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Cimmarusti GM, Shastry A, Boone MN, Cnudde V, Braeckman K, Brooker ADM, Robles ESJ, Britton MM. Characterization of Open-Cell Sponges via Magnetic Resonance and X-ray Tomography. MATERIALS (BASEL, SWITZERLAND) 2021; 14:2187. [PMID: 33923267 PMCID: PMC8123218 DOI: 10.3390/ma14092187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 12/03/2022]
Abstract
The applications of polymeric sponges are varied, ranging from cleaning and filtration to medical applications. The specific properties of polymeric foams, such as pore size and connectivity, are dependent on their constituent materials and production methods. Nuclear magnetic resonance imaging (MRI) and X-ray micro-computed tomography (µCT) offer complementary information about the structure and properties of porous media. In this study, we employed MRI, in combination with µCT, to characterize the structure of polymeric open-cell foam, and to determine how it changes upon compression, µCT was used to identify the morphology of the pores within sponge plugs, extracted from polyurethane open-cell sponges. MRI T2 relaxation maps and bulk T2 relaxation times measurements were performed for 7° dH water contained within the same polyurethane foams used for µCT. Magnetic resonance and µCT measurements were conducted on both uncompressed and 60% compressed sponge plugs. Compression was achieved using a graduated sample holder with plunger. A relationship between the average T2 relaxation time and maximum opening was observed, where smaller maximum openings were found to have a shorter T2 relaxation times. It was also found that upon compression, the average maximum opening of pores decreased. Average pore size ranges of 375-632 ± 1 µm, for uncompressed plugs, and 301-473 ± 1 µm, for compressed plugs, were observed. By determining maximum opening values and T2 relaxation times, it was observed that the pore structure varies between sponges within the same production batch, as well as even with a single sponge.
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Affiliation(s)
| | - Abhishek Shastry
- Centre for X-ray Tomography (UGCT), Ghent University, Proeftuinstraat 86, B-9000 Gent, Belgium; (A.S.); (M.N.B.); (V.C.)
- Department of Physics and Astronomy, Ghent University, B-9000 Gent, Belgium
| | - Matthieu N. Boone
- Centre for X-ray Tomography (UGCT), Ghent University, Proeftuinstraat 86, B-9000 Gent, Belgium; (A.S.); (M.N.B.); (V.C.)
- Department of Physics and Astronomy, Ghent University, B-9000 Gent, Belgium
| | - Veerle Cnudde
- Centre for X-ray Tomography (UGCT), Ghent University, Proeftuinstraat 86, B-9000 Gent, Belgium; (A.S.); (M.N.B.); (V.C.)
- PProGRess, Department of Geology, Ghent University, Krijgslaan 281/S8, B-9000 Ghent, Belgium
- Environmental Hydrogeology, Department of Earth Sciences, Utrecht University, Princetonlaan 8a, 3584 CB Utrecht, The Netherlands
| | - Karl Braeckman
- The Procter and Gamble Company, Brussel Innovation Center, 1853 Strombeek Bever, 100 Temselaan, Belgium;
| | - Anju D. M. Brooker
- The Procter and Gamble Company, Newcastle Innovation Center, Newcastle upon Tyne, Whitley Road, Longbenton NE12 9TS, UK; (A.D.M.B.); (E.S.J.R.)
| | - Eric S. J. Robles
- The Procter and Gamble Company, Newcastle Innovation Center, Newcastle upon Tyne, Whitley Road, Longbenton NE12 9TS, UK; (A.D.M.B.); (E.S.J.R.)
