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Schneider AL, Ritter Schenk C, Zimmermann P. Fifteen-minute consultation: Management of mammalian bites in children - from local wound care to prophylactic antibiotics. Arch Dis Child Educ Pract Ed 2024:edpract-2023-326403. [PMID: 38448218 DOI: 10.1136/archdischild-2023-326403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/11/2024] [Indexed: 03/08/2024]
Abstract
Animal and human bites are a common reason for emergency consultation, especially in children. The most common complication of bite wounds is local infection. Systemic infections are much rarer. The key in reducing the risk of infection after a mammalian bite is local wound management with either primary or delayed closure. The benefit of administering prophylactic antibiotics is controversial.In this review, we provide a summary of the current evidence for the management of mammalian bites in children, including recommendations for appropriate investigations, wound management, administration of prophylactic and therapeutic antibiotics and the prevention of systemic infections.
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Affiliation(s)
| | | | - Petra Zimmermann
- Department of Paediatrics, Fribourg Hospital, Fribourg, Fribourg, Switzerland
- Department of Community Health, University of Fribourg, Fribourg, Switzerland
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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2
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Lu S, Wang L, Luo W, Wang G, Zhu Z, Liu Y, Gao H, Fu C, Ren J, Zhang Y, Zhang Y. Analysis of the epidemiological status, microbiology, treatment methods and financial burden of hematogenous osteomyelitis based on 259 patients in Northwest China. Front Endocrinol (Lausanne) 2023; 13:1097147. [PMID: 36686458 PMCID: PMC9846127 DOI: 10.3389/fendo.2022.1097147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
Background The incidence of hematogenous osteomyelitis is on the rise, and the prognosis is poor. There has been no large-scale epidemiological analysis of hematogenous osteomyelitis in the world, and the treatment method is still controversial. Methods A retrospective case study method was used to collect and analyze clinical data obtained from patients with hematogenous osteomyelitis in a tertiary hospital in Northwest China from January 1, 2011, to December 31, 2020. The aim of this study was to investigate the epidemiological status, microbiological characteristics, treatment and financial burden of hematogenous osteomyelitis in Northwest China to explore the therapeutic effects of different treatment methods, elucidate the epidemiological characteristics of hematogenous osteomyelitis and to provide a basis for the choice of treatment. Results We included 259 patients with hematogenous osteomyelitis, including 96 patients with acute hematogenous osteomyelitis and 163 patients with chronic hematogenous osteomyelitis. The cause of the disease was not obvious in most patients, the sex ratio of males to females was 1.98, and the three most common infected sites were the tibia, femur and phalanx. Regarding preoperative serum inflammatory markers, the rate of positivity for ESR was the highest at 67.58%. Among pathogenic microorganisms, Staphylococcus aureus was the most common. Regarding the financial burden, the median total cost per patient was 25,754 RMB, and medications accounted for the largest proportion of the main costs. Conclusions The most common pathogen associated with HO infection was MSSA. Oxacillin has good PK and PD and is recommended as the first-line drug. Some blood-borne bone infections may lead to complications, such as pulmonary infection through bacteremia, which requires early detection to avoid a missed diagnosis. Regarding surgical intervention, debridement plus absorbable calcium sulfate bone cement and calcium sulfate calcium phosphate bone cement exclusion have achieved good therapeutic effects, but they are worthy of further in-depth research. Regarding the financial burden, the median total cost per patient was 25,754 RMB. The financial burden of blood-borne osteomyelitis was lower than that of traumatic osteomyelitis. Among the main costs, drugs accounted for the largest proportion.
