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1.
Background
Dermal regeneration template (DRT) has been well implicated in the reconstruction of full-thickness burn injury. This case series specifically presents our experience and our clinical application of Pelnac® to achieve wound closure with complex acute full-thickness defect.Methods
A retrospective review of patients treated with Pelnac for complex wound defects from 2008 to 2014 at Concord Burns Unit was carried out. Variables such as wound aetiology, wound size and complications were considered.Results
Five patients (four females and one male with a mean age 54?±?20) all had full-thickness defects (mean defect size 4.3?±?2.0 % TBSA), some with exposed tendon and bone. The wounds were treated with Pelnac®; the silicone layer was removed at postoperative day 14 and a split-thickness skin graft (0.2 to 0.3 mm) was applied. Clinically, the reconstructed areas demonstrated good granulation tissue at 14 days with good take of the skin graft. There were no major acute graft loss, rejection or associated infection. However, there were small areas of graft loss which did not require re-grafting.Conclusions
DRT provides a safe and efficacious alternative when dealing with acute contaminated full-thickness wounds. Pelnac® seems versatile in obtaining wound coverage in difficult complex wounds, especially in critically ill patients where free or pedicle flap reconstruction would be problematic.Level of Evidence: Level V, therapeutic study.2.
Paolo Cappabianca Felice Esposito Isabella Esposito Luigi Maria Cavallo Carlo Antonio Leone 《Acta neurochirurgica》2009,151(1):69-77
Objective
The management of intradural bleeding during extended endoscopic endonasal surgery is challenging. This technical note describes the use of a biological haemostatic agent which could be useful when other established strategies and materials are not effective.Materials and methods
From January 2004 to January 2008, 65 consecutive patients underwent extended endoscopic endonasal interventions. Of these, 29 procedures required the application of a thrombin–gelatin haemostatic matrix. We reviewed the patients’ operative records to determine the source, type of bleeding and haemostatic strategy.Results
We analysed bleedings from the venous sinuses, arteries, tumour bed and internal carotid artery and observed complete haemostasis immediately after application of FloSeal®. The matrix was useful for both oozing and focal haemorrhage and effective even for high-flow bleeding. Only bleeding from an internal carotid artery tear required a second application.Conclusion
The thrombin–gelatin matrix could represent a valuable tool when other haemostatic strategies are ineffective or suboptimal. It is safe and biocompatible when compared with haemostatic agents currently in use.3.
Background
Pediatric burn injuries are one of the most psychologically and physically traumatizing injuries. They can cause lifelong stigma due to scarring. Conservative therapy for scar management follows on directly from acute burn treatment. However, it is not always possible to prevent the development of hypertrophic scars and scar contractures.Methods
This article describes the principles of percutaneous collagen induction (PCI) and its successful use as a minimally invasive method in scars following thermal injuries in children and adolescents.Results
Between November 2013 and March 2018, a total of 122 PCI treatments were performed on 43 children and adolescents. A medical roller device (Dermaroller®, Dermaroller GmbH, Wolfenbüttel, Germany) with 2.5?mm long needles was used and the procedures were carried out under general anesthesia. All patients applied a 0.5% vitamin-A ointment on the treated scars every evening over a period of 4 weeks. Post-treatment scar assessments in 20 patients performed with an integrated skin testing device (DermaLab® Combo, Cortex Technology, Hadsund, Denmark) with high frequency ultrasound showed improved collagen synthesis after only one PCI.Conclusions
PCI with medical needling is an effective method for scar treatment following thermal injuries, having a maximum effect on scar elasticity and patient satisfaction. It provides an ideal treatment option for pediatric and adolescent burn survivors whishing to avoid surgery due to their history of suffering, but still desire a functional or aesthetic improvement of their scars.4.
5.
Purpose
Open abdominal wall reconstruction is often a complex endeavor, usually performed on patients with multiple risk factors and co-morbidities.Methods
In this article, we review soft tissue management techniques that can optimize the skin and subcutaneous tissue, with the goal of reducing surgical-site occurrences.Results
Regardless of the hernia repair technique used, outcomes can be highly dependent on the appropriate management of the skin and subcutaneous tissue. Indeed, dehiscence and surgical-site infection can jeopardize the entire reconstruction, especially in cases where synthetic mesh might become exposed and/or infected, setting up a “vicious cycle” (Holihan et al. in J Am Coll Surg 221:478–485, 2015).Conclusion
Multidisciplinary cooperation between the general and plastic surgeon is useful in cases of tenuous blood supply to the abdominal skin, in cases of redundant, marginal or excessive skin, and in cases of deficient skin.6.
