Open wound management following pull‐through resection for oral cancer: A case series of 14 patients

Abstract Background Encapsulating Peritoneal Sclerosis (EPS) is a rare phenomenon in paediatric patients with kidney failure treated with peritoneal dialysis (PD). This study highlights clinical challenges in the management of EPS, with particular emphasis on peri-operative considerations and surgical technique. Methods Retrospective analysis of all paediatric patients with EPS treated at the Manchester Centre for Transplantation. Results Four patients were included with a median duration of 78 months on PD. All patients had recurrent peritonitis (> 3 episodes), and all had symptoms within three months of a change of dialysis modality from PD to haemodialysis or transplant. In Manchester, care was delivered by a multi-disciplinary team, including surgeons delivering the adult EPS surgical service with a particular focus on nutritional optimisation, sepsis control, and wound management. The surgery involved laparotomy, lavage, and enterolysis of the small bowel + / − stoma formation, depending on intra-abdominal contamination. Two patients had a formal stoma, which were reversed at three and six months, respectively. Two patients underwent primary closure of the abdomen, whereas two patients had re-look procedures at 48 h with secondary closure. One patient had a post-operative wound infection, which was managed medically. One patient’s stoma became detached, leading to an intra-abdominal collection requiring re-laparotomy. The median length of stay was 25 days, and patients were discharged once enteral feeding was established. All patients remained free of recurrence with normal gut function and currently two out of four have functioning transplants. Conclusions This series demonstrates 100% survival and parenteral feed independence following EPS surgery. Post-operative morbidity was common; however, with individualised experience-based decision-making and relevant additional interventions, patients made full recoveries. Health and development post-surgery continued, allowing the potential for transplantation. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information

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EP.TU.854Happy Patients and Updated Open Wound Management Protocols

British Journal of Surgery ◽

10.1093/bjs/znab311.108 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Harish Peri ◽

Rafique Umer Harvitkar

Keyword(s):

Chronic Wound ◽

Clinical Audit ◽

Wound Dressings ◽

Wound Management ◽

Open Wound ◽

Current Management ◽

Pdsa Cycle ◽

Management Protocol ◽

Open Injuries

Abstract Introduction Open injuries have a potential for serious bacterial wound infections and may lead to long term disabilities, chronic wound or bone infection, and even death. This QI study was undertaken to ring in changes to the current management protocol and align them as per WHO guidelines. Method Implementing changes through a Plan-Do-Study-Act (PDSA) cycle post an initial clinical audit among 38 patients of the organization. Re-audits were done to measure the outcome against the standard and establish a new protocol. Results Initial audit showed only a dismal 37% (n = 14) of patients being managed as per WHO protocol. Patient satisfaction percentage (as measured by a questionnaire) was also low with only 54% of patients satisfied with the treatment. Significant variations were noted post implementation of changes after the first PDSA cycle where >90% (n = 35) of patients reported that they noticed better wound healing, transition to optimal performance and were satisfied with treatment outcomes. Conclusions Timely wound dressings, appropriate antibiotic prophylaxis and increased patient’s awareness on wound hygiene through means of regular educational sessions and updated management protocols have led to healthier patients, lesser long term disabilities and happy patients.

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Assessment of wound bio-burden and prevalence of multi-drug resistant bacteria during open wound management

Journal of Small Animal Practice ◽

10.1111/jsap.12476 ◽

2016 ◽

Vol 57 (5) ◽

pp. 255-259 ◽

Cited By ~ 11

Author(s):

M. C. Nolff ◽

S. Reese ◽

M. Fehr ◽

R. Dening ◽

A. Meyer-Lindenberg

Keyword(s):

Wound Management ◽

Resistant Bacteria ◽

Drug Resistant ◽

Open Wound ◽

Drug Resistant Bacteria

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Open wound management of esophagocutaneous fistula in unstable cervical spine after corpectomy and multilevel laminectomy: A case report and review of the literature

World Journal of Orthopedics ◽

10.5312/wjo.v8.i8.651 ◽

2017 ◽

Vol 8 (8) ◽

pp. 651

Author(s):

Hossein Elgafy ◽

Mustafa Khan ◽

Jacob Azurdia ◽

Nicholas Peters

Keyword(s):

