and National Health Institute, we called with the Italian acronym M.O.D.A. (Matrice Omologa Dermica Acellulata). We present here the first use of a new H-ADM for treatment of distal lower extremity wounds with exposed tendons managed in one-stage pocedure with STSG. The excellent performance suggests that in cases where autologous tissue is unavailable or undesirable, the use of M.O.D.A. in one-stage procedure represents a promising alternative for covering wounds associated with tendons exposition.
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Karabeg, Reuf, Selma Arslanagic, Malik Jakirlic, Vanis Dujso, and Goran Obradovic. "Results of Primary Reparing of Hand Extensor Tendons Injuries Using Surgical Treatment." Medical Archives 67, no. 3 (2013): 192. http://dx.doi.org/10.5455/medarh.2013.67.192-194.
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Druyk, N. N., V. I. Gaiovich, and S. S. Strafun. "Old injuries of flexor digitorum tendons in critical zone: treatment and rehabilitation." N.N. Priorov Journal of Traumatology and Orthopedics 3, no. 2 (June 15, 1996): 31–36. http://dx.doi.org/10.17816/vto64224.
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In 86 patients with old injuries of flexor digitorum tendons in critical zone long-term results have been studied in postoperative period from 2,5 months to 1,5 years. All patients received rehabilitation by clinics method using early active mobilization and other types of treatment (drugs, stimulation, physiotherapy). Resulting index of wrist grasps was from 10,6 to 54%. Use of authors method for reconstructive treatment and postoperative rehabilitation allows to improve significantly the functional results and avoid the reoperation in most of cases.
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Amarantov, D. G., M. F. Zarivchatskii, A. A. Kholodar, O. S. Gudkov, and E. V. Kolyshova. "Modern approaches to surgical treatment of thoraco-abdominal wounds." VESTNIK KHIRURGII IMENI I.I.GREKOVA 177, no. 5 (November 23, 2018): 100–104. http://dx.doi.org/10.24884/0042-4625-2018-177-5-100-104.
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Thoraco-abdominal wounds are the most severe injuries of the chest and abdomen, with mortality reaching 13–20 %. The main focus of treatment of such patients is surgical correction of the injuries. Wide range of classical and minimally invasive interventions is used for treatment of victims . The paper presents the range of views of modern researchers on the indications for laparocentesis, drainage of the pleural cavity, thoracoscopy and laparoscopy, thoracotomy and laparotomy in this pathology. The opinions of various researchers on the optimal combination of interventions and tactics of surgical treatment of victims with thoraco-abdominal wounds are presented. It is necessary to continue the search for optimal combinations of classical and minimally invasive interventions in relation to a variety of clinic situations that arise in the treatment of patients with thoraco-abdominal wounds.
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Trukhan, A. P., D. V. Alkhovik, I. G. Kosinsky, V. A. Koryachkin, V. A. Porkhanov, and I. Yu Zherkal. "REPUBLICAN CENTER FOR TREATMENT OF GUNSHOT WOUNDS AND MINE-EXPLOSIVE INJURIES: 3 YEARS OF EXPERIENCE AND TRENDS OF DEVELOPMENT." Novosti Khirurgii 29, no. 2 (April 21, 2021): 207–12. http://dx.doi.org/10.18484/2305-0047.2021.2.207.
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Objective. To evaluate the results of organizational measures for improving the efficiency of the Republican Center for the treatment of gunshot wounds and mine-explosive injuries. Methods. The study is based on an analysis of the work of the Republican Center for the treatment of gunshot wounds and mine-explosive injuries and includes patients (n=54) who were treated from November 1, 2016 to October 31, 2019. Gunshot wounds were detected in 42 patients (77.8%). Explosive trauma was detected in 12 patients (22.2%). The most common causes of injuries were personal carelessness (20 cases (37.0%)), carelessness of others (16 cases (29.6%)), suicidal attempts (9 cases (16.6%)). In accordance with the purpose of the survey, three equal time intervals (three periods) each being equal to one year were studied. The following indicators were analyzed: the number of patients, the time from the moment of injuring to hospitalization, the type of patient’s transportation, the quality of surgical care at the hospitalization stages. Results. Implementation of the proposed organizational measures allowed increasing the number of patients hospitalized into the Republican Center for the treatment of gunshot wounds and mine-explosive injuries during the third year of work by 66.7% and 78.6%, respectively, compared with the previous time intervals. The frequency of hospitalization of patients within 24 hours after receiving an injury increased from 66.7% to 72.7%, and among patients who are not military personnel - from 45.5% to 69.2%. The proportion of errors in the treatment of patients with gunshot wounds and explosive injuries decreased by 34.0%. Conclusion. The proposed organizational measures allowed increasing the efficiency of the Republican Center for the treatment of gunshot wounds and mine-explosive injuries. In the future, it is advisable to continue close cooperation with healthcare organizations and to improve the regulatory framework for the treatment of gunshot wounds of various localization. What this paper adds The paper presents the results of the analysis of three-year work of the RepublicanCenter for the treatment of gunshot wounds and mine-explosive injuries.Realization of the proposed organizational measures allowed increasing the number of hospitalized patients, shortening the period from injury to hospitalization, and reducing the number of errors in patient care.
