Definitive Wound Closure Techniques in Fournier's Gangrene

2018 ◽  
Vol 84 (1) ◽  
pp. 86-92
Author(s):  
Margaret Lauerman ◽  
Olga Kolesnik ◽  
Habeeba Park ◽  
Laura S. Buchanan ◽  
William Chiu ◽  
...  
Keyword(s):  
Wound Healing ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Primary Closure ◽  
Wound Closure ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
Secondary Intention ◽  
Primary Wound Closure

Necrotizing soft tissue infection of the perineum, or Fournier's gangrene (FG), is a morbid and mortal diagnosis. Despite the severity of FG, the optimal definitive wound closure strategy is unknown, as are long-term wound outcomes. A retrospective review was performed over a 3-year period at a single trauma center. Patients were managed according to our institutional approach focusing on primary wound closure and secondary intention healing in residual wounds. Overall 168 patients were included. Complete primary wound closure was accomplished in 39.9 per cent of patients. Patients undergoing primary wound closure were primarily male (89.6 vs 64.4%, P < 0.001), had lower mean sequential organ failure assessment (SOFA) scores (1.70 ± 2.30 vs 2.98 ± 3.36, P = 0.004), more often had perineum-limited FG (67.2 vs 42.6%, P = 0.003), and required fewer debridements (2.40 vs 2.79, P = 0.02). On logistic regression, predictors of primary closure included gender (odds ratio 4.643, 95% confidence interval 1.885–11.437, P = 0.001) and SOFA score (odds ratio 0.834, 95% confidence interval 0.727–0.957, P = 0.01). Wound healing rates increased over time, to an 82.1 per cent wound healing rate without further intervention at greater than six months of follow-up. Wounds healed with secondary intention ranged from 70 to 9520 cm3 and primary closure ranged from 126 to 6912 cm3, whereas wounds requiring skin grafts ranged from 405 to 16,170 cm3. Complete primary wound closure is often achievable in FG patients. Using this standardized approach to FG wound management, even large wounds and wounds undergoing secondary intention healing will often close with long-term wound care and do not require flap creation or early skin grafting.

Efficacy of Wound Coverage Techniques in Extremity Necrotizing Soft Tissue Infections

2018 ◽  
Vol 84 (11) ◽  
pp. 1790-1795 ◽  
Author(s):  
Margaret H. Lauerman ◽  
Thomas M. Scalea ◽  
W. Andrew Eglseder ◽  
Raymond Pensy ◽  
Deborah M. Stein ◽  
...  
Keyword(s):  
Wound Closure ◽  
Skin Grafting ◽  
Wound Coverage ◽  
Secondary Intention ◽  
Primary Wound Closure ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Necrotizing Soft Tissue Infections ◽  
Flap Creation

Little data exist about management of wounds created by debridement in necrotizing soft tissue infections (NSTIs). Multiple wound coverage techniques exist, including complete primary wound closure, split-thickness skin grafting, secondary intention, and flap creation. We hypothesized that all wound coverage techniques would be associated with high rates of successful wound coverage and low crossover rates to other wound coverage techniques. NSTIs over a three-year period were retrospectively reviewed. Both the initial and secondary wound coverage techniques (if necessary) were recorded. The primary outcome was the ability to achieve complete wound coverage. Overall, 46 patients with NSTIs had long-term data available. Of the patients undergoing split-thickness skin grafting as the initial wound coverage technique, 8/8 (100%) achieved complete wound coverage; and of those undergoing flap creation, 1/1 (100%) achieved complete wound coverage; and of those undergoing complete primary wound closure, 4/4 (100%) achieved complete wound coverage. Of the patients undergoing secondary intention as the initial wound coverage technique, 5/33 (15.2%) achieved complete wound coverage and 28/33 (84.8%) required a secondary wound coverage technique with split-thickness skin grafting. All 46 patients achieved long-term successful wound coverage. Time to wound coverage did not vary with initial wound coverage technique ( P = 0.44). Split-thickness skin grafting, flap creation, complete primary wound closure, and secondary intention are all reasonable choices for initial wound coverage for NSTIs. Although secondary intention had a low success rate as an initial wound coverage technique, all patients ultimately achieved complete wound coverage without a significant increase in time to coverage.

scholarly journals Pulmonary restriction predicts long-term pulmonary impairment in people with HIV and tuberculosis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara C. Auld ◽  
Hardy Kornfeld ◽  
Pholo Maenetje ◽  
Mandla Mlotshwa ◽  
William Chase ◽  
...  
Keyword(s):  
Lung Function ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Logistic Regression Models ◽  
Pulmonary Impairment ◽  
Mixed Pattern