Case Report ◽

Cervical Spine ◽

Wound Management ◽

Review Of The Literature ◽

Open Wound ◽

Unstable Cervical Spine

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Plastic Surgery at War: A Scoping Review of Current Conflicts

Military Medicine ◽

10.1093/milmed/usaa361 ◽

2020 ◽

Author(s):

Justin P Fox ◽

Nickolay P Markov ◽

Alexandra M Markov ◽

Eamon O’Reilly ◽

Kerry P Latham

Keyword(s):

Plastic Surgery ◽

Scoping Review ◽

Wound Care ◽

Critical Role ◽

Case Series ◽

The United States ◽

Lessons Learned ◽

Plastic Surgeon ◽

Wound Management ◽

Search Criterion

Abstract Introduction The scope of military plastic surgery and location where care is provided has evolved with each major conflict. To help inform plastic surgeon utilization in future conflicts, we conducted a review of military plastic surgery-related studies to characterize plastic surgeon contributions during recent military operations. Materials and Methods Using a scoping review design, we searched electronic databases to identify articles published since September 1, 2001 related to military plastic surgery according to a defined search criterion. Next, we screened all abstracts for appropriateness based on pre-established inclusion/exclusion criteria. Finally, we reviewed the remaining full-text articles to describe the nature of care provided and the operational level at which care was delivered. Results The final sample included 55 studies with most originating in the United States (54.5%) between 2005 and 2019 and were either retrospective cohort studies (81.8%) or case series (10.9%). The breadth of care included management of significant upper/lower extremity injuries (40%), general reconstructive and wound care (36.4%), and craniofacial surgery (16.4%). Microsurgical reconstruction was a primary focus in 40.0% of published articles. When specified, most care was described at Role 3 (25.5%) or Roles 4/5 facilities (62.8%) with temporizing measures more common at Role 3 and definite reconstruction at Roles 4/5. Several lessons learned were identified that held commonality across plastic surgery domain. Conclusions Plastic surgeons continue to play a critical role in the management of wounded service members, particularly for complex extremity reconstruction, craniofacial trauma, and general expertise on wound management. Future efforts should evaluate mechanisms to maintain these skill sets among military plastic surgeons.

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Complete Abolition of Opioid Prescribing in an Upper Extremity Surgical Practice

Hand ◽

10.1177/1558944720966713 ◽

2020 ◽

pp. 155894472096671

Author(s):

Mark Henry

Keyword(s):

Soft Tissue ◽

Upper Extremity ◽

Pain Control ◽

Case Series ◽

Similar Efficacy ◽

Wound Management ◽

Elbow Fracture ◽

Level Of Evidence ◽

Hand Fracture ◽

Fracture Bone

Background Prescription opioids threaten potential addiction, diversion, and death. Nonopioid regimens have demonstrated similar efficacy for select upper extremity postoperative patients. Methods After adopting a practice policy completely abolishing opioid prescriptions, data were collected on all consecutive surgical cases for the next 6 months, without exclusion. There were 800 cases, 61% male and 39% female, with a mean age of 45. Seventy patients (9%) reported already using prescription medications employed in multimodality regimens; no instruction was given to alter consumption. Patients were divided into 5 groups based on the type of surgery: elective soft tissue (24%), trauma wound management (19%), soft tissue structural repairs (9%), hand fracture/bone procedures (34%), and wrist to elbow fracture/bone procedures (14%). Each group was compared directly to each other group with a 2-tailed t-test, P < .05. Results Patients reported achieving pain control without the need for further medication assistance by a mean of postoperative day 2.7. Times to pain control by group were as follows: 1.5, 3.1, 2.7, 2.9, and 3.6 days respectively. Mean postoperative daily pain scores (using a 10-point visual analog scale) for days 1 to 5 were as follows: 2.8, 2.1, 1.5, 1.0, and 0.6, respectively, with a sum of 8.0. During the 6-month tracking period, the practice only received 4 calls from patients with questions about pain control (0.5% of cases). Conclusions Patients achieved good immediate pain control without opioids and reported rapidly declining pain levels over the next several days to the point of no longer requiring medication. Type of Study/Level of Evidence Prospective cohort case series, therapeutic; Level IV.