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Roddy E, Patterson JT, Kandemir U. Delay of Antibiotic Administration Greater than 2 Hours Predicts Surgical Site Infection in Open Fractures. Injury 2020; 51:1999-2003. [PMID: 32482427 DOI: 10.1016/j.injury.2020.04.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 04/03/2020] [Accepted: 04/18/2020] [Indexed: 02/02/2023]
Abstract
AIMS Antibiotic administration, severity of injury, and debridement are associated with surgical site infection (SSI) after internal fixation of open fractures. We sought to validate a time-dependent treatment effect of antibiotic administration. PATIENTS Consecutive open fracture patients at a level 1 trauma center with minimum 30-day follow-up were identified from an orthopaedic registry from 2013-2017. METHODS The primary endpoint was SSI within 90 days. A threshold time to antibiotic administration associated with SSI was ascertained by receiver-operator analysis. A Cox proportional hazards model adjusted for age, smoking, and drug use determined the treatment effect of antibiotic administration within the threshold period. RESULTS Ten percent of 230 patients developed a SSI. There was a trend for patients who did not develop an SSI to receive antibiotics earlier than those who did develop an SSI (61 minutes, IQR 33-107 vs 83 minutes, IQR 40-186), p=0.053). Intravenous antibiotic administration after 120 minutes of presentation of an open fracture to emergency department was significantly associated with a 2.4 increased hazard of surgical site infection (p=0.036) within 90 days. CONCLUSION Antibiotic administration greater than 120 minutes after ED presentation of an open fracture was associated with an increased risk of SSI.
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Affiliation(s)
- Erika Roddy
- Dept. of Orthopedic Surgery, University of California San Francisco, San Francisco General Hospital, San Francisco, CA.
| | - Joseph T Patterson
- Dept. of Orthopedic Surgery, University of California San Francisco, San Francisco General Hospital, San Francisco, CA
| | - Utku Kandemir
- Dept. of Orthopedic Surgery, University of California San Francisco, San Francisco General Hospital, San Francisco, CA
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Nawfal Dagher T, Al-Bayssari C, Diene SM, Azar E, Rolain JM. Bacterial infection during wars, conflicts and post-natural disasters in Asia and the Middle East: a narrative review. Expert Rev Anti Infect Ther 2020; 18:511-529. [PMID: 32267179 DOI: 10.1080/14787210.2020.1750952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Bacterial infections resulting from wars and natural disasters represent a major public health problem. Over the past 50 years, Asia and the Middle East have suffered several wars. Moreover, East-Asian countries are considered the most natural disaster-prone countries in the world.Areas covered: This review focuses on bacterial infection occurring during wars and after natural disasters, among refugees, wounded citizens and soldiers as well as the prevention and control measures that must be taken.Expert opinion: During wars, refugees and soldiers represent the two main sources of bacterial infections. Refugees coming from countries with a high prevalence of antimicrobial resistance can spread these pathogens to their final destination. In addition, these refugees living in inadequate shelters can contribute to the spread of bacterial infections. Moreover, some factors including the presence of fixed imported fragments; environmental contamination and nosocomial transmissions, play a key role in the dissemination of bacteria among soldiers. As for natural disasters, several factors are associated with increased bacterial transmissions such as the displacement of large numbers of people into over-crowded shelters, high exposure to disease vectors, lack of water and sanitation. Here, we carry out a systematic review of the bacterial infections that follow these two phenomena.