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Affiliation(s)
- Shuaikun Lu
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Linhu Wang
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Wen Luo
- Department of Ultrasound, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Guoliang Wang
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Zhenfeng Zhu
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Yunyan Liu
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Hao Gao
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Congxiao Fu
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Jun Ren
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Yunfei Zhang
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Yong Zhang
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi’an, China
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Esposito S, Sgarzani R, Bianchini S, Monaco S, Nicoletti L, Rigotti E, Di Pietro M, Opri R, Caminiti C, Ciccia M, Conti G, Donà D, Giuffré M, La Grutta S, Lancella L, Lima M, Lo Vecchio A, Pelizzo G, Piacentini G, Pietrasanta C, Puntoni M, Simonini A, Venturini E, Staiano A, Principi N. Surgical Antimicrobial Prophylaxis in Pediatric Patients Undergoing Plastic Surgery: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics (Basel) 2022; 11:antibiotics11040506. [PMID: 35453257 PMCID: PMC9029976 DOI: 10.3390/antibiotics11040506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 01/27/2023] Open
Abstract
For many years, it was clearly shown that surgical procedures might be associated with surgical site infection (SSI). Many scientific institutions prepared guidelines to use in surgery to reduce abuse and misuse of antibiotics. However, in the general guidelines for surgical antibiotic prophylaxis, plastic surgical procedures are not addressed or are only marginally discussed, and children were almost systematically excluded. The main aim of this Consensus document is to provide clinicians with recommendations on antimicrobial prophylaxis for pediatric patients undergoing plastic surgery. The following scenarios were considered: clean plastic surgery in elective procedures with an exclusive skin and subcutis involvement; clean-contaminated/contaminated plastic surgery in elective procedures with an exclusive skin and subcutis involvement; elective plastic surgery with use of local flaps; elective plastic surgery with the use of grafts; prolonged elective plastic surgery; acute burns; clean contused lacerated wounds without bone exposure; high-risk contused lacerated wounds or with bone exposure; contused lacerated wound involving the oral mucosa; plastic surgery following human bite; plastic surgery following animal bite; plastic surgery with tissue expander insertion. Our Consensus document shows that antimicrobial perioperative prophylaxis in pediatric patients undergoing plastic surgery is recommended in selected cases. While waiting the results of further pediatric studies, the application of uniform and shared protocols in these procedures will improve surgical practice, with a reduction in SSIs and consequent rationalization of resources and costs, as well as limiting the phenomenon of antimicrobial resistance.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
- Correspondence: ; Tel.: +39-0521-903524
| | - Rossella Sgarzani
- Servizio di Chirurgia Plastica, Centro Grandi Ustionati, Ospedale M. Bufalini, AUSL Romagna, 47521 Cesena, Italy;
| | - Sonia Bianchini
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Sara Monaco
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Laura Nicoletti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Erika Rigotti
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (M.D.P.); (R.O.); (G.P.)
| | - Marilia Di Pietro
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (M.D.P.); (R.O.); (G.P.)
| | - Roberta Opri
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (M.D.P.); (R.O.); (G.P.)
| | - Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy; (C.C.); (M.P.)
| | - Matilde Ciccia
- Neonatology and Neonatal Intensive Care Unit, Ospedale Maggiore, 40133 Bologna, Italy;
| | - Giorgio Conti
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, Italy;
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy;
| | - Mario Giuffré
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90141 Palermo, Italy;
| | - Stefania La Grutta
- Institute of Translational Pharmacology IFT, National Research Council, 90146 Palermo, Italy;
| | - Laura Lancella
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Mario Lima
- Pediatric Surgery, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
| | - Gloria Pelizzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy;
| | - Giorgio Piacentini
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (M.D.P.); (R.O.); (G.P.)
| | - Carlo Pietrasanta
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Mother, Child and Infant, 20122 Milan, Italy;
| | - Matteo Puntoni
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy; (C.C.); (M.P.)
| | - Alessandro Simonini
- Pediatric Anesthesia and Intensive Care Unit, Salesi Children’s Hospital, 60123 Ancona, Italy;
| | - Elisabetta Venturini
- Pediatric Infectious Disease Unit, Meyer’s Children Hospital, 50139 Florence, Italy;
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
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Abstract
While many hand infections are superficial, diligent evaluation, diagnosis, and treatment of these infections are central for preventing disability and morbidity. Maintaining a wide differential diagnosis is important as some hand infections may mimic others. In geographic areas with more than a 10% to 15% prevalence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) hand infections, empiric antibiotics should adequately cover MRSA. Once culture results are available, antibiotic regimens should be narrowed to reduce the development of resistant pathogens.
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Affiliation(s)
- Vivek K Bilolikar
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Asif M Ilyas
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.,Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
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Sikka N, Jayam C, Choudhary RS, Bala S. Animal Bite in a 6-month-old Child and Facial Injury with Associated Unusual Nasal Injury: Management of Injuries along with 1-year Follow-up. Int J Clin Pediatr Dent 2019; 12:560-565. [PMID: 32440075 PMCID: PMC7229397 DOI: 10.5005/jp-journals-10005-1683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In children, accidental injuries (AI) are the most common cause of major trauma. Although rare, nonaccidental injuries (NAI) can also cause major trauma. Among NAI, animal bites form a significant fraction. Animal bites form a significant fraction of NAI in children. Amongst animal bites, dog and cat bites are the most common. In adults, the likelihood of bites is on leg/thigh but in children due to their low stature, bites are more common on scalp, head, neck, or chest region. As children have lower tissue mass/size, what appears a small wound in adults comparatively appears as a larger wound in children, causing severe disfigurement. The present paper discusses cat bite injury to maxillofacial region, distinguishing from other differential diagnoses. Potential complications, initial management, and total rehabilitation of facial injuries especially nasal injury caused by a cat in a 6-month-old child are also discussed.
