Base de dados : MEDLINE
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[PMID]:29205969
[Au] Autor:Zhang W
[Ad] Endereço:Department of Forensic Medicine, National Police University of China, Shenyang 110035, China.
[Ti] Título:[Forensic Analysis of the Characteristics of Pelvic Fracture in 65 Road Traffic Accident Death Cases].
[So] Source:Fa Yi Xue Za Zhi;32(6):428-430, 2016 Dec.
[Is] ISSN:1004-5619
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:OBJECTIVES: To analyze the characteristics and mechanisms of pelvic fractures in the cases of road traffic accident deaths. METHODS: Total 65 cases of road traffic accident deaths with pelvic fracture were collected, and the sites, characteristics and injury mechanisms of pelvic fracture were statistically analyzed. RESULTS: Among the 65 cases of pelvic fracture, 38 cases of dislocation of sacroiliac joint were found, and most combined with pubis symphysis separation or fracture of pubis. In the fractures of pubis, ischium and acetabulum, linear fractures were most common, while comminuted fractures were most common in sacrum and coccyx fractures. There were 54 cases combined with pelvic soft tissue injury, and 8 cases with pelvic organ injury and 44 cases with abdominal organ injury. In the types of pelvic ring injury, 32 cases were separation, 49.32%, followed by compression, 26.15% and only one case was verticality, 1.54%. CONCLUSIONS: Detailed and comprehensive examination of the body and determination of the pelvic fracture type contribute to analyze the mechanisms of injury.
[Mh] Termos MeSH primário: Acidentes de Trânsito
Fraturas Ósseas/diagnóstico
Ossos Pélvicos/lesões
[Mh] Termos MeSH secundário: Acetábulo/lesões
Morte
Patologia Legal
Fraturas Cominutivas/diagnóstico
Seres Humanos
Ísquio/lesões
Lesões dos Tecidos Moles/diagnóstico
Fraturas da Coluna Vertebral/diagnóstico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.3969/j.issn.1004-5619.2016.06.008


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[PMID]:29169598
[Au] Autor:Bashir MM; Sohail M; Shami HB
[Ad] Endereço:Department of Plastic, Reconstructive Surgery and Burn Unit, King Edward Medical University, Mayo Hospital, House No 327-block-H DHA, Phase 5, Lahore, Pakistan.
[Ti] Título:Traumatic Wounds of the Upper Extremity: Coverage Strategies.
[So] Source:Hand Clin;34(1):61-74, 2018 02.
[Is] ISSN:1558-1969
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Soft tissue coverage of traumatic wounds of the upper extremity is often required to restore adequate function and form. An optimal coverage should be stable, durable, and able to withstand heavy demands of work, should allow free joint mobility, and should have an aesthetically acceptable appearance. Reconstructive options for coverage include autologous tissue and dermal skin substitutes. Multiple factors, including wound characteristics and complexity, general condition of the patient, and surgeon comfort and expertise, help in selection of the reconstructive technique. This article summarizes commonly used soft tissue reconstructive options for traumatic wounds of the upper extremity.
[Mh] Termos MeSH primário: Lesões dos Tecidos Moles/cirurgia
Extremidade Superior/lesões
Extremidade Superior/cirurgia
[Mh] Termos MeSH secundário: Algoritmos
Desbridamento
Seres Humanos
Tratamento de Ferimentos com Pressão Negativa
Pele Artificial
Retalhos Cirúrgicos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180303
[Lr] Data última revisão:
180303
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171125
[St] Status:MEDLINE


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[PMID]:29169595
[Au] Autor:Iorio ML; Harper CM; Rozental TD
[Ad] Endereço:Department of Orthopaedics, Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215, USA. Electronic address: mattiorio@gmail.com.
[Ti] Título:Open Distal Radius Fractures: Timing and Strategies for Surgical Management.
[So] Source:Hand Clin;34(1):33-40, 2018 02.
