Wounds, fractures, orthopaedics

2012 ◽  
pp. 401-502
Author(s):  
Jonathan P. Wyatt ◽  
Robin N. Illingworth ◽  
Colin A. Graham ◽  
Kerstin Hogg ◽  
Michael J. Clancy ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Needlestick Injury ◽  
Wound Management ◽  
Skin Wounds ◽  
Infected Wounds ◽  
Bites And Stings ◽  
Bite Wounds

The approach to wounds 402 Further assessment of skin wounds 404 Wound management 406 Tetanus prophylaxis 410 Antibiotic prophylaxis 411 Wound aftercare 412 Infected wounds and cellulitis 413 Bite wounds 414 Specific bites and stings 416 Needlestick injury 418 Puncture wounds 419 How to describe a fracture ...

Wounds, fractures, and orthopaedics

2020 ◽  
pp. 408-518
Author(s):  
Jonathan P. Wyatt ◽  
Robert G. Taylor ◽  
Kerstin de Wit ◽  
Emily J. Hotton ◽  
Robin J. Illingworth ◽  
...  
Keyword(s):  
Tissue Injury ◽  
Forearm Fracture ◽  
Soft Tissue Injury ◽  
Hip Dislocation ◽  
Humeral Fracture ◽  
Shaft Fracture ◽  
Tendon Injury ◽  
Needlestick Injury ◽  
Carpal Injury ◽  
Bites And Stings

This chapter in the Oxford Handbook of Emergency Medicine investigates wounds, fractures, and orthopaedics in the emergency department (ED). It reviews classification and assessment of skin wounds, puncture wounds, and foreign bodies, and discusses wound cleaning, closure, aftercare, infected wounds, bites and stings, tetanus, and needlestick injury. It explores fractures, including open (compound) fracture and dislocation (and subluxation), casts and their problems, and osteoporosis, as well as soft tissue injury, physiotherapy in the ED, and fracture clinic and alternatives. It describes different areas of fracture and injury in detail, including hand, thumb, scaphoid, and carpal injury, Colles’ fracture, Smith’s fracture, Barton’s and reverse Barton’s fracture, wrist injury, forearm fracture, elbow injury, humeral fracture, shoulder dislocation, clavicle injury, neck injury, facial wounds, pelvic fracture, hip dislocation, sacral and coccygeal fracture, femur fracture, knee injury, tibial and fibular shaft fracture, pretibial laceration, calf and Achilles tendon injury, ankle injury, foot fracture and dislocation, toe injury, low back pain, arthritis, and eponymous fractures.

Use of Antibiotic-Impregnated Absorbable Beads and Tissue Coverage of Complex Wounds

2016 ◽  
Vol 82 (11) ◽  
pp. 1068-1072 ◽  
Author(s):  
Terris L. White ◽  
Alfred T. Culliford ◽  
Martin Zomaya ◽  
Gary Freed ◽  
Christopher P. Demas
Keyword(s):  
Wound Management ◽  
Fasciocutaneous Flaps ◽  
Local Antibiotics ◽  
Standard Management ◽  
Systemic Antibiotic Therapy ◽  
Infected Wounds ◽  
Complex Wound ◽  
High Concentrations ◽  
Multicenter Retrospective Review ◽  
Complex Wounds

The treatment of complex wounds is commonplace for plastic surgeons. Standard management is debridement of infected and devitalized tissue and systemic antibiotic therapy. In cases where vital structures are exposed within the wound, coverage is obtained with the use of vascularized tissue using both muscle and fasciocutaneous flaps. The use of nondissolving polymethylmethacrylate and absorbable antibiotic-impregnated beads has been shown to deliver high concentrations of antibiotics with low systemic levels of the same antibiotic. We present a multicenter retrospective review of all cases that used absorbable antibiotic-impregnated beads for complex wound management from 2003 to 2013. A total of 104 cases were investigated, flap coverage was used in 97 cases (93.3%). Overall, 15 patients (14.4%) required reoperation with the highest groups involving orthopedic wounds and sternal wounds. The advantages of using absorbable antibiotic-impregnated beads in complex infected wounds have been demonstrated with minimal disadvantages. The utilization of these beads is expanding to a variety of complex infectious wounds requiring high concentrations of local antibiotics.