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Affiliation(s)
- Neha Sikka
- Department of Dental Materials, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
- Neha Sikka, Department of Dental Materials, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India, Phone: +91 9416330633, e-mail:
| | - Cheranjeevi Jayam
- Department of Dentistry, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | - Rama S Choudhary
- Department of Dentistry, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | - Shashi Bala
- Department of Dental Materials, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
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Millogo M, Ouedraogo RWL, Ily V, Konsem T, Ouedraogo D. Labial lesions by human bite. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2018. [DOI: 10.1051/mbcb/2018017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: A bite from another human is an unusual cause of maxillo-facial traumatology. Our objective was to describe the epidemiologic and clinical characteristics of labial lesions caused by this kind of bite. Patients and methods: A descriptive prospective study was carried out at the University hospitals of Yalgado OUEDRAOGO and Blaise COMPAORE in Ouagadougou in Burkina Faso between June 2012 and May 2017. Results: We collected a sample of 28 patients with an average age of 32.5 years. The sex ratio was about 0.3. All the bites had been inflicted by women. The victims generally came from an underprivileged socioprofessional background. The bite had occurred during a brawl in 26 patients (92.9% cases) and in some context of aggression among 2 patients. The lesions were located on the lower lip among 21 patients, the upper lip among 4 patients, and along the commissure among 3 patients and resulted in a loss of tissue among 23 patients (82.1%). The treatment was surgical in nature, using trimming and labialization with satisfactory results in all cases. Conclusion: The circumstances surrounding the bites are not always clear and the lesions are almost always serious and require delicate treatment.
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7
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Abstract
Clostridia can cause unique histotoxic syndromes produced by specific toxins (e.g., gas gangrene and food poisoning) as well as non-syndromic infections (e.g., abscess, local infections, and blood born infection). Clostridia can also be recovered from various body sites as part of polymicrobial aerobic-anaerobic infection. These include intra-abdominal (peritonitis and abscess), biliary tract, female genital tract, abscess (rectal area and oropharyngeal), pleuropulmonary, central nervous system, and skin and soft-tissue infections. Clostridia were recovered from children with bacteremia of gastrointestinal origin, necrotizing enterocolitis, and sickle cell disease. They have also been isolated in acute and chronic otitis media, chronic sinusitis and mastoiditis, peritonsillar abscesses, and neonatal conjunctivitis. Early and aggressive surgical debridement, decompression, and drainage of affected tissues are critical to successful outcome of histotoxic infections. Effective antimicrobials include penicillin, clindamycin, chloramphenicol, third-generation cephalosporins, carbapenems, and vancomycin.
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8
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Vijayan R, Awad G. The tooth, the whole tooth: an unusual fight bite with an unnoticed embedded tooth in the hand. BMJ Case Rep 2015; 2015:bcr-2015-209313. [PMID: 25935918 DOI: 10.1136/bcr-2015-209313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 19-year-old man presented to the plastic surgeons with a wound between his fourth and fifth metacarpophalangeal joints, with associated hand swelling and pain. He admitted to accidentally striking his brother in the mouth the previous evening. His brother reportedly made a hasty exit, and the patient dismissed the wound to his hand until waking up the next morning with swelling, pain and ascending lymphangitis. Radiographs revealed the unusual extent of his 'fight bite' injury with an entire human tooth embedded in his hand. Removal of the tooth and aggressive debridement was performed in theatre. Establishing an accurate account of events in these injuries can be difficult, with the orientation of the tooth in the soft tissues being more consistent with an uppercut than the reported jab. The patient made a good recovery following elevation, intravenous antibiotics, rigorous surgical debridement and postoperative hand therapy.