[Is] ISSN:1558-1969
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Open distal radius fractures are rare injuries with few studies to guide treatment. Degree of soft tissue injury and contamination may be a primary consideration to dictate timing and operative intervention. Antibiotics should be started as early as possible and include a first-generation cephalosporin. Surgical fixation remains a matter of surgeon preference: although studies support the use of definitive internal fixation, many surgeons address contaminated injuries with external fixation. Although postoperative outcomes are similar to closed injuries for low-grade open distal radius fractures, high-grade injuries with more complex fracture patterns carry a high risk of complications, poor outcomes, and repeat surgical procedures.
[Mh] Termos MeSH primário: Fraturas Expostas/cirurgia
Fraturas do Rádio/cirurgia
[Mh] Termos MeSH secundário: Antibacterianos/uso terapêutico
Desbridamento
Fixação Interna de Fraturas
Fraturas Expostas/classificação
Seres Humanos
Lesões dos Tecidos Moles/cirurgia
Irrigação Terapêutica
Tempo para o Tratamento
Infecção dos Ferimentos/prevenção & controle
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180303
[Lr] Data última revisão:
180303
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171125
[St] Status:MEDLINE


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[PMID]:29443757
[Au] Autor:Deng C; Li H; Wei Z; Jin W; Nie K; Li S; Wu B; Wang D
[Ad] Endereço:Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, People's Republic of China.
[Ti] Título:Various surgical techniques to create an aesthetic appearance at the donor site of anterolateral thigh free flaps based on the oblique branch: Twenty-one clinical case reports.
[So] Source:Medicine (Baltimore);97(7):e9885, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Reducing the morbidity associated with anterolateral thigh (ALT) donor sites by performing aesthetic restoration has become a popular research topic. Various surgical techniques have been developed allowing for direct closure of the donor site. However, closure techniques for ALT donor sites based on the oblique branch have not been systematically reported. PATIENT CONCERNS: Data from 21 patients (18 males, 3 females) undergoing operative reconstruction with an ALT free flap between January 2016 and December 2016. The mean age of the participants was 42 years (range, 18-60 years). DIAGNOSES: The soft-tissue defects resulted from a traffic accident in 9 patients, a fall injury in 7 patients, a machinery injury in 3 patients, an electrical injury in 1 patient, and a burn scar in 1 patient. The wound areas ranged from 6 × 3.5 to 28 cm × 10 cm. INTERVENTIONS: Several surgical techniques, including the split skin paddle technique and utilization of an adjacent perforator flap or an ipsilateral groin flap, were utilized to facilitate direct closure of the ALT flap donor site. OUTCOMES: Of the 21 patients included in the study, the donor sites were directly sutured in 14 patients (8 of which required a split skin paddle technique). Four patients required an adjacent perforator flap, and 3 patients received an ipsilateral groin flap. The size of the adjacent perforator flaps ranged from 15 × 5 to 17 × 6 cm. The groin flaps ranged from 18 × 6 to 28 × 6 cm. All the flaps had excellent appearance and texture. A linear scar in the donor area was not conspicuous and achieved an aesthetic appearance. LESSONS: The ALT flap donor site based on the oblique branch pedicle can be directly closed without skin grafts through the use of several surgical techniques.
[Mh] Termos MeSH primário: Retalhos de Tecido Biológico
Procedimentos Cirúrgicos Reconstrutivos/métodos
Transplante de Pele/métodos
Lesões dos Tecidos Moles/cirurgia
Coxa da Perna/cirurgia
Sítio Doador de Transplante/cirurgia
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Masculino
Meia-Idade
Retalho Perfurante
Cirurgia Plástica/métodos
Resultado do Tratamento
Técnicas de Fechamento de Ferimentos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009885


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[PMID]:29391116
[Au] Autor:Badash I; Burtt KE; Leland HA; Gould DJ; Rounds AD; Azadgoli B; Patel KM; Carey JN
[Ad] Endereço:Keck School of Medicine of University of Southern California, Los Angeles, California, USA.
[Ti] Título:Outcomes of Soft Tissue Reconstruction for Traumatic Lower Extremity Fractures with Compromised Vascularity.