scholarly journals Ozonetherapy for wound management in dogs [abstract]

2019 ◽  
Vol 3 (4) ◽  
Author(s):  
Susana Gabriela Gayon-Amaro ◽  
Eduardo Flores-Colin
Keyword(s):  
Therapeutic Option ◽  
Local Treatment ◽  
Wound Management ◽  
Ozone Therapy ◽  
Recovery Processes ◽  
Plastic Materials ◽  
Purulent Wounds ◽  
Management Protocol ◽  
Infected Wounds ◽  
Polyethylene Bags

PURPOSE: To demonstrate the bactericide and regenerative capabilities of ozone through the execution of established protocols for infected wounds management. MATERIAL AND METHODS: - Ozone generator - Medical oxygen - Drinking water - Nelaton lead - Gauzes - Polyethylene bags of different sizes - 10 ml syringes - 30G needles Collect information of clinical cases of 5 patients with purulent wounds caused by bite of congener treated with ozone therapy (OP) with bagging technique (1) – injury washing with ozonized water and posterior bagged of affected area with polyethylene for 15 minutes with an ozone concentration of 56 mg/L and infiltration of wound edges with the gas in an anti-inflammatory concentration of 33 mg/L. It was possible to observe short recovery processes of disinfection and regeneration of infected wounds using in only OP as wound management protocol. DISCUSSION: Ozone bactericide property is probably the most studied topic because it was early used in the management of infected wounds (2,3). Later, with the invention of plastic materials, local treatment of septic limbs with gaseous ozone became possible. The regeneration helped with ozone has been intensively described, the acceleration of the process is related with cytokines release and the increase of tisular oxygenation (4). CONCLUSION: Based on that, it is possible to conclude that ozonetherapy could be used as another therapeutic option in the management of infected wounds with bagging technique due to bactericide and regenerative properties of this gas.

Mammalian and Reptile Bites

2016 ◽  
Author(s):  
David Scordino ◽  
Susan Peterson
Keyword(s):  
Morbidity And Mortality ◽  
Wound Management ◽  
Bite Wound ◽  
Wound Irrigation ◽  
Vascular Area ◽  
The Face ◽  
Bite Wounds

Bites from animals and humans can result in significant infections, morbidity, and mortality if not managed well. Individuals who are unable to provide an adequate history or who are unaware of if they were bitten or scratched require skin evaluation that may show puncture wounds, suggesting a bite, or simple scrapes, suggesting a scratch. A thorough exam of the bite for evidence of contamination or infection as well as the location and type of wound is critical for wound management, follow-up, and disposition. Treatment includes addressing the patient’s airway, breathing, and circulation; wound irrigation and management as well as tetanus prophylaxis should be provided because the skin has been broken. In general, bite wounds should not be closed unless the bite wound is in a highly vascular area such as the face.

scholarly journals Hydrogel-Based Strategies to Advance Therapies for Chronic Skin Wounds

2019 ◽  
Vol 21 (1) ◽  
pp. 145-169 ◽  
Author(s):  
Lucília P. da Silva ◽  
Rui L. Reis ◽  
Vitor M. Correlo ◽  
Alexandra P. Marques
Keyword(s):  
Tissue Engineering ◽  
Chronic Wounds ◽  
Significant Risk ◽  
Skin Regeneration ◽  
Wound Management ◽  
Skin Wounds ◽  
Preclinical Models ◽  
Moist Environment ◽  
Chronic Skin ◽  
Bioactive Agents