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Inferior Gluteus Maximus Island Flap for Reconstruction of Ischial Pressure Sores

Annals of King Edward Medical University ◽

10.21649/akemu.v23i1.1521 ◽

2017 ◽

Vol 23 (1) ◽

Author(s):

Yawar Sajjad ◽

Beenish Rahat ◽

Salman Hameed

Keyword(s):

Case Series ◽

Gluteus Maximus ◽

Wound Dehiscence ◽

Island Flap ◽

Wound Management ◽

Medical Institute ◽

High Recurrence Rate ◽

Pressure Sores ◽

Retrospective Case ◽

Grade 3

Surgical management of ischial pressure sores has always been a challenge due to high recurrence rate. Ischial pressure sores develop due to unrelieved pressure over the Ischium. Inferior gluteus maximus island flap has been used effectively for coverage of ischial pressure sores.Objective: To describe the efficacy of inferior gluteus maximus flap for reconstruction of ischial pressure sores.Methods: A retrospective case series, consisted of sample of 17 cases. The study was conducted in the Department of Plastic and Reconstructive Surgery, Post Graduate Medical Institute, Lahore General Hospital Lahore, over a period of 8 years from March 2008 to March 2016. The case series included17 patients with grade 3 and grade 4 ischial pressure sores, comprising 12 male and 5 female, with age range of 28 to 64 (mean = 46 years).Follow-up ranged from 1 to 4 years with a mean of 2.5 years. Inferior gluteus maximus island flap was used for reconstruction of Ischial pressure sores.Results: In thirteen (76%) of the seventeen patients, wound healed uneventfully without any complication. Partial wound dehiscence was observed in 2 patients (12%). Both of these healed with conservative wound management. Recurrence was seen in 2 patients (12%) after 8 months. These two patients underwent reoperation and gluteus maximus flap was readvanced that resulted in satisfactory wound coverage.Conclusion: Inferior gluteus maximus island flap can be considered as a reliable option for reconstruction of ischial pressure sores.

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Using Graphics to Promote the Health Values of Indigenous Vegetables in Anaemia, Metabolic Syndrome, and Wound Management

Bioactive Compounds in Health and Disease ◽

10.31989/bchd.v3i9.739 ◽

2020 ◽

Vol 3 (9) ◽

pp. 166

Author(s):

Isaac C. Ishiekwene ◽

Solomon E.O. Egwenu ◽

Helen Chime ◽

Eunice O. Igumbor ◽

Ezekiel U. Nwose

Keyword(s):

Metabolic Syndrome ◽

Health Promotion ◽

Case Series ◽

Leafy Vegetables ◽

Added Value ◽

Wound Management ◽

Pictorial Representation ◽

Bone Maintenance ◽

Health Values ◽

Indigenous Vegetables

Vegetables are any plant whose fruit, seeds, roots, tubers, bulbs, stems, leaves, or flower parts are used as food. However, this study captures leafy vegetables which are affordable and quick to cook; rich in several macro and micronutrients including vitamins, minerals and fibers which are essential for anemic, metabolic syndrome and wound management. Though the nutritive contents of these vegetables abound, this study aims at advancing the education on the relevant contents of indigenous vegetables based on established data of the synonymous vegetables. This Case Series article was intended to be pictorial representation of functional leafy vegetables that are available in the research site. Unique graphic designs of the seven indigenous vegetables, which have been previously reviewed, were made to portray their potential micronutrient values and relevance as functional foods in health and disease. Although the seven graphical images indicated similarities, various add-on health values are highlighted. The pictograms depict medical nutrition therapy potentials. . Each pictogram represents an educational tool for health promotion about a vegetable. Bitter leaf had an added value for kidney functions management, Amaranthus for bone maintenance, Lemon grass for insomnia management and general detox, Mint leaf for stomach upset management, Moringa for cancer and malnutrition management, Fluted pumpkin, and Water leaf for constipation management. The health values of these indigenous vegetables include management of common ailments such as anemia, metabolic syndrome and wound management is relatively scarce. This Case Series provides a compendium of seven pictorials to be used as graphical health educational resource to promote consumption of indigenous vegetables in Delta State Nigeria. The significance is to advance health promotion on food matters among a populations where the people may be more inclined to visual prompts. Implications for the COVID19 pandemic is briefly addressed.Keywords: antioxidants, haematinics, health promotion, immunomodulation, infections, metabolic syndrome, micronutrients, wound management

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