Abstract Background While tuberculosis is considered a risk factor for chronic obstructive pulmonary disease, a restrictive pattern of pulmonary impairment may actually be more common among tuberculosis survivors. We aimed to determine the nature of pulmonary impairment before and after treatment among people with HIV and tuberculosis and identify risk factors for long-term impairment. Methods In this prospective cohort study conducted in South Africa, we enrolled adults newly diagnosed with HIV and tuberculosis who were initiating antiretroviral therapy and tuberculosis treatment. We measured lung function and symptoms at baseline, 6, and 12 months. We compared participants with and without pulmonary impairment and constructed logistic regression models to identify characteristics associated with pulmonary impairment. Results Among 134 participants with a median CD4 count of 110 cells/μl, 112 (83%) completed baseline spirometry at which time 32 (29%) had restriction, 13 (12%) had obstruction, and 9 (7%) had a mixed pattern. Lung function was dynamic over time and 30 (33%) participants had impaired lung function at 12 months. Baseline restriction was associated with greater symptoms and with long-term pulmonary impairment (adjusted odds ratio 5.44, 95% confidence interval 1.16–25.45), while baseline obstruction was not (adjusted odds ratio 1.95, 95% confidence interval 0.28–13.78). Conclusions In this cohort of people with HIV and tuberculosis, restriction was the most common, symptomatic, and persistent pattern of pulmonary impairment. These data can help to raise awareness among clinicians about the heterogeneity of post-tuberculosis pulmonary impairment, and highlight the need for further research into mediators of lung injury in this vulnerable population.

scholarly journals Management of peno-scrotal wound defects in a tertiary hospital in North-Western Nigeria: a 20-year retrospective review

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Abubakar Sadiq Muhammad ◽  
Ngwobia Peter Agwu ◽  
Abdullahi Abduwahab-Ahmed ◽  
Ahmed Mohammed Umar ◽  
Muhammad Ujudud Musa ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Graft Loss ◽  
External Genitalia ◽  
Tertiary Hospital ◽  
Advancement Flap ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
Direct Closure ◽  
Secondary Intention ◽  
North Western

Abstract Background Fournier’s gangrene and trauma to the external genitalia are the commonest causes of peno-scrotal wound defects in our environment. The management of these patients includes initial resuscitation and subsequent wound care with or without wound cover. The aim of this study is to document our experience in the management of peno-scrotal defects in a tertiary hospital of North-Western Nigeria. Methods This is a 20-year retrospective study of patients managed for peno-scrotal wound defects by the Urology Unit in the Department of Surgery of our hospital from January 2001 to December 2019. Data were collected from the patients’ case notes and entered into a proforma. Data were analysed using SPSS version 25.0. Results A total number of 54 patients with peno-scrotal wound defects were managed within the study period with the mean age of 46.27 ± 22.09 years and a range of six weeks to 107 years. The wound defects were sequelae of Fournier’s gangrene in 42 patients (77.8%) and traumatic in 12 patients (22.2%). Healing by secondary intention was achieved in 20 patients (37.0%). Direct closure was done in 17 patients (31.5%), skin graft in nine patients (16.7%), and advancement flap in eight patients (14.8%) depending on the location and size of the defects. Fourteen patients (26.0%) developed surgical site infection ± wound dehiscence and partial graft loss. The complication rate was higher in post-Fournier’s gangrene wound defects, but without statistical significance (p = 0.018). Conclusion Fournier’s gangrene and trauma to the external genitalia are the commonest causes of peno-scrotal wound defects in our environment. Smaller wound defects were healed by secondary intention, while larger defects required either direct closure or the use of advancement flap or skin grafting depending on the location and size of the wound. The study reported a higher post-repair complication in patients that had Fournier’s gangrene.

scholarly journals Initial renal histology and early response predict outcomes of Brazilian lupus nephritis patients

Lupus ◽  
2019 ◽  
Vol 29 (1) ◽  
pp. 83-91
Author(s):  
G Vajgel ◽  
C B L Oliveira ◽  
D M N Costa ◽  
M A G M Cavalcante ◽  
L M Valente ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Lupus Nephritis ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Estimated Glomerular Filtration Rate ◽  
Interstitial Fibrosis ◽  
End Stage ◽  
Class Iv