Johannes B. Erhardt G. Roderer K. Grob T. N. Forster K. Stoffel M. S. Kuster 《Archives of orthopaedic and trauma surgery》2009,129(10):1367-1374
Objectives
We report early results using a second generation locking plate, non-contact bridging plate (NCB PH®, Zimmer Inc. Warsaw, IN, USA), for the treatment of proximal humeral fractures. The NCB PH® combines conventional plating technique with polyaxial screw placement and angular stability.Design
Prospective case series.Setting
A single level-1 trauma center.Patients
A total of 50 patients with proximal humeral fractures were treated from May 2004 to December 2005.Intervention
Surgery was performed in open technique in all cases.Main outcome measures
Implant-related complications, clinical parameters (duration of surgery, range of motion, Constant–Murley Score, subjective patient satisfaction, complications) and radiographic evaluation [union, implant loosening, implant-related complications and avascular necrosis (AVN) of the humeral head] at 6, 12 and 24 weeks.Results
All fractures available to follow-up (48 of 50) went to union within the follow-up period of 6 months. One patient was lost to follow-up, one patient died of a cause unrelated to the trauma, four patients developed AVN with cutout, one patient had implant loosening, three patients experienced cutout and one patient had an axillary nerve lesion (onset unknown). The average age- and gender-related Constant Score (n = 35) was 76.Conclusions
The NCB PH® combines conventional plating technique with polyaxial screw placement and angular stability. Although the complication rate was 19%, with a reoperation rate of 12%, the early results show that the NCB PH® is a safe implant for the treatment of proximal humeral fractures.7.
Valerio Cozza Gilda Pepe Marco Cintoni Flavio De Maio Giuseppe Tropeano Sabina Magalini Gabriele Sganga Giovanni Delogu Daniele Gui 《World journal of emergency surgery : WJES》2018,13(1):53
Background
Negative pressure wound therapy is now largely used to treat infected wounds. The prevention and reduction of healthcare-associated infections is a high priority for any Department of Health and great efforts are spent to improve infection control systems. It is assumed that vacuum-assisted closure (VAC®) dressings should be watertight and that all the secretions are gathered in a single container but there is no consistent data on air leakage and possible dispersion of bacteria from the machine.Methods
We have conducted a prospective experimental study on 10 patients with diagnosis of wound infection to verify whether the filtration process is microbiologically efficient. We compared the bacteria population present in the wound to the one present in the air discharged by the VAC® machine.Results
This study shows that the contamination of the VAC® machine is considerably lower than the environment or wound contamination.Conclusions
Negative pressure wound therapy system does not represent a risk factor for healthcare-associated infections.8.
Erhardt JB Grob K Roderer G Hoffmann A Forster TN Kuster MS 《Archives of orthopaedic and trauma surgery》2008,128(4):409-416
Objectives
We report the application of a new fixed angle plate (NCB DF®, Zimmer inc. USA, Warsaw, IN) in the treatment of periprosthetic femur fractures. The NCB DF® combines conventional plating technique with polyaxial screw placement and angular stability.Design
Prospective cohort study.Setting
A single level-1 trauma center.Patients
From May 2003 to December 2005, a total of 24 patients with periprosthetic femur fractures were treated. The NCB DF® femur plate was used in all cases. The average follow-up period was 12 months (3–31 months). Twelve patients had a periprosthetic fracture after total knee replacement (TKA) and 12 patients after total hip replacement (THA). The mean period from primary joint replacement to periprosthetic fracture was 8.2 years for the THA group and 7.2 years for the TKA group.Intervention
A combined conventional/locking surgical technique was performed in all the cases.Main outcome measures
Union, non-union, mal-union, duration of surgery, range of motion, postoperative mobility, subjective patient satisfaction and complications.Results
The union rate was 90%, the mal-union rate 5% and the re-operation rate 15%. Postoperative mobility reached the preoperative level in all but for two patients. Three complications occurred relating to the implant or the procedure: one fatigue failure of the plate (non-union), one screw breakage, and one wound infection.Conclusions
The NCB DF® combines conventional plating technique with polyaxial screw placement and angular stability. This combination technique shows promising results regarding union and mal-union rates in periprosthetic fractures in elderly and osteoporotic patients.9.
Reinhold Andreas Lang Dianne Egli-Gany Florian Holger Hubert Brill Johannes Georg Böttrich Marion Breuer Burkhard Breuer Martin Hartwig Kirschner 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2011,396(7):1055-1060
Background and aims
Ethanol- or 1-propanol-containing hand disinfectants are widely used as surgical hand antisepsis. The primary objective of this study was to investigate transdermal absorption of ethanol and 1-propanol from combination of 45% ethanol and 18% 1-propanol with skin protecting ingredients (Softa-Man®) within 1 h after application in comparison to the absorption of these alcohols from the product in the absence of the cosmetic additives. The secondary objective was to evaluate the dermal tolerability.Materials and methods
Following the double-blind, randomized cross-over design for this clinical trial, 20 ml of two different alcohol-containing disinfectants was applied with a 200-cm2 gauze swab on a skin area, identical in size and location, of 14 healthy volunteers for 10 min to investigate the absorption rate of ethanol and 1-propanol. Local dermal tolerability was evaluated using a four-point erythema scale.Results
No clinically relevant dermal absorption, with respect to ethanol and 1-propanol, could be observed within 1 h after application. Disinfectant-related mild local skin erythema was observed in three cases.Conclusion
The use of the tested formulations containing ethanol and 1-propanol can be considered as safe. The tested formulation containing skin protecting additives (Softa-Man®) does not result in more alcoholic absorption than the formulation without protective additives.10.