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Affiliation(s)
- Tania Nawfal Dagher
- Faculté de Médecine et de Pharmacie, Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France.,Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Charbel Al-Bayssari
- Faculty of Sciences 3, Lebanese University, Michel Slayman Tripoli Campus, Ras Maska, Lebanon
| | - Seydina M Diene
- Faculté de Médecine et de Pharmacie, Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Eid Azar
- Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Jean-Marc Rolain
- Faculté de Médecine et de Pharmacie, Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
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Cocjin HGB, Jingco JKP, Tumaneng FDC, Coruña JMR. Wound-Healing Following Negative-Pressure Wound Therapy with Use of a Locally Developed AquaVac System as Compared with the Vacuum-Assisted Closure (VAC) System. J Bone Joint Surg Am 2019; 101:1990-1998. [PMID: 31764361 DOI: 10.2106/jbjs.19.00125] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Negative-pressure wound therapy (NPWT) gained widespread clinical use after its introduction in the 1990s because of its many beneficial effects on the wound environment. However, high treatment costs have limited its use in third-world countries. The present study compares a low-cost, locally developed NPWT system with a commercially available system in terms of efficacy, reliability, ease of application, and safety. METHODS This prospective, randomized controlled trial involved 36 patients who were managed with NPWT with either a low-cost, locally developed system (AquaVac) or a commercially available Vacuum-Assisted Closure Advanced Therapy System (VAC ATS; KCI). The low-cost NPWT system described consists of a converted aquarium pump as a reusable vacuum source and a dressing system that can be found in the hospital supply room: food plastic wrap as an occlusive drape, surgical gauze as wound filler, nasogastric tubes as tubing, and used intravenous (IV) bottles as effluent canisters. The purpose of the study was to compare the 2 systems in terms of (1) time to apply the dressing, (2) exudate levels, (3) amount of granulation tissue, (4) wound size reduction, (5) average cost of treatment, (6) visual analog scale (VAS) pain scores, and (7) complications. RESULTS The experimental low-cost system had a small but statistically insignificant advantage over the commercially available system in terms of application time, pain during dressing changes, and wound contraction percentage. The 2 systems were comparable in terms of the amount of exudate, granulation tissue coverage, and VAS scores during the course of treatment. No wound or periwound complications were observed. The systems were significantly different in terms of cost, with the AquaVac system being 7 times less expensive than the VAC ATS system ($63.75 compared with $491.38 USD). CONCLUSIONS The low-cost AquaVac system was shown to be comparable with the commercial VAC ATS system, suggesting that it is an effective and safe alternative method for NPWT in resource-challenged settings. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hansel Gould B Cocjin
- Department of Orthopaedics & Traumatology, Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH), Bacolod City, Philippines
| | - Jair Kimri P Jingco
- Department of Orthopaedics & Traumatology, Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH), Bacolod City, Philippines
| | - Franklin Delano C Tumaneng
- Department of Orthopaedics & Traumatology, Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH), Bacolod City, Philippines
| | - Jose Maria R Coruña
- Department of Orthopaedics & Traumatology, Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH), Bacolod City, Philippines
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Bhat TA, Ibrahim R, Bhat TA, Bhat AA. In-hospital low-cost custom made VAC: Effective method for reducing infection in late presenting Open lower limb fractures in overburdened Indian hospitals. J Clin Orthop Trauma 2019; 10:195-200. [PMID: 30705559 PMCID: PMC6349653 DOI: 10.1016/j.jcot.2017.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/07/2017] [Accepted: 11/23/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Open fractures are still associated with troublesome rates of infection. Thorough debridement irrigation and antibiotic cover are of paramount importance irrespective of the fixation method. VAC therapy is a well known method of accelerating the wound healing and decreasing the infection in non healing ulcers. The main drawback of VAC therapy is requirement of a special equipment and high cost. We in our hospital are using low cost custom made VAC therapy for non healing ulcers in lower socio-economic people and have seen extremely good results in wound healing and infection control. OBJECTIVE To evaluate the role of pre operative low cost custom made VAC therapy as an adjunctive method of decreasing the rates of infection in late presenting lower limb open fractures. METHODS A retrospective study of 26 open femur and tibia fractures for which low cost VAC therapy was used between January 2014 to January 2017. RESULTS 2 out of 26 cases (7.4%) ended up with deep infection. CONCLUSION Pre operative in-hospital low cost custom made VAC therapy is a useful adjunctive method of reducing infection rates in late presenting open fractures.
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Affiliation(s)
| | | | | | - Aejaz Ahmad Bhat
- Registrar, Physical Medicine and Rehabilitation, GMC, Srinagar, India1
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Gordon W, Balsamo L, Talbot M, Osier C, Johnson A, Shero J, Potter B, Stockinger ZT. Amputation: Evaluation and Treatment. Mil Med 2018; 183:112-114. [PMID: 30189055 DOI: 10.1093/milmed/usy075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Indexed: 11/14/2022] Open
Abstract
Combat extremity injury and amputation is a life threatening injury. Initial surgical care should focus on hemostasis followed by irrigation and debridement of contaminated and nonviable tissue. Preservation of limb length begins at the initial surgical procedure, to include retention of atypical soft tissue flaps for later reconstruction and treatment of proximal fractures. Serial irrigation and debridements are required throughout the MEDEVAC system as the evolving zone of injury becomes more mature, followed by the appropriate timing of closure outside the combat theater.