Chronic skin wounds are the leading cause of nontraumatic foot amputations worldwide and present a significant risk of morbidity and mortality due to the lack of efficient therapies. The intrinsic characteristics of hydrogels allow them to benefit cutaneous healing essentially by supporting a moist environment. This property has long been explored in wound management to aid in autolytic debridement. However, chronic wounds require additional therapeutic features that can be provided by a combination of hydrogels with biochemical mediators or cells, promoting faster and better healing. We survey hydrogel-based approaches with potential to improve the healing of chronic wounds by reviewing their effects as observed in preclinical models. Topics covered include strategies to ablate infection and resolve inflammation, the delivery of bioactive agents to accelerate healing, and tissue engineering approaches for skin regeneration. The article concludes by considering the relevance of treating chronic skin wounds using hydrogel-based strategies.

scholarly journals Thoracic dog bite wounds in cats: a retrospective study of 22 cases (2005–2015)

2019 ◽  
Vol 22 (2) ◽  
pp. 146-152 ◽  
Author(s):  
Anna K Frykfors von Hekkel ◽  
Zoë J Halfacree
Keyword(s):  
Flail Chest ◽  
Radiographic Finding ◽  
Penetrating Injury ◽  
Wound Management ◽  
Respiratory Pattern ◽  
Dog Bite ◽  
Radiographic Findings ◽  
Exact Test ◽  
Penetrating Wound ◽  
Bite Wounds

Objectives The aim of this study was to describe a series of cats suffering from thoracic dog bite wounds, in order to detail the clinical, radiographic and surgical findings, and evaluate outcomes and factors associated with mortality. Methods The medical records of cats with thoracic dog bite wounds presenting to a single institution between 2005 and 2015 were retrospectively reviewed. Data relating to clinical presentation, wound depth and management, radiographic findings, surgical findings and mortality were collected. Wound depth was defined as no external wound, superficial, deep or penetrating, and wound management was defined as conservative, exploratory or thoracic exploration. Statistical analyses were performed using Fisher’s exact test, the Mann–Whitney U-test and the χ2 test. Results Twenty-two cats were included, of which two were euthanased on presentation. In cats where wound depth could be assessed (21/22), six had no external wounds, four had superficial wounds, three had deep wounds and eight suffered penetrating wounds. Sixteen cats also suffered wounds elsewhere, most commonly to the abdomen. Neither an abdominal wound nor abdominal surgery were associated with mortality. Pneumothorax was the most common radiographic finding (11/18). Individual radiographic lesions were not significantly associated with respiratory pattern, presence of pseudo-flail, need for thoracotomy or lung lobectomy, or survival. The presence of ⩾3 radiographic lesions was associated with the presence of a penetrating wound ( P = 0.025) and with having thoracic exploration ( P = 0.025). Local exploration was performed in 7/20 cats, while 8/20 underwent thoracic exploration. Wound management type was not significantly associated with mortality. Overall mortality rate was 27%. Conclusions and relevance Presence of ⩾3 radiographic lesions should raise suspicion of a penetrating injury and may be suggestive of injury requiring a greater level of intervention. The treating veterinarian should have a high index of suspicion for penetrating injury and be prepared in case thoracic exploratory surgery is necessary, particularly in the presence of pseudo-flail chest, pneumothorax or ⩾3 radiographic lesions.

scholarly journals TERAPI LARVA PADA LUKA KRONIS TERBUKA

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Sunny Wangko
Keyword(s):  
Wound Healing ◽  
Growth Factors ◽  
Chronic Wound ◽  
Healing Process ◽  
Bioactive Molecules ◽  
Wound Management ◽  
Wound Healing Process ◽  
Beneficial Effects ◽  
Infected Wounds ◽  
Larval Therapy