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Affiliation(s)
- Roshan Vijayan
- Department of Plastic Surgery, The Queen Victoria Hospital, East Grinstead, UK
| | - Guirgis Awad
- Department of Plastic Surgery, The Queen Victoria Hospital, East Grinstead, UK
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9
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Affiliation(s)
- Kristin Shoji
- University of Connecticut Health Center, Farmington, Connecticut 06034-4037, USA
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10
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Bear attack injury to maxillofacial region: Report of 3 cases and review of management. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2012. [DOI: 10.1016/j.ajoms.2011.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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11
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Dekou A, Fofana A, Vodi C, Gowe E, Manzan K. Arrachement du scrotum par morsure humaine: présentation d’un cas et revue de la littérature. Basic Clin Androl 2011. [DOI: 10.1007/s12610-011-0143-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Résumé
La morsure humaine des organes génitaux externes est rare. Nous rapportons un cas de plaie scrotale par morsure humaine, liée à un différend d’ordre sexuel. La lésion était une plaie récente par arrachement du sommet du scrotum, sans atteinte testiculaire. Cette plaie a été favorablement traitée par un parage et une suture scrotale sous couverture d’une antibiothérapie, avec un calendrier vaccinal contre le tétanos à jour.
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12
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Abstract
Bite wounds are especially prone to infectious complications, both local and systemic. In bite wounds to the face, such complications can create more difficulties than the initial tissue damage itself for the task of restoring an esthetic appearance. Management should aim to neutralize this potential for infection and provide an infection-free environment for wound healing. Wound cleansing followed by primary closure is the treatment of choice, and the use of prophylactic antibiotics may further decrease the risk of infection. Delay in presentation beyond 24 hours is not necessarily a contraindication to immediate repair, but excessive crushing of the tissues or extensive edema usually dictates a more conservative approach, such as delayed closure.
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13
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Rigopoulos N, Dailiana ZH, Varitimidis S, Hantes M, Bargiotas K, Malizos KN. Compartmental infections of the hand. ACTA ACUST UNITED AC 2009; 42:38-42. [DOI: 10.1080/02844310701553967] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Basaran S, Ozkan C, Coskun-Benlidayi I, Kozanoglu E. Management of a Case of Human Bite Complicated by Myonecrosis and Compartment Syndrome. J Natl Med Assoc 2009; 101:266-9. [DOI: 10.1016/s0027-9684(15)30856-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dailiana ZH, Rigopoulos N, Varitimidis S, Hantes M, Bargiotas K, Malizos KN. Purulent flexor tenosynovitis: factors influencing the functional outcome. J Hand Surg Eur Vol 2008; 33:280-5. [PMID: 18562357 DOI: 10.1177/1753193408087071] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This retrospective study aimed to evaluate the factors that influence the final outcome of treatment of purulent flexor tenosynovitis, viz. delay in treatment, severity of the condition, the infecting pathogen and the method of treatment. Of 41 patients with this condition treated by drainage and irrigation through two small incisions (16) and wide incision (25), 16 were treated after a delay. Continuous postoperative irrigation was applied in 26 patients. Re-operation was necessary in 11 patients. In most cases, Staphylococcus aureus was detected. The results were excellent in 32 cases and the mean Disabilities of the Arm, Shoulder and Hand score was 8.1. Irrigation through small incisions and continuous postoperative irrigation decreased the probability of an unfavourable outcome. Delayed treatment and infections with specific pathogens led to a worse outcome. Early diagnosis of purulent flexor tenosynovitis followed by drainage through small incisions and continuous postoperative irrigation appear, from this retrospective review, to lead to the best functional outcome.
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Affiliation(s)
- Z H Dailiana
- Department of Orthopaedic Surgery, School of Health Sciences, University of Thessalia, Larissa, Greece.
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17
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Angoules AG, Lindner T, Vrentzos G, Papakostidis C, Giannoudis PV. Prevalence and current concepts of management of farmyard injuries. Injury 2007; 38 Suppl 5:S27-34. [PMID: 18045599 DOI: 10.1016/j.injury.2007.10.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Farmyard injuries in young adults and the elderly usually result from machinery accidents, whereas children tend to be injured by runovers and motor vehicle collisions. A variety of farmyard injuries secondary to environmental and human factors may cause permanent disability or even death. Common injuries include lacerations, hand injuries, amputations, farm animal bites, fractures and dislocations. Special considerations should be taken into account when treating these injuries, focusing on their noteworthy bacterial load in order to minimise the risk of chronic morbidity.