J. Oswald 《Der Urologe. Ausg. A》2016,55(1):35-43
Background
Children with ambiguous genitalia due to different chromosome or gonadal sex are a particular challenge concerning the diagnostic and therapeutic implications. Proximal hypospadias patients with normal gonadal development should be distinguished from children with DSD (disorders of sex development) to guarantee normal gender identity and the best possible surgical therapy.Objectives
This paper focuses on the terminology, embryology, and pathophysiology of the different manifestations of DSD. The state of knowledge about this disease pattern with particular emphasis on proximal hypospadias based on national and international scientific discussions is presented.Materials and methods
The different clinical pictures as well as therapeutic options of DSD with a special focus on recent literature and giving particular attention to patients with proximal hypospadias are presented.Results
Because of the complexity of patients suffering from disorders of sex development an interdisciplinary DSD healthcare team including a paediatric endocrinologist as well as paediatric urologist should be provided. These specialists enable an accurate diagnosis in severe hypospadias patients without reference to DSD diseases patterns.11.
Faycal El Majdoub Mario Löhr Mohammad Maarouf Anna Brunn Werner Stenzel Ralf-Ingo Ernestus 《Acta neurochirurgica》2009,151(7):833-835
Purpose
The objective of this work was to present possible, though rare, complications of Neuro-Patch® implantation after brain surgery.Methods
Two patients, aged 62 and 63 years, who had a partial dural substitution with an artificial polyurethane graft after neurosurgical resection of a gross tumour, are presented.Results
In the two patients, the avital tissue was infiltrated by either inflammatory or neoplastic tissue respectively.Conclusions
This report demonstrates a new pathological point of view in using synthetic materials for the reconstruction of dural defects.12.
Objective
Operative stabilization is recommended even for non-displaced or only slightly displaced femoral neck fractures. In addition to the known osteosynthetic procedures, an angular stabile implant system (Targon® FN) has been established since 2006 for treatment of such fractures.Indications
Displaced femoral neck fractures (Garden III and IV) and non-displaced fractures (Garden I and II).Contraindications
Fractures close to the hip joint, which are not classified as typical medial femoral neck fractures and patients with advanced osteoarthritis of the hip who would profit from an endoprosthetic procedure.Surgical technique
The operative procedure is shown after fracture reposition and central positioning of the guide wire as a standard course.Postoperative Management
Early postoperative mobilization under guidance of a physiotherapist. Initially, partial weight bearing only in selected cases with severe displacement.Results
In our patients collective the Targon® FN has been implanted in over 100 cases. Revision indications and secondary endoprosthesis were documented in only 9?% of the cases. This angular stable screw osteosynthesis system is a safe procedure to achieve patient mobility if the indications are adhered to and implantation is correctly carried out.13.
T. H. Tosounidis P. V. Giannoudis 《European journal of trauma and emergency surgery》2016,42(3):297-301
Purpose
Paediatric trauma is the leading cause of mortality in children. Paediatric trauma resuscitation is the first and foremost step towards a successful treatment and subsequent recovery. Significant advances have taken place in the last years in relation to this field of trauma care.Methods
In this narrative review, we attempt to summarise the recent development in the concepts of fluid resuscitation, massive transfusion, permissive resuscitation, management of coagulopathy and use of tranexamic acid, literature pertaining to implementation of transfusion protocols in the paediatric population and education related to the paediatric trauma resuscitation.Results/Conclusions
The current evidence although emerging is still sparse and high-quality studies are needed to shed more light on most of the above domains of resuscitation.14.
15.
John A. Kanis Helena Johansson Nicholas C. Harvey Eugene V. McCloskey 《Archives of osteoporosis》2018,13(1):118
Summary
This paper reviews the research programme that went into the development of FRAX® and its impact in the 10 years since its release in 2008.Introduction
Osteoporosis is defined on the measurement of bone mineral density though the clinical consequence is fracture. The sensitivity of bone mineral density measurements for fracture prediction is low, leading to the development of FRAX to better calculate the likelihood of fracture and target anti-osteoporosis treatments.Methods
The method used in this paper is literature review.Results
FRAX, developed over an 8-year period, was launched in 2008. Since the launch of FRAX, models have been made available for 64 countries and in 31 languages covering more than 80% of the world population.Conclusion
FRAX provides an advance in fracture risk assessment and a reference technology platform for future improvements in performance characteristics.16.
