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Demmer W, Meyer E, Volkmer E, Ehrl D, Haas-Lützenberger EM, Kuhlmann C, Giunta RE, Wachtel N. [Perioperative Use of Antibiotics as Infection Prophylaxis in Elective Wrist Arthroscopy: A Nationwide Survey]. HANDCHIR MIKROCHIR P 2024; 56:250-256. [PMID: 38657620 DOI: 10.1055/a-2273-4864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Wrist arthroscopy is a standard procedure in hand surgery for the diagnosis and treatment of wrist conditions. While perioperative antibiotic prophylaxis (PAP) is not generally recommended for elective hand surgery, there is no official standard for elective wrist arthroscopy. This study aimed to determine the actual clinical use of PAP in elective wrist arthroscopy in Germany and relate it to the structural conditions of clinics performing this procedure. MATERIAL AND METHODS We conducted a systematic search of all facilities in Germany offering wrist arthroscopy. Among these, we performed an online survey using the SoSci Survey online tool via email. RESULTS PAP is more frequently administered in cases involving simultaneous bone procedures. Cephalosporins are the most commonly used antibiotics in cases of PAP administration. Hospitals administer PAP more frequently than outpatient settings, with most surveyed institutions following facility-specific internal standards for antibiotic administration. The number of arthroscopies performed in the surveyed centres does not influence antibiotic administration. CONCLUSIONS The use of PAP in wrist arthroscopies in Germany is inconsistent. The increased use in arthroscopies with bone involvement corresponds to AWMF guidelines, but a general recommendation for wrist arthroscopies, including soft tissue arthroscopies, is necessary to provide physicians with medical and legal certainty.
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Affiliation(s)
- Wolfram Demmer
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, München, Germany
| | - Emanuel Meyer
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, München, Germany
| | - Elias Volkmer
- Klinik für Handchirurgie, Helios Klinikum München West, München, Germany
| | - Denis Ehrl
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, München, Germany
- Klinik für Plastische, Wiederherstellende und Handchirurgie, Zentrum für Schwerbrandverletzte, Klinikum Nürnberg, Nürnberg, Germany
| | | | - Constanze Kuhlmann
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, München, Germany
| | - Riccardo E Giunta
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, München, Germany
| | - Nikolaus Wachtel
- Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, München, Germany
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Wachtel N, Meyer E, Volkmer E, Knie N, Lukas B, Giunta R, Demmer W. Efficacy of perioperative antibiotic prophylaxis in elective soft-tissue-only wrist arthroscopy. Bone Jt Open 2023; 4:219-225. [PMID: 37051839 PMCID: PMC10065847 DOI: 10.1302/2633-1462.44.bjo-2023-0019] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Aims Wrist arthroscopy is a standard procedure in hand surgery for diagnosis and treatment of wrist injuries. Even though not generally recommended for similar procedures, general administration of perioperative antibiotic prophylaxis (PAP) is still widely used in wrist arthroscopy. Methods A clinical ambispective dual-centre study was performed to determine whether PAP reduces postoperative infection rates after soft tissue-only wrist arthroscopies. Retrospective and prospective data was collected at two hospitals with departments specialized in hand surgery. During the study period, 464 wrist arthroscopies were performed, of these 178 soft-tissue-only interventions met the study criteria and were included. Signs of postoperative infection and possible adverse drug effects (ADEs) of PAP were monitored. Additionally, risk factors for surgical site infection (SSIs), such as diabetes mellitus and BMI, were obtained. Results The overall infection rate of SSI was zero. Neither in the PAP group (n = 69) nor in the control group (n = 109) were signs of postoperative infection observed. Observed symptoms of ADEs were three-times higher in the PAP group when compared to the control-group (16.3 vs 5.5%; p = 0.043). No major ADEs were observed, but one in ten patients in the PAP group reported mild to severe intestinal or hypersensitivity symptoms. Conclusion We demonstrate that the number needed to treat (NNT) with PAP to prevent one postoperative infection in soft-tissue arthroscopies of the wrist is > 109. Conversely, symptoms of ADEs were reported by one out of ten patients given PAP. Considering the high NNT to prevent postoperative infection and the large number of ADEs caused by PAP, we recommend not to use PAP routinely in soft-tissue arthroscopies of the wrist. Subsequent large-scale studies should be conducted to substantiate these results. Cite this article: Bone Jt Open 2023;4(4):219–225.