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Affiliation(s)
- Wade Gordon
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
| | - Luke Balsamo
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
| | - Max Talbot
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
| | - Charles Osier
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
| | - Anthony Johnson
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
| | - John Shero
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
| | - Benjamin Potter
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
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Masters JPM, Achten J, Cook J, Dritsaki M, Sansom L, Costa ML. Randomised controlled feasibility trial of standard wound management versus negative-pressure wound therapy in the treatment of adult patients having surgical incisions for hip fractures. BMJ Open 2018; 8:e020632. [PMID: 29654039 PMCID: PMC5898317 DOI: 10.1136/bmjopen-2017-020632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Deep wound infection is a catastrophic complication after hip fracture surgery. However, current understanding of infection rates in this population is limited. Many technologies such as incisional negative-pressure wound therapy (NPWT) show promise in reducing the rate of infection. This trial is a feasibility study looking to establish a value estimated with a greater precision of the rate of deep infection after hip fracture treatment in patients treated with NPWT versus standard dressing following hip fracture surgery. METHODS AND ANALYSIS A randomised controlled trial of 464 patients will be run across multiple centres. It is embedded in the World Hip Trauma Evaluation cohort study. Any patient over the age of 65 years having surgery for hip fracture is eligible unless they are being treated with percutaneous screw fixation. A web-based randomisation sequence will stratify patients by centre. Patients will be allocated to either NPWT or standard care on a 1:1 basis. The primary outcome measure is the Centre for Disease Control definition of deep infection at 30 days. Follow-up at 4 months will also assess deep infection and the core outcome dataset for hip fractures. This includes health-related quality of life (EQ-5D-5L), mobility, mortality and late complications such as further surgery. The primary analysis will be intention to treat. ETHICS AND DISSEMINATION Oxford C Research Ethics Committee granted ethical approval on 28/04/2017, 17/SC/0207. The results of this study will be reported in a peer-reviewed publication and inform the design of a future full-scale trial. TRIAL REGISTRATION NUMBER ISRCTN55305726.
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Affiliation(s)
- James P M Masters
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Juul Achten
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Jonathan Cook
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Melina Dritsaki
- Oxford Clinical Trial Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Lucy Sansom
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Matthew L Costa
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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8
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Thabet AM, Simson JE, Gerzina C, Dabash S, Adler A, Abdelgawad AA. The impact of acute compartment syndrome on the outcome of tibia plateau fracture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:85-93. [PMID: 28785833 DOI: 10.1007/s00590-017-2017-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acute compartment syndrome (ACS) is often associated with tibial plateau fractures and is a limb-threatening injury. Staged management through fasciotomy with delayed definitive fixation can prevent muscle necrosis and increase limb salvage rates. This procedure opens a large area for potential contamination and infection in the lower extremity. Recent studies have shown an increased risk of infection following fasciotomy and staged management for tibial plateau fractures. This study reports the rate of infection, delayed union, and nonunion in patients with this injury pattern. METHODS This study was a retrospective chart review, which received institutional review board approval. It surveyed patient radiographs, clinical notes, and operating room reports from a level I trauma center between 2010 through 2016. RESULTS The results demonstrated that 23 out of 221 consecutive patients with ACS of the lower extremity presented with tibial plateau fracture over a 65-month period. Of these 23 patients, four were lost to follow-up or died. Nineteen patient charts were surveyed, 63% were male (12/19) and 37% were female (7/19). One patient developed deep infection (5.3%). Three patients experienced delayed union (15.8%), and their fractures eventually achieved union without intervention. The mean time to union was 14 weeks. Schatzker type V/VI fractures were the most prevalent type of fractures seen among patients. CONCLUSION The infection rate found is lower than in other recently published studies. The incidence of delayed union or nonunion of the fracture was also lower than in other publications in the literature. Early decompression through double- or single-incision fasciotomy does not increase the risk of infection or nonunion of the fracture. The delayed union rates found in this study are lower than those in previous studies. LEVEL OF EVIDENCE Level IV prognostic.