[So] Source:Am Surg;83(10):1161-1165, 2017 Oct 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Traumatic lower extremity fractures with compromised arterial flow are limb-threatening injuries. A retrospective review of 158 lower extremities with traumatic fractures, including 26 extremities with arterial injuries, was performed to determine the effects of vascular compromise on flap survival, successful limb salvage and complication rates. Patients with arterial injuries had a larger average flap surface area (255.1 vs 144.6 cm2, P = 0.02) and a greater number of operations (4.7 vs 3.8, P = 0.01) than patients without vascular compromise. Patients presenting with vascular injury were also more likely to require fasciotomy [odds ratio (OR): 6.5, confidence interval (CI): 2.3-18.2] and to have a nerve deficit (OR: 16.6, CI: 3.9-70.0), fracture of the distal third of the leg (OR: 2.9, CI: 1.15-7.1) and intracranial hemorrhage (OR: 3.84, CI: 1.1-12.9). After soft tissue reconstruction, patients with arterial injuries had a higher rate of amputation (OR: 8.5, CI: 1.3-53.6) and flap failure requiring a return to the operating room (OR: 4.5, CI: 1.5-13.2). Arterial injury did not correlate with infection or overall complication rate. In conclusion, arterial injuries resulted in significant complications for patients with lower extremity fractures requiring flap coverage, although limb salvage was still effective in most cases.
[Mh] Termos MeSH primário: Artérias/lesões
Fraturas Ósseas/cirurgia
Salvamento de Membro/métodos
Extremidade Inferior/lesões
Lesões dos Tecidos Moles/cirurgia
Retalhos Cirúrgicos
Lesões do Sistema Vascular/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Amputação/estatística & dados numéricos
Artérias/cirurgia
Criança
Feminino
Seguimentos
Seres Humanos
Salvamento de Membro/estatística & dados numéricos
Extremidade Inferior/irrigação sanguínea
Extremidade Inferior/cirurgia
Masculino
Meia-Idade
Complicações Pós-Operatórias/epidemiologia
Complicações Pós-Operatórias/etiologia
Estudos Retrospectivos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE


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[PMID]:29275614
[Au] Autor:Shen YM; Ma CX; Qin FJ; Zhang C; Wang C; Hu XH
[Ad] Endereço:Department of Burns, Beijing Jishuitan Hospital, Beijing 100035, China.
[Ti] Título:[Wound repair and functional reconstruction of high-voltage electrical burns in wrists].
[So] Source:Zhonghua Shao Shang Za Zhi;33(12):738-743, 2017 Dec 20.
[Is] ISSN:1009-2587
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To explore the methods and effects of wound repair and functional reconstruction of high-voltage electrical burns in wrists. From January 2009 to June 2016, 71 patients with high-voltage electrical burns in wrists were hospitalized, with 118 wrist wounds including 21 of type â… , 69 of type â…¡, 9 of type â…¢, and 19 of type â…£. According to the wrist injuries, different surgical operations were performed. Forearm amputation was conducted in 20 wrists with necrosis in the distal end. On the basis of fasciotomy for decompression, early debridement was performed on the other 98 wrist wounds. After debridement, wounds with area ranging from 10 cm×7 cm to 30 cm×18 cm were repaired with tissue flaps with abundant blood supply. Thirty-two wounds were repaired with pedicled groin flaps, 11 wounds with pedicled paraumbilical flaps, 3 wounds with pedicled anterolateral thigh island flaps, 9 wounds with combined abdominal axial pattern flaps, 37 wounds with free skin flaps or myocutaneous flaps, and 6 wounds with flow-through descending branch of lateral femoral circumflex artery flaps, with tissue flap area ranging from 12 cm×8 cm to 34 cm×20 cm. Ulnar artery or radial artery vascular reconstruction was performed in 20 wrist wounds. Forty-one