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Affiliation(s)
- Nikolaus Wachtel
- Division of Hand, Plastic, and Aesthetic Surgery, University Hospital, Munich, Germany
| | - Emanuel Meyer
- Division of Hand, Plastic, and Aesthetic Surgery, University Hospital, Munich, Germany
| | - Elias Volkmer
- Clinic of Hand Surgery, Helios Klinikum München West, Munich, Germany
| | | | - Bernhard Lukas
- Center for Hand Surgery, Microsurgery and Plastic Surgery, Schoen Clinic Munich Harlaching, Munich, Germany
| | - Riccardo Giunta
- Division of Hand, Plastic, and Aesthetic Surgery, University Hospital, Munich, Germany
| | - Wolfram Demmer
- Division of Hand, Plastic, and Aesthetic Surgery, University Hospital, Munich, Germany
- Correspondence should be sent to Wolfram Demmer. E-mail:
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Gefen A. The influence zone: a critical performance measure for negative pressure wound therapy systems. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S8-S12. [PMID: 35980923 DOI: 10.12968/bjon.2022.31.15.s8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This article provides an introduction to the theory of, what is termed, the 'influence zone' in the context of negative pressure wound therapy (NPWT). It is a quantitative bioengineering performance measure for NPWT systems, to indicate their effectiveness, namely, how far from the wound bed edges a specific system is able to deliver effective mechano-stimulation into the periwound, and at which intensity. The influence zone therefore provides objective and standardised metrics of one of the fundamental modes of action of NPWT systems: the ability to effectively and optimally deform both the wound and periwound macroscopically and microscopically. Most important is the mechanical deformation of the periwound area to activate cells responsible for tissue repair, particularly (myo)fibroblasts. Notably, the influence zone must extend sufficiently into the periwound to stimulate (myo)fibroblasts in order that they migrate and progress the wound healing process, facilitating the formation of scar tissue, without overstretching the periwound tissues so as not cause or escalate further cell and tissue damage. The inclusion of the influence zone theory within research to investigate the efficacy of NPWT systems facilitates systematic comparisons of commercially available and potentially new systems. This approach has the capacity to guide not only research and development work, but also clinical decision-making. Recently published research found that inducing an effective influence zone first and foremost requires continuous delivery of the intended pressure to the wound bed.
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Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, The Herbert J Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel
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OMICS Approaches Evaluating Keloid and Hypertrophic Scars. Int J Inflam 2022; 2022:1490492. [PMID: 36483731 PMCID: PMC9722497 DOI: 10.1155/2022/1490492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/01/2022] [Indexed: 11/18/2022] Open
Abstract
Abnormal scar formation during wound healing can result in keloid and hypertrophic scars, which is a major global health challenge. Such abnormal scars can cause significant physiological pain and psychological distress and become a financial burden. Due to the biological complexity of scar formation, the pathogenesis of such scars and how to prevent them from forming remains elusive. In this review paper, we delve into the world of "omics" approaches to study abnormal scars and provide examples of genomics, transcriptomics, proteomics, epigenomics, and metabolomics. The benefits of "omics" approaches are that they allow for high-throughput studies and the analysis of 100s to 1000s of genes and proteins with the accumulation of large quantities of data. Currently in the field, there is a lack of "omics" review articles describing pathological scars. In this review, we summarize genome-wide linkage analysis, genome-wide association studies, and microarray data to name a few omics technologies. Such data can provide novel insights into different molecular pathways and identify novel factors which may not be captured through small-scale laboratory techniques.
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Cheng N, Jeschke MG, Sheikholeslam M, Datu AK, Oh HH, Amini-Nik S. Promotion of dermal regeneration using pullulan/gelatin porous skin substitute. J Tissue Eng Regen Med 2019; 13:1965-1977. [PMID: 31350941 PMCID: PMC7020691 DOI: 10.1002/term.2946] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 12/18/2022]
Abstract
Tissue-engineered dermal substitutes represent a promising approach to improve wound healing and provide more sufficient regeneration, compared with current clinical standards on care of large wounds, early excision, and grafting of autografts. However, inadequate regenerative capacity, impaired regeneration/degradation profile, and high cost of current commercial tissue-engineered dermal regeneration templates hinder their utilization, and the development of an efficient and cost-effective tissue-engineered dermal substitute remains a challenge. Inspired from our previously reported data on a pullulan/gelatin scaffold, here we present a new generation of a porous pullulan/gelatin scaffold (PG2) served as a dermal substitute with enhanced chemical and structural characteristics. PG2 shows excellent biocompatibility (viability, migration, and proliferation), assessed by in vitro incorporation of human dermal fibroblasts in comparison with the Integra® dermal regeneration template (Control). When applied on a mouse full-thickness excisional wound, PG2 shows rapid scaffold degradation, more granulation tissue, more collagen deposition, and more cellularity in comparison with Control at 20 days post surgery. The faster degradation is likely due to the enhanced recruitment of inflammatory macrophages to the scaffold from the wound bed, and that leads to earlier maturation of granulation tissue with less myofibroblastic cells. Collectively, our data reveal PG2's characteristics as an applicable dermal substitute with excellent dermal regeneration, which may attenuate scar formation.
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Affiliation(s)
- Nan Cheng
- Sunnybrook Research Institute, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Marc G Jeschke
- Sunnybrook Research Institute, University of Toronto, Toronto, ON M4N 3M5, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Ross-Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | | | - Andrea-Kaye Datu
- Sunnybrook Research Institute, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Hwan Hee Oh
- Sunnybrook Research Institute, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Saeid Amini-Nik
- Sunnybrook Research Institute, University of Toronto, Toronto, ON M4N 3M5, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
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