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Affiliation(s)
- A G Angoules
- Academic Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, United Kingdom
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18
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Abstract
It has been estimated that at least one half of the population will experience some type of bite in their lifetime. Human bites are the third leading cause of all bites seen in hospital emergency departments after dog and cat bites. Human bites can be the source of exposure to body fluids, transmission of communicable diseases, infections ranging from cellulitis to osteomyelitis, and joint deformity from septic arthritis. Approximately 10-15% of human bites will become infected. In the school setting, a teacher or other staff member can sustain a human bite while trying to protect a student from injury. Often the first responder to this type of incident is the school nurse. The role of the school nurse is to promote early reporting, accurate history taking of the time and mechanism of injury, administering immediate wound care, initiating early referrals to appropriate medical providers, and supporting proactive care in the form of adult hepatitis B immunization.
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Abstract
Attacks on humans by wild boar (Sus scrofa) are occasionally reported in rural areas of Turkey. While fatalities are rare, individuals may sustain significant soft tissue trauma. Lower extremity lacerations of up to 10 cm in length and 4 cm deep were seen in the 3 cases reviewed. Injuries to the upper abdomen and chest occurred in one case. Attacks frequently occur in forested areas covered by dense brushwood, and their incidence is increased during the rutting season. In contrast to other large, feral animal attacks, injuries sustained from wild boar typically are limited to the lower extremities. This case series examines 3 attacks by wild boar in rural Turkey.
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Affiliation(s)
- Abdulkadir Gunduz
- Department of Emergency Medicine, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey.
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20
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Abstract
The primary goal of wound management is to achieve a functional closure with minimal scarring. Preventing infection is important to facilitate the healing process. Most simple, uncomplicated wounds do not need systemic antibiotics but benefit from the use of topical antibiotics. Judicious use of antibiotics reduces unnecessary adverse events and helps reduce the development of resistance. Although antibiotics can help reduce infection risk and promote healing, they are not a substitute for good local wound care, in particular irrigation and surgical débridement. This article reviews the role of antibiotics in emergency department wound management.
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Affiliation(s)
- Yoko Nakamura
- Department of Emergency Medicine, Oregon Health & Science University, 2730 NW Pettygrove Street, Portland, OR 97210-2449, USA
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21
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Abstract
Veterinarians are frequently presented with bullet, bite, or burn trauma patients. Injuries can vary from simple minor penetrating skin wounds to major life-threatening soft and hard tissue damage with concurrent complex metabolic ramifications. This article reviews the diagnostic and therapeutic options for each type of injury.
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Affiliation(s)
- Michael M Pavletic
- Angell Animal Medical Center, 350 South Huntington Avenue, Boston, MA 02130, USA.
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22
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Affiliation(s)
- Julie Anderson
- University of North Dakota College of Nursing, Grand Forks, ND, USA
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23
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Abstract
A survey of the isolation of Clostridium spp. from 1543 specimens sent to anaerobic microbiology laboratories revealed 113 isolates from 107 specimens (7.0% of all specimens) from 96 children. The isolates comprised 43 (38%) unidentified Clostridium spp., 37 (33%) C. perfringens, 13 (12%) C. ramosum, five (4%) C. innocuum, six (5%) C. botulinum, three (3%) C. difficile, two (2%) C. butyricum, and one isolate each of C. bifermentans, C. clostridiiforme, C. limosum and C. paraputrificum. Most clostridial isolates were from abscesses (38), peritonitis (26), bacteraemia (10), and chronic otitis media (7). Predisposing or underlying conditions were present in 31 (32%) cases. These were immunodeficiency (12), malignancy (9), diabetes (7), trauma (7), presence of a foreign body (6) and previous surgery (6). The clostridia were the only bacterial isolates in 14 (15%) cases; 82 (85%) cases had mixed infection. The species most commonly isolated with clostridia were anaerobic cocci (57); Bacteroides spp. (B. fragilis group) (50), Escherichia coli (22), pigmented Prevotella or Porphyromonas spp. (18) and Fusobacterium spp. (10). Most Bacteroides and Escherichia coli isolates with clostridia were from abdominal infections and skin and soft tissue infections adjacent to the rectal area; most pigmented Prevotella and Porphyromonas isolates were from oropharyngeal, pulmonary, and head and neck sites. Antimicrobial therapy was given to all patients, in conjunction with surgical drainage in 34 (35%). Only two patients died. These data illustrate the importance of Clostridium spp. in paediatric infections.
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Affiliation(s)
- I Brook
- Department of Pediatrics, Georgetown University School of Medicine, Washington, DC
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