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Affiliation(s)
- Ahmed M Thabet
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, 4801 Alberta Ave, El Paso, TX, 79905, USA
| | - Joshua E Simson
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Chris Gerzina
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Sherif Dabash
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, 4801 Alberta Ave, El Paso, TX, 79905, USA
| | - Adam Adler
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, 4801 Alberta Ave, El Paso, TX, 79905, USA
| | - Amr A Abdelgawad
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, 4801 Alberta Ave, El Paso, TX, 79905, USA.
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Abstract
Debridement is an integral step in the orthopaedic management of traumatic wounds, from open soft tissue injuries and routine open fracture care to the management of extensive high-energy blast injuries. While the necessity of debridement has been well established, the level of energy and degree of contamination of blast wounds encountered in recent armed conflict has offered a challenge and a new opportunity for military surgeons to revisit the most recent literature to guide our practice with the best evidence currently available. While the core tenants of removing the nonviable tissue and preserving the viable to maintain the best functional outcome have not changed, new wound care therapies and advances in prosthetics and salvage techniques and the ability to rapidly evacuate casualties have changed the approach to care provided on the front lines. This paper seeks to review the core principles of debridement and guide treatment using evidence-based methods that can be applied to contaminated open injuries on the battlefront and disaster and intentional violence injuries abroad and at home.
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10
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Achten J, Parsons NR, Bruce J, Petrou S, Tutton E, Willett K, Lamb SE, Costa ML. Protocol for a randomised controlled trial of standard wound management versus negative pressure wound therapy in the treatment of adult patients with an open fracture of the lower limb: UK Wound management of Lower Limb Fractures (UK WOLLF). BMJ Open 2015; 5:e009087. [PMID: 26395498 PMCID: PMC4593163 DOI: 10.1136/bmjopen-2015-009087] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Patients who sustain open lower limb fractures have reported infection risks as high as 27%. The type of dressing applied after initial debridement could potentially affect this risk. In this trial, standard dressings will be compared with a new emerging treatment, negative pressure wound therapy, for patients with open lower limb fractures. METHODS AND ANALYSIS All adult patients presenting with an open lower limb fracture, with a Gustilo and Anderson (G&A) grade 2/3, will be considered for inclusion. 460 consented patients will provide 90% power to detect a difference of eight points in the Disability Rating Index (DRI) score at 12 months, at the 5% level. A randomisation sequence, stratified by trial centre and G&A grade, will be produced and administered by a secure web-based service. A qualitative substudy will assess patients' experience of giving consent for the trial, and acceptability of trial procedures to patients and staff. Patients will have clinical follow-up in a fracture clinic up to a minimum of 12 months as per standard National Health Service (NHS) practice. Functional and quality of life outcome data will be collected using the DRI, SF12 and EQ-5D questionnaires at 3, 6, 9 and 12 months postoperatively. In addition, information will be requested with regards to resource use and any late complications or surgical interventions related to their injury. The main analysis will investigate differences in the DRI score at 1 year after injury, between the two treatment groups on an intention-to-treat basis. Tests will be two sided and considered to provide evidence for a significant difference if p values are less than 0.05. ETHICS AND DISSEMINATION Ethical approval was given by NRES Committee West Midlands-Coventry & Warwickshire on 6/2/2012 (ref: 12/WM/0001). The results of the trial will be disseminated via peer-reviewed publications and presentations at relevant conferences. TRIAL REGISTRATION NUMBER ISRCTN33756652.