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Necmioglu, S., M. Subasi, C. Kayikci, and D. B. Young. "Lower limb landmine injuries." Prosthetics and Orthotics International 28, no. 1 (April 2004): 37–43. http://dx.doi.org/10.3109/03093640409167923.
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The medical records of 186 patients seeking treatment for landmine injuries in the authors' region between 1993 and 2001 were evaluated. Of these patients 13 died of accompanying complications. Ten (10) patients with general body trauma and upper limb trauma were excluded from the study. Of 163 patients with lower-limb injuries included in the study, 21 with traumatic amputation underwent surgical amputation at different levels. Patients without traumatic amputation were divided into 2 groups. There were 41 patients (29%) in Group I who were treated by limb salvage procedures. Treatments used in Group I including wound debridement, tendon repair, skin approximation, minimal osteosynthesis, external fixation of long bones and secondary wound coverage. In Group II, there were 101 patients (71%) with primary amputation. Trans-tibial amputation was performed in 52 cases (51.4%), ankle disarticulation in 24 (23.7%), trans-femoral amputation in 9 (8.9%), partial foot amputation in 8 (7.9%), knee disarticulation in 7 (6.9%) and hip disarticulation in 1 case. In Group I, there was infection in 21 patients (51.2%), revision in 27 (65.8%), and amputation in 15 (36.5%). In Group II, there was infection in 28 patients (27.7%), revision in 17 (16.8%), and amputation at a higher level in 8 (7%). In crush injuries such as those resulting from landmines, soft tissue, vascular, and neurological assessment must be performed with utmost care. Even so, the desired success in interventions intended to save a limb is complicated by a high infection rate, soft tissue complications, and high revision amputation rates. Therefore, a decision to amputate in the early term based on an accurate preoperative assessment is crucial
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Jalili, Reza, Myriam Maude Verly, Breshell Russ, Ruhangiz T. Kilani, and Aziz Ghahary. "645 Topical Application of a Novel Powdered Scaffold for Rapid Treatment of Skin Injuries." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S168—S169. http://dx.doi.org/10.1093/jbcr/iraa024.265.
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Abstract Introduction In large skin injuries, lack of matrix deposition impedes timely healing process. The longer a wound remains open, the greater is the risk of infection, non-healing, and other complications. It is therefore crucial to find effective means to promote rapid closure of skin defects. Our group has previously developed a liquid in situ-forming nutritional scaffold, known as MeshFill (MF). MF has been previously proven to be very effective in accelerating the wound repair process, notably that of complex wounds. However, MF is limited in its application to deep and tunnelling wounds, and requires reconstitution with a solvent as well as maintenance at cold temperature until application. To address these limitations, our group has developed a powdered form of MF for rapid topical application on superficial skin injuries such as dehisced surgical wounds and burn injuries. Methods Our goal was to investigate whether a powdered form of MF could be directly applied onto the wounds to accelerate healing. Ideally, powdered MF would absorb the moisture within the wound environment and reconstitute into the gel form in situ. We examined the efficacy of powder MF (PMF) compared to reconstituted gel MF (GMF) and to a standard dressing protocol. To do so, splinted full thickness wounds were generated on the back of mice and treated with either PMF or GMF or were bandaged with no treatment (NT). The healing process was monitored until wounds were fully closed. Clinical wound measurements and histological assessments were performed to compare different treatment regimens. Results Application of both PMF and GMF accelerated wound epithelialization at days 7 and 14, compared to NT, and had faster wound closure times. On average, the PMF treatments healed 17% faster than the NT control, and the GMF treatments healed 21% faster than the NT control. No significant difference between PMF and GMF was found for any outcomes. Additionally, our results suggest that epidermis formation was more effective in P and MF conditions compared to NT. Conclusions These findings suggest that topical application of a powdered form of MeshFill is as effective as standard reconstituted MeshFill gel in accelerating the healing process of skin injuries. Applicability of Research to Practice Topical application of a powdered scaffold may be a very convenient and practical method for rapid treatment of large superficial wounds such as dehisced surgical wounds, burn injuries, and filling gaps in meshed skin grafts.
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Sizyi, M. Yu. "Septic complications in patients with neck wounds." Експериментальна і клінічна медицина 84, no. 3 (August 21, 2020): 64–66. http://dx.doi.org/10.35339/ekm.2019.84.03.10.
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Nowadays, we have been a steady increase in injuries as the social conditions of life and have changed. Statistically found that 54.0 % of people of car accidents have injuries to the head and neck. According to the literature, mortality in patients with neck injury which is complicating by pyoinflammatory persists up to 30.0-76.0 %. The management of neck trauma can be challenging and sometimes overwhelming, as this anatomical region contains many vital structures. These structures may pose a diagnostic and therapeutic dilemma. Our research based on the results of diagnosis and treatment of 124 patients with a purulent mediastinitis, complicating traumatic injuries of the neck organs. Among these men – 92 (74.2 %), women – 32 (25.8 %). The results of treatment depend on timely diagnosis, hospitalization in a specialized compartment and conducting active surgical tactics