Abstract: The usage of larvae in wound treatment has been known across the centuries in different countries. However, larval therapy is offered when the conventional therapy has failed in the management of chronic, infected wounds. Concerning the larval therapy, it was presumed that the wound healing was due to the mechanical debridement effect of the larval movement and of their hooks. To date, a variety of study reports reveals that there are several beneficial effects of the larval therapy, inter alia: secretion/excretion of larvae contains enzymes, growth factors, and cytokines that collaborate in the wound healing process. The bioactive molecules in the secretion/excretion of the larvae has to be further studied and to be developed, therefore, they can be applied in the wound management efficiently and economically. Keywords: larval therapy, chronic wound, healing process.     Abstrak: Walaupun pemanfaatan larva pada luka kronis telah sangat lama dikenal di berbagai negara, terapi larva umumnya digunakan bila terapi konvensional telah gagal. Awalnya diduga bahwa efek debridemen mekanis oleh gerakan larva dan kaitnya yang paling berperan. Dewasa ini, laporan berbagi studi telah mengungkapkan bahwa larva menyekresi dan menyintesis berbagai bahan baik berupa enzim, sitokin, dan growth factors yang turut berperan dalam proses penyembuhan luka. Adanya molekul bioaktif dalam ekskresi dan sekresi larva perlu diteliti dan dikembangkan agar dapat diaplikasikan dengan lebih efisien dan ekonomis. Kata kunci: terapi larva, luka kronis, penyembuhan luka.

scholarly journals Acetic acid dressings: Finding the Holy Grail for infected wound management

2017 ◽  
Vol 50 (03) ◽  
pp. 273-280 ◽  
Author(s):  
Kapil S. Agrawal ◽  
Anup Vidyadhar Sarda ◽  
Raghav Shrotriya ◽  
Manoj Bachhav ◽  
Vinita Puri ◽  
...  
Keyword(s):  
Wound Healing ◽  
Acetic Acid ◽  
Topical Application ◽  
Donor Site ◽  
Wound Management ◽  
Venous Ulcers ◽  
Health Care Burden ◽  
Wide Range ◽  
Infected Wounds ◽  
Graft Donor

ABSTRACT Background: Wounds have since long, contributed majorly to the health-care burden. Infected long-standing non-healing wounds place many demands on the treating surgeon and are devastating for the patients physically, nutritionally, vocationally, financially, psychologically and socially. Acetic acid has long been included among agents used in the treatment of infected wounds. In this study, we have evaluated the use of acetic acid for topical application in the treatment of infected wounds. Materials and Methods: A total of 100 patients with infected wounds were treated with topical application of 1% acetic acid as dressing material after appropriate cleaning. A specimen of wound swab was collected before first application and further on days 3, 7, 10 and 14. Daily dressings of wounds were done similarly. Minimum inhibitory concentration (MIC) of acetic acid against various organisms isolated was determined. Results: The patients treated ranged between 9 and 60 years, with the mean age 33 years. Nearly 70% of patients were male. Aetiologies of wounds: infective 35, diabetic 25, trauma 20, burns 10, venous ulcers 5 and infected graft donor site 5. Various microorganisms isolated include Pseudomonas aeruginosa (40%), Staphylococcus aureus (2%), Acinetobacter (12%), Escherichia Coli (5%), Proteus mirabilis (3%), Klebsiella (18%), methicillin-resistant S. aureus (10%), Streptococcus (2%) and Enterococcus (1%), Citrobacter (1%). Few wounds (6%) also isolated fungi. About 28%, 64% and 8% of patients isolated no growth on culture after 7, 14 and 21 days, respectively. MIC of all isolated organisms was ≤0.5%. Conclusion: pH of the wound environment plays a pivotal role in wound healing. Acetic acid with concentration of 1% has shown to be efficacious against wide range of bacteria as well as fungi, simultaneously accelerating wound healing. Acetic acid is non-toxic, inexpensive, easily available and efficient topical agent for effective elimination of wound infections caused due to multi-drug resistant, large variety of bacteria and fungus.

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