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Affiliation(s)
- Juul Achten
- Warwick Medical School, The University of Warwick, Coventry, UK
| | - Nick R Parsons
- Warwick Medical School, The University of Warwick, Coventry, UK
| | - Julie Bruce
- Warwick Medical School, The University of Warwick, Coventry, UK
| | - Stavros Petrou
- Warwick Medical School, The University of Warwick, Coventry, UK
| | - Elizabeth Tutton
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Keith Willett
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Matthew L Costa
- Warwick Medical School, The University of Warwick, Coventry, UK
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Gordon W, Kuhn K, Staeheli G, Dromsky D. Challenges in definitive fracture management of blast injuries. Curr Rev Musculoskelet Med 2015; 8:290-7. [PMID: 26104316 PMCID: PMC4596208 DOI: 10.1007/s12178-015-9286-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The United States military remains engaged in the longest armed conflict in this nation's history. The majority of casualties in the global war on terror come from blast-related injuries. Multiple centers have published their experience and outcomes with these complex patients. Findings from the study of injured military personnel have implications for mass casualty events resulting from industrial accidents or terrorism in the civilian sector. This article will review the pathophysiology of blast-related injury. The authors will summarize treatment considerations, priorities, and techniques that have proven successful. Finally, the authors will discuss the incidence and management of common complications after blast-related injuries.
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Affiliation(s)
- Wade Gordon
- />Walter Reed National Military Medical Center, Bethesda, MD USA
| | - Kevin Kuhn
- />Naval Medical Center San Diego, San Diego, CA USA
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12
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Soares KC, Baltodano PA, Hicks CW, Cooney CM, Olorundare IO, Cornell P, Burce K, Eckhauser FE. Novel wound management system reduction of surgical site morbidity after ventral hernia repairs: a critical analysis. Am J Surg 2015; 209:324-32. [DOI: 10.1016/j.amjsurg.2014.06.022] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/16/2014] [Accepted: 06/20/2014] [Indexed: 11/30/2022]
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A N, Khan WS, J P. The evidence-based principles of negative pressure wound therapy in trauma & orthopedics. Open Orthop J 2014; 8:168-77. [PMID: 25067971 PMCID: PMC4110388 DOI: 10.2174/1874325001408010168] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 03/21/2014] [Accepted: 04/06/2014] [Indexed: 12/20/2022] Open
Abstract
Negative pressure wound therapy is a popular treatment for the management of both acute and chronic wounds. Its use in trauma and orthopedics is diverse and includes the acute traumatic setting as well as chronic troublesome wounds associated with pressure sores and diabetic foot surgery. Efforts have been made to provide an evidence base to guide its use however this has been limited by a lack of good quality evidence. The following review article explores the available evidence and describes future developments for its use in trauma and orthopaedic practice.
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Affiliation(s)
- Novak A
- Department of Trauma & Orthopedics, Basingstoke & North Hampshire Hospital, Wessex, UK
| | - Wasim S Khan
- University College London Institute of Orthopedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Palmer J
- Department of Trauma & Orthopedics, Basingstoke & North Hampshire Hospital, Wessex, UK
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14
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Pitt KA, Stanley BJ. Negative pressure wound therapy: experience in 45 dogs. Vet Surg 2014; 43:380-7. [PMID: 24512302 DOI: 10.1111/j.1532-950x.2014.12155.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 04/01/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report experience with negative pressure wound therapy (NPWT) in 45 consecutive dogs admitted with extensive cutaneous wounds and to determine if NPWT is feasible in veterinary hospital practice. STUDY DESIGN Prospective descriptive study. ANIMALS Dogs (n = 45). METHODS Collected data were organized into 6 categories: patient data, wound data, NPWT data, adjunctive treatments, complications, and final outcome. RESULTS Wounds (53 in 45 dogs) were largely traumatic in origin, and distributed fairly evenly to the trunk, proximal and distal aspects of the limbs. Most wounds (34 dogs, 76%) had no granulation tissue and were treated a mean of 4.2 days after wounding, whereas 11 dogs had granulating wounds that were initially treated a mean of 87 days after wounding. Median NPWT use was 3 days with a mean hospitalization of 7.8 days. Most wounds (33; 62%) were closed surgically after NPWT and were healed by 14 days. The other 18 wounds healed (mean, 21 days) by second intention after hospital discharge. Overall, 96% of the wounds healed; 2 dogs died before definitive closure could be attempted. CONCLUSION NPWT is applicable to a wide variety of canine wounds, is well tolerated, allows for several days between dressing changes, and can used to optimize the wound bed for surgical closure or second intention healing.