Purpose
Reconstruction of the ruptured interosseous membrane (IOM) is critical to restore forearm stability for the chronic Essex-Lopresti injury. Positive outcomes have been reported following IOM reconstruction with a single-bundle suture button (Mini-Tightrope) construct, although recent work suggests that double-bundle Mini-TightRope® IOM reconstruction is biomechanically superior. The purpose of this study was to determine whether double-bundle Mini-TightRope® reconstruction of the forearm IOM results in superior clinical outcomes to the single-bundle technique.Methods
Five patients with chronic Essex-Lopresti injuries treated with double-bundle Mini-TightRope® IOM reconstruction were matched to five patients treated with single-bundle Mini-TightRope® reconstruction. Improvement in clinical examination measures and patient-reported outcomes was compared between the groups.Results
Results were good to excellent in all 10 patients. At final follow-up, forearm rotation was significantly better in the single-bundle group, while maintenance of ulnar variance was better in the double-bundle group. No significant differences were noted between the two groups for any other numerical outcomes, and no complications occurred.Conclusion
These findings suggest that while IOM reconstruction with a double-bundle Mini-TightRope® construct results in greater resistance to proximal migration of the radius in the intermediate term, there is a modest concomitant loss of forearm rotation when compared to single-bundle reconstruction.Level of evidence
Therapeutic Level IV.17.
Objective
The treatment strategy for diabetic foot syndrome must take into account protective sensibility of the foot, open wounds, infection status, and the rules of septic bone surgery. Interventions are classified as elective, prophylactic, curative, or emergency. Amputations in the forefoot and midfoot region are performed as ray amputations (including metatarsal), which can often be carried out as ”inner“ amputations. Gentle tissue treatment mandatory because of greater risk of revision with re-amputation compared to classical amputation.Indications
Good demarcation of infection, acute osteomyelitis, osteolytic lesions, neurotropic ulcer, arterial and venous blood flow to the other toes, gangrene of other toes with metatarsal affection.Contraindications
Arterial occlusive disease, infection of neighboring areas, avoidable amputations, poorly healing ulcers on the lower leg.Surgical technique
Primary dorsal approach; minimal incisional distance (5 cm) to minimize skin necrosis risk. Atraumatic preparation, minimize hemostasis to not compromise the borderline perfusion situation. In amputations, plantar skin preparation and longer seams placed as dorsal as possible, either disarticulated and maintain cartilage, or round the cortical metatarsal bone after resection.Postoperative treatment
Diabetes control. Braun splint, mobilization in a shoe with forefoot decompression and hindfoot support, physiotherapy. Antibiotics based on resistance testing. If no complications, dressing change on postoperative day 1. Optimal wound drainage by lowering foot several times a day; drainage removal after 12–24 h. Insoles and footwear optimization.Results
Amputations require continued attention and if necessary treatment to avoid sequelae. Insufficient treatment associated with recurrent ulceration and altered anatomy.18.
Marie O Mir Ciara Cooney Cliona O’Sullivan Catherine Blake Paula Kelly Pat Kiely Jacques Noel David Moore 《Journal of children's orthopaedics》2016,10(2):169-175
Background
The demand for paediatric orthopaedic care is growing, and providing the service required is an increasingly challenging task. Physiotherapist-led triage clinics are utilised in adult orthopaedics to enable the provision of care to patients who may not require a surgical consult. The Physiotherapy Orthopaedic Triage Clinic (POTC) was established in Our Lady’s Children’s Hospital Crumlin in response to increasing demands on the paediatric orthopaedic service. The clinic is run by physiotherapists working in an advanced practice role (APP), and is the first paediatric clinic of its type and scale in the Republic of Ireland.Purpose
To evaluate the efficacy of the service over the 3-year period from January 2011 to December 2013.Methods
A review of the prospectively gathered database was performed in order to establish the demographic profile of patients, investigate clinic outcomes, and evaluate the reduction in patient waiting times.Results
2650 patients were managed by the clinic over the 3-year period. A total of 77 % of patients were managed without consultant intervention. Fifty-three percent of patients were diagnosed as having a normal presentation. The mean waiting time reduced from 101.9 weeks pre-2010 to 15.4 weeks in 2013 for those patients managed by the POTC.Conclusion
Since its inception, the clinic has significantly reduced waiting times for routine elective paediatric orthopaedic patients while managing the majority of patients independent of surgical opinion. This study shows that the APP can deliver high-quality care in the paediatric orthopaedic setting, benefitting both patients and service.19.