Objective We analyzed baseline and follow-up characteristics related to poorer renal outcomes in a Brazilian cohort of admixture race patients with lupus nephritis. Methods Overall, 280 outpatients with a diagnosis of systemic lupus erythematosus and previous kidney biopsy of lupus nephritis were recruited from August 2015 to December 2018 and had baseline laboratory and histologic data retrospectively analyzed; patients were then followed-up and data were recorded. The main outcome measure was the estimated glomerular filtration rate at last follow-up. Secondary analyses assessed the impact of initial kidney histology and treatment in long-term kidney survival. Results Median duration of lupus nephritis was 60 months (interquartile range: 27–120); 40 (14.3%) patients presented progressive chronic kidney disease (estimated glomerular filtration rate <30 and ≥10 ml/min/1.73 m2) or end-stage kidney disease at last visit. Adjusted logistic regression analysis showed that class IV lupus nephritis (odds ratio 14.91; 95% confidence interval 1.77–125.99; p = 0.01) and interstitial fibrosis ≥25% at initial biopsy (odds ratio 5.87; 95% confidence interval 1.32–26.16; p = 0.02), lack of complete or partial response at 12 months (odds ratio 16.3; 95% confidence interval 3.74–71.43; p < 0.001), and a second renal flare (odds ratio 4.49; 95% confidence interval 1.10–18.44; p = 0.04) were predictors of progressive chronic kidney disease. In a Kaplan-Meier survival curve we found that class IV lupus nephritis and interstitial fibrosis ≥25% were significantly associated with end-stage kidney disease throughout follow-up (hazard ratio 2.96; 95% confidence interval 1.3–7.0; p = 0.036 and hazard ratio 4.96; 95% confidence interval 1.9–12.9; p < 0.0001, respectively). Conclusion In this large cohort of admixture race patients, class IV lupus nephritis and chronic interstitial damage at initial renal biopsy together with non-response after 1 year of therapy and relapse were associated with worse long-term renal outcomes.

Second-Generation Consequences of Small-for-Dates Birth

PEDIATRICS ◽  
1989 ◽  
Vol 84 (2) ◽  
pp. 343-347
Author(s):  
Mark A. Klebanoff ◽  
Olav Meirik ◽  
Heinz W. Berendes
Keyword(s):  
Confidence Interval ◽  
Birth Outcomes ◽  
Odds Ratio ◽  
Intrauterine Growth Retardation ◽  
Long Term Effects ◽  
Intrauterine Growth ◽  
Increased Risk ◽  
Reported Study ◽  
Increase In Risk

This is the first reported study of birth outcomes of a group of women whose own birth weights and gestational ages had been previously recorded. Births occurring from 1972 to 1983 among 1154 Swedish women, born from 1955 to 1965, were studied. Women who were themselves small for gestational age (SGA) at birth were at increased risk of giving birth to a SGA infant (odds ratio = 2.21, 95% confidence interval = 1.41, 3.48). Women who had been SGA had an even greater increase in risk of giving birth to a preterm infant (odds ratio = 2.96, 95% confidence interval = 1.47, 5.94). Women who were preterm at birth were not at increased risk of giving birth to either preterm (odds ratio = 0.65, 95% confidence interval = 0.15, 2.74) or SGA (odds ratio 1.21, 95% confidence interval = 0.62, 2.38) infants. It is concluded that the long-term effects of intrauterine growth retardation may extend to the next generation; women who had been SGA should be considered at increased risk to give birth to both growth-retarded and preterm infants.

Abstract TP74: Early Administration of Tissue-plasminogen Activator Improves the Long-term Clinical Outcome at 5 Years After Onset

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Junya Aoki ◽  
Kazumi Kimura ◽  
Yuki Sakamoto
Keyword(s):  
Regression Analysis ◽  
Confidence Interval ◽  
Plasminogen Activator ◽  
Clinical Outcomes ◽  
Tissue Plasminogen Activator ◽  
Odds Ratio ◽  
Univariate Analysis ◽  
Favorable Outcome ◽  
Tissue Plasminogen