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Affiliation(s)
- Kathryn A Pitt
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
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Use of a Negative Pressure Incisional Dressing After Surgical Treatment of Calcaneal Fractures. TECHNIQUES IN FOOT AND ANKLE SURGERY 2013. [DOI: 10.1097/btf.0b013e3182a2b403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Pauli EM, Krpata DM, Novitsky YW, Rosen MJ. Negative Pressure Therapy for High-Risk Abdominal Wall Reconstruction Incisions. Surg Infect (Larchmt) 2013; 14:270-4. [DOI: 10.1089/sur.2012.059] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eric M. Pauli
- Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, Ohio
| | - David M. Krpata
- Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Yuri W. Novitsky
- Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Michael J. Rosen
- Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, Ohio
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17
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Spyropoulou A, Jeng SF. Microsurgical coverage reconstruction in upper and lower extremities. Semin Plast Surg 2011; 24:34-42. [PMID: 21286303 DOI: 10.1055/s-0030-1253244] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Trauma is one of the main causes of upper- and lower-limb defects. Limb injuries frequently result in complex defects, hence reconstruction can be demanding. The basic principles of trauma management and methods of reconstruction are analyzed. Then, the evolution of free tissue transfer is reviewed with particular attention to the use of anterolateral thigh flap in reconstruction of upper- and lower-limb trauma cases. The anterolateral thigh flap is the workhorse flap in our department due to its versatility in the reconstruction of complex defects. Finally, the concept of free-style perforator flaps is presented. Microsurgery has supplied the armamentarium of the plastic surgeon with a very powerful tool. Essentially, microsurgery may almost always provide a solution in cases of complex defects that cannot be covered with the simpler options of the reconstructive ladder. The recently acquired perforator flap concept will gradually become the most popular method of microsurgical reconstruction, as it minimizes donor-site morbidity and replaces "like tissue with like tissue."
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Affiliation(s)
- Alexandra Spyropoulou
- Microsurgical Fellow, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kaoshiung Medical Center, Chang Gung University College of Medicine, Kaoshiung Hsien, Taiwan
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18
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Surgical Amputation of a Digit and Vacuum-Assisted-Closure (V.A.C.) Management in a Case of Osteomyelitis and Wound Care in an Eastern Black Rhinoceros (Diceros bicornis michaeli). J Zoo Wildl Med 2011; 42:317-21. [DOI: 10.1638/2010-0149.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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19
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Eardley WGP, Brown KV, Bonner TJ, Green AD, Clasper JC. Infection in conflict wounded. Philos Trans R Soc Lond B Biol Sci 2011; 366:204-18. [PMID: 21149356 DOI: 10.1098/rstb.2010.0225] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Although mechanisms of modern military wounding may be distinct from those of ancient conflicts, the infectious sequelae of ballistic trauma and the evolving microbial flora of war wounds remain a considerable burden on both the injured combatant and their deployed medical systems. Battlefield surgeons of ancient times favoured suppuration in war wounding and as such Galenic encouragement of pus formation would hinder progress in wound care for centuries. Napoleonic surgeons eventually abandoned this mantra, embracing radical surgical intervention, primarily by amputation, to prevent infection. Later, microscopy enabled identification of microorganisms and characterization of wound flora. Concurrent advances in sanitation and evacuation enabled improved outcomes and establishment of modern military medical systems. Advances in medical doctrine and technology afford those injured in current conflicts with increasing survivability through rapid evacuation, sophisticated resuscitation and timely surgical intervention. Infectious complications in those that do survive, however, are a major concern. Addressing antibiotic use, nosocomial transmission and infectious sequelae are a current clinical management and research priority and will remain so in an era characterized by a massive burden of combat extremity injury. This paper provides a review of infection in combat wounding from a historical setting through to the modern evidence base.
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Affiliation(s)
- W G P Eardley
- Academic Department of Military Trauma and Surgery, Royal Centre for Defence Medicine, Academic and Research Directorate, West Wing, Institute of Research and Development, Vincent Drive, Birmingham B15 2SQ, UK
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