donor sites were sutured directly, while 14 were closed by thin split-thickness skin grafts from same-side thighs, and 43 were closed by thin split-thickness skin grafts from opposite-side thighs. Fifty-three wrist wounds were performed with tendon and nerve repair surgery, of which 20 were performed with simple tendon and nerve release surgery. Flexor digitorum profundus tendons and (or) flexor pollicis longus tendons were reconstructed with autologous or allogeneic tendon transplantation in 33 wrist wounds, and the median nerve was repaired with sural nerve graft in 21 wrist wounds. In 6 to 24 months after the last operation, tendon function of 53 wrist wounds which had tendon repair was evaluated with finger total active motion (TAM) method, while median nerve function of 21 wrist wounds which had median nerve repair was evaluated with integrate estimation method. (1) After forearm amputation, the incisions of 20 wrists with necrosis in the distal end were healed. (2) Among the 98 tissue flaps, 90 had good blood flow, while 8 had distal necrosis, of which 6 were healed after necrotic tissue removal and skin grafting, and two were sutured directly after debridement. Infection occurred under 7 flaps, of which 3 were healed by dressing change, and 4 were healed after second debridement. Twenty wrist wounds which had radial artery or ulnar artery repair had good blood supply of hand and amputation was avoided. During follow-up of 1 to 3 years, the incisions and flaps of patients who had tissue flap repair surgery healed well. (3) The excellent and good rate of TAM in each finger of the corresponding affected limbs of 53 wrist wounds which had tendon and nerve repair surgery was 51%. (4) Twenty wrists which had simple tendon and nerve release surgery were followed up for 1 to 2 years. The strength of muscle dominated by the median nerve was restored to grade â…¤ in 1 wrist, grade â…£ in 3 wrists, and grade â…¢ in 2 wrists. The strength of muscle dominated by the ulnar nerve was restored to grade â…£ in 3 wrists, with no recovery in other wrists. Sensory function examination showed grade S0 in 4 wrists, grade S1 in 2 wrists, grade S2 in 3 wrists, grade S3 in 8 wrists, and grade S4 in 3 wrists. Twenty-one wrists which had median nerve repair were followed up for 1 to 2 years. There was no recovery in muscle strength dominated by the median nerve. Sensory function examination showed grade S0 in 3 wrists, grade S1 in 5 wrists, grade S2 in 8 wrists, and grade S3 in 5 wrists. It is a good method to sequentially conduct early fasciotomy for decompression, early debridement, vascular reconstruction, transplant of tissue flap with abundant blood supply, tendon and nerve repair in repairing electrical burn wounds of wrists, avoiding amputation, and reconstructing hand function according to the condition of electrical burns of wrists.
[Mh] Termos MeSH primário: Queimaduras por Corrente Elétrica/cirurgia
Procedimentos Cirúrgicos Reconstrutivos/métodos
Cicatrização
Traumatismos do Punho/cirurgia
[Mh] Termos MeSH secundário: Adulto
Desbridamento
Feminino
Seres Humanos
Masculino
Meia-Idade
Retalho Miocutâneo
Higiene da Pele
Transplante de Pele
Lesões dos Tecidos Moles/terapia
Retalhos Cirúrgicos
Traumatismos do Punho/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171226
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.1009-2587.2017.12.004


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[PMID]:29193926
[Au] Autor:Zierenberg García C; Beaton Comulada D; Pérez López JC; Lamela Domenech A; Rivera Ortiz G; González Montalvo HM; Reyes-Martínez PJ
[Ti] Título:Acute Shortening and re-lengthening in the management of open tibia fractures with severe bone of 14 CMS or more and extensive soft tissue loss.
[So] Source:Bol Asoc Med P R;108(1):89-92, 2016.