Introduction & Hypothesis: Data on long-term outcomes after tissue-plasminogen activator (tPA) therapy are limited. We evaluated the rate of favorable outcomes and mortality at 5 years after tPA therapy and investigated factors related to long-term clinical outcomes. Methods: Telephone interviews were used to assess the to the the modified Rankin Scale (mRS) scores at 3 months, 6 months, 1 year, 2 years, 3 years, 4 years, and 5 years after tPA therapy after written informed consent was obtained. When a telephone interview was not successfully accomplished, an interview letter was sent as an alternative method. Favorable outcome was defined as mRS 0-2, and unfavorable outcome was as mRS 3-6. Multivariate logistic regression analysis was conducted to investigate factors associated with favorable outcomes and mortality at 5 years after tPA therapy. Results: From 2005 to 2013, 256 (median age, 77 [interquartile range, 68-84] years; 157 [61%] males) patients were enrolled. The onset-to-treatment time (OTT) was 153 (120-176) minutes. At 3 months after tPA therapy, the median mRS score was assessed as 3 (1-5). Kaplan-Meier curve showed that favorable outcomes after 5 years after tPA therapy occurred in 45% patients and that the mortality rate was 40%. Univariate analysis showed that OTT was 123 (107-172) minutes in patients with favorable outcomes and 155 (124-172) minutes in patients with non-favorable outcomes (p=0.046). In addition, OTT was 157 (133-172) minutes in the death group and 123 (106-169) minutes in the survival group (p=0.001). Multivariate regression analysis indicated that OTT was an independent factor related to favorable outcomes (odds ratio 0.97, 95% confidence interval 0.95-0.99, p=0.008) and mortality (odds ratio 1.04, 95% confidence interval 1.02-1.06, p=0.001). Receiver operating characteristic curve analysis showed that OTT ≥ 136 minutes was the optimal cut-off value to predict favorable outcome at 5 years after tPA therapy, with a sensitivity of 0.67, a specificity of 0.70, and an area under curve (AUC) of 0.662 (p=0.016), and that to predict death within 5 years after tPA therapy, with a sensitivity of 0.70, a specificity of 0.66, and an AUC of 0.679 (p=0.001). Conclusion: Early tPA administration can improves long-term clinical outcomes.

Comparison of primary and delayed wound closure of dog-bite wounds

2013 ◽  
Vol 26 (03) ◽  
pp. 204-207 ◽  
Author(s):  
H. Xiaowei ◽  
X. Yunbei ◽  
L. Zhenhua ◽  
Y. Yeqing ◽  
Y. Jiaqi ◽  
...  
Keyword(s):  
Infection Rate ◽  
Primary Closure ◽  
Wound Closure ◽  
Systemic Infection ◽  
Dog Bite ◽  
Cosmetic Appearance ◽  
Primary Wound Closure ◽  
Bite Wounds ◽  
Delayed Closure ◽  
Closure Group

Summary Background: Primary bite wound suturing in the emergency department remains controversial in some cases. Objective: We conducted a study to investigate the infection rate and cosmetic appearance between primary wound closure and delayed wound closure in dog bite wounds in humans. Methods: All patients with bite wounds were treated with oral antibiotic medications. We adopted a randomized cohort study, dividing the patients who needed wound closure into two groups: 60 patients for primary closure, and 60 patients for delayed closure, and compared the infection rate and wound cosmetic appearance scores. Results: In the primary closure group, four people (6.7%) developed a wound infection without systemic infection. In the delayed closure group, three people (5%) developed a wound infection (p = 0.093), but there were not any patients that developed a systemic infection. Thirty-three patients (55%) in the primary closure group had optimal cosmetic scores, whereas 20 patients (33.3%) in the delayed closure group had optimal cosmetic scores (p = 0.012). Conclusion: Although primary wound closure for dog bites may be associated with a higher infection rate, the cosmetic appearance after primary closure was still acceptable.

scholarly journals Labor Dystocia and Risk of Histological Chorioamnionitis and Funisitis: A Study from a Single Tertiary Referral Center

2020 ◽  
Author(s):  
Hyo Kyozuka ◽  
Tuyoshi Murata ◽  
Toma Fukuda ◽  
Shun Yasuda ◽  
Aya Kanno ◽  
...  
Keyword(s):  
Risk Factor ◽  
Preterm Birth ◽  
Confidence Interval ◽  
Umbilical Cord ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Neonatal Outcomes ◽  
Spontaneous Preterm Birth ◽  
Labor Dystocia

Abstract Background: Intrauterine inflammation affects short- and long-term neonatal outcomes. Histological chorioamnionitis and funisitis are acute inflammatory responses in the fetal membranes and umbilical cord, respectively. Although labor dystocia includes a potential risk of intrauterine inflammation, the risk of labor dystocia in histological chorioamnionitis and funisitis has not been evaluated yet. This study aimed to examine the association between labor dystocia and risk of histological chorioamnionitis and funisitis.Methods: In this retrospective cohort study, the patients who underwent histopathological examinations of the placenta and umbilical cord at Fukushima Medical University Hospital, Japan, between 2015 and 2020, were included. From the dataset, the pathological findings of the patients with labor dystocia and spontaneous preterm birth were reviewed. Based on the location of leukocytes, the inflammation in the placenta (histological chorioamnionitis) and umbilical cord (funisitis) was graded as 0–3. Multiple logistic regression analysis was performed to evaluate the risk of histological chorioamnionitis, histological chorioamnionitis stage ≥2, funisitis, and funisitis stage ≥2