[Is] ISSN:0004-4849
[Cp] País de publicação:Puerto Rico
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: A traumatic event to the tibia with more than 14 cm of bone and soft tissue loss represents a challenge to most orthopedic surgeons and is considered a limb-threatening condition. Few solutions are available in such clinical situations and among them is the acute shortening and re-lengthening of bone and soft tissue. MATERIALS AND METHODS: Our study presents the management of 7 patients with grade III B open fractures (according to the Gustillo-Anderson classification) of the tibia who underwent resection of all the devitalized tissues, acute limb shortening to close the defect, application of an external fixator, and metaphyseal osteotomy for re-lengthening. The patient outcomes were based on different parameters using the evaluation system established by Paley et al. RESULTS: Results acquired during the study show an average bone loss of 19cm (with a minimum of 14 cm and a maximum of 31.50cm). The average time to full recovery of all patients was 19 months with a minimum of 14 months and a max of 34 months. Patient presented with excellent bony union and none existent or small refractory leg length discrepancy and did not require bone grafts or free flaps. Complications that the patients had were contractures, which required secondary procedures such as Achilles tendon re-lengthening and recurrent infections. DISCUSSION: Overall patients had excellent bone union and were able to perform activities of their daily living. The Ilizarov technique of compression-dis- traction osteogenesis is an elegant treatment option that should be considered in patients suffering such traumatic events providing excellent bony union and good functional outcomes for the patient.
[Mh] Termos MeSH primário: Fraturas Expostas/cirurgia
Desigualdade de Membros Inferiores/cirurgia
Lesões dos Tecidos Moles/etiologia
Fraturas da Tíbia/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Fixadores Externos
Fixação de Fratura/métodos
Consolidação da Fratura/fisiologia
Seres Humanos
Técnica de Ilizarov
Desigualdade de Membros Inferiores/etiologia
Osteotomia/métodos
Recuperação de Função Fisiológica
Lesões dos Tecidos Moles/patologia
Fraturas da Tíbia/complicações
Fatores de Tempo
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171214
[Lr] Data última revisão:
171214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE


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[PMID]:29180217
[Au] Autor:Gong X; Cui J; Jiang Z; Maharjan S; Lu L; Li X
[Ad] Endereço:Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, China P.R.
[Ti] Título:Comparison of perioperative complications of pedicled island flap in reconstruction of extremities.
[So] Source:J Surg Res;220:94-104, 2017 Dec.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The aim of this study was to analyze the differences in perioperative complications for pedicled island flaps in the reconstruction of extremities and to identify the factors contributing to pedicled island flap necrosis. Furthermore, the flap indications based on these outcomes are summarized. METHODS: Based on the inclusion criteria, 228 skin flaps were included in this study. Univariate and multivariate analyses were used to identify the risk factors for pedicled island flap necrosis. Differences in perioperative complications between upper and lower extremities were analyzed using the chi-square test or Fisher's exact test. RESULTS: The average age of the patients was 38 years. The overall complication rate was 21.93%, including partial flap necrosis (10.09%) and total flap necrosis (5.70%). The overall complication rate and flap necrosis rate in upper extremity reconstruction were significantly lower than the rates in lower extremity reconstruction. Flap area and postoperative wound infection were statistically significant risk factors for pedicled island flap necrosis in extremity reconstruction. Preoperative contamination of the wound bed was a statistically significant risk factor for postoperative wound infection. CONCLUSIONS: The flap area and postoperative wound infection were both independent risk factors for pedicled island flap necrosis in extremity reconstruction. The causes contributing to the differences in perioperative complications between upper and lower extremities reconstruction included preoperative contamination of the wound bed, postoperative wound infection, and the flap area but were also related to anatomical factors of the skin flap. Pedicled island flaps are more suitable for small- and medium-sized soft tissue defects.
[Mh] Termos MeSH primário: Período Perioperatório/estatística & dados numéricos
Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos
Pele/patologia
Retalhos Cirúrgicos/patologia
Infecção da Ferida Cirúrgica/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Criança
Pré-Escolar
Feminino
Seres Humanos
Lactente
Extremidade Inferior/cirurgia
Masculino
Meia-Idade
Necrose/epidemiologia
Fatores de Risco
Infecções dos Tecidos Moles/cirurgia
Lesões dos Tecidos Moles/cirurgia
Neoplasias de Tecidos Moles/cirurgia
Extremidade Superior/cirurgia
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE


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[PMID]:29019891
[Au] Autor:Schultz J; Leupold S; Grählert X; Pfeiffer R; Schwanebeck U; Schröttner P; Djawid B; Artsimovich W; Kozak K; Fitze G
[Ad] Endereço:aPediatric Surgery bCoordinating Centre for Clinical Trials Dresden cInstitute of Medical Microbiology and Hygiene, Carl Gustav Carus Medical Faculty, Technische Universität Dresden, Fetscherstrasse dFraunhofer Institute for Material and Beam Technology IWS Dresden eCarl Gustav Carus Medical Faculty, Technische Universität Dresden, Fetscherstrasse, Dresden, Germany fWroclaw Medical University, Wybrzeze Ludwika Pasteura 1, Wroclaw, Poland.
[Ti] Título:Study protocol for a randomized controlled pilot-trial on the semiocclusive treatment of fingertip amputation injuries using a novel finger cap.
[So] Source:Medicine (Baltimore);96(41):e8224, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Fingertip amputation injuries are common in all ages. Conservatively treated fingertips can regenerate skin and soft tissues to form a functionally and cosmetically excellent new fingertip. Little is known about this ability that, in humans, is confined to the fingertips. Even less is known about the role of the bacteria that regularly colonize these wounds without negative impact on regeneration and healing.As an alternative to surgery, self-adhesive film dressings are commonly used to establish a wet chamber around the injury. These dressings leak malodorous wound fluid eventually until the wound is dry. Having that into consideration, we have therefore developed a silicone finger cap that forms a mechanically protected, wet chamber around the injury for optimal regeneration conditions. It contains a puncturable reservoir for excess wound fluid, which can be thus routinely analyzed for diagnostic and research purposes.This study protocol explains the first randomized controlled trial (RCT) on the semiocclusive treatment of fingertip amputations in both children and adults comparing traditional film dressings with the novel silicone finger cap. Being the first RCT using 2 medical devices not yet certified for this indication, it will gather valuable information for the understanding of fingertip regeneration and the design of future definitive studies. METHODS AND ANALYSIS: By employing an innovative pseudo-cross-over-design with a dichotomous primary endpoint based on patients preference, this pilot study will gain statistically significant data with a very limited sample size. Our RCT will investigate acceptance, safety, effectiveness, and efficacy of this novel medical device while gathering information on the clinical course and outcome of conservatively treated fingertip injuries. A total of 22 patients older than 2 years will be randomly assigned to start the conservative treatment with either the traditional film-dressing or the novel finger cap. The treatment will be changed to the other alternative for another 2 weeks before the patient or the guardian is confronted with the decision of which method they would prefer for the rest of the treatment (if required). ETHICS AND DISSEMINATION: Ethical approval (EK 148042015) of the study protocol has been obtained from Institutional Review Board at the TU Dresden. The trial is registered at the European Database on Medical Devices (EUDAMED-No.: CIV-15-03-013246) and at ClinicalTrials.gov (NCT03089060).
[Mh] Termos MeSH primário: Tratamento Conservador/métodos
Traumatismos dos Dedos/terapia
Equipamentos de Proteção
Lesões dos Tecidos Moles/terapia
[Mh] Termos MeSH secundário: Adulto
Amputação Traumática/complicações
Pesquisa Comparativa da Efetividade
Desenho de Equipamento
Feminino
Traumatismos dos Dedos/etiologia
Seres Humanos
Masculino
Curativos Oclusivos
Projetos Piloto
Reepitelização/efeitos dos fármacos
Projetos de Pesquisa
Silicones/uso terapêutico
Lesões dos Tecidos Moles/etiologia
Técnicas de Fechamento de Ferimentos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Silicones)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171122
[Lr] Data última revisão:
171122
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171012
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008224


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[PMID]:28837757
[Au] Autor:Ramasubbu DA; Smith V; Hayden F; Cronin P
[Ad] Endereço:Dental Department, HSE, Kilbarrack Dental Clinic, Foxfield Crescent, Dublin, Ireland, D5.
[Ti] Título:Systemic antibiotics for treating malignant wounds.
[So] Source:Cochrane Database Syst Rev;8:CD011609, 2017 08 24.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Malignant wounds are a devastating complication of cancer. They usually develop in the last six months of life, in the breast, chest wall or head and neck regions. They are very difficult to treat successfully, and the commonly associated symptoms of pain, exudate, malodour, and the risk of haemorrhage are extremely distressing for those with advanced cancer. Treatment and care of malignant wounds is primarily palliative, and focuses on alleviating pain, controlling infection and odour from the wound, managing exudate and protecting the surrounding skin from further deterioration. In malignant wounds, with tissue degradation and death, there is proliferation of both anaerobic and aerobic bacteria. The aim of antibiotic therapy is to successfully eliminate these bacteria, reduce associated symptoms, such as odour, and promote wound healing. OBJECTIVES: To assess the effects of systemic antibiotics for treating malignant wounds. SEARCH METHODS: We searched the following electronic databases on 8 March 2017: the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library, 2017, Issue 3), Ovid MEDLINE, Ovid Embase and EBSCO CINAHL Plus. We also searched the clinical trial registries of the World Health Organization (WHO) International Clinical Trials Registry Platform (apps.who.int/trialsearch) and ClinicalTrials.gov on 20 March 2017; and OpenSIGLE (to identify grey literature) and ProQuest Dissertations & Theses Global (to retrieve dissertation theses related to our topic of interest) on 13 March 2017. SELECTION CRITERIA: Randomised controlled trials that assessed the effects of any systemic antibiotics on malignant wounds were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Two review authors independently screened and selected trials for inclusion, assessed risk of bias and extracted study data. A third reviewer checked extracted data for accuracy prior to analysis. MAIN RESULTS: We identified only one study for inclusion in this review. This study was a prospective, double-blind cross-over trial that compared the effect of systemic metronidazole with a placebo on odour in malignant wounds. Nine participants with a fungating wound and for whom the smell was troublesome were recruited and six of these completed both the intervention and control (placebo) stages of the trial. Each stage lasted fourteen days, with a fourteen day gap (washout period) between administration of the metronidazole and the placebo.The study, in comparing metronidazole and placebo, reported on two of this review's pre-specified primary outcomes (malodour and adverse effects of the treatment) and on none of the review's pre-specified secondary outcomes.MalodourThe mean malodour (smell) scores for the metronidazole group was 1.17 (standard deviation (SD) 1.60) and the mean for the placebo group was 3.33 (SD 0.82). It is unclear if systemic antibiotics were associated with a difference in malodour (1 study with 6 participants; MD -2.16, 95% CI -3.6 to -0.72) as the quality of the evidence (GRADE) was very low for this outcome. The study was downgraded due to high risk of attrition bias (33% loss to follow-up) and very serious imprecision due to the small sample size.Adverse effectsNo adverse effects of the treatment were reported in either the intervention or control group by the trial authors. AUTHORS' CONCLUSIONS: It is uncertain whether systemic metronidazole leads to a reduction in malodour in patients with malignant wounds. This is because we were only able to include a single study at high risk of bias with a very small sample size, which focused only on patients with breast cancer. More research is needed to substantiate these findings and to investigate the effects of systemic metronidazole and other antibiotics on quality of life, pain relief, exudate and tumour containment in patients with malignant wounds.
[Mh] Termos MeSH primário: Antibacterianos/uso terapêutico
Anti-Infecciosos/uso terapêutico
Metronidazol/uso terapêutico
Neoplasias/complicações
Odorantes
Ferimentos e Lesões/tratamento farmacológico
[Mh] Termos MeSH secundário: Método Duplo-Cego
Seres Humanos
Estudos Prospectivos
Lesões dos Tecidos Moles/tratamento farmacológico
Lesões dos Tecidos Moles/etiologia
Ferimentos e Lesões/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Anti-Infective Agents); 140QMO216E (Metronidazole)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170920
[Lr] Data última revisão:
170920
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170825
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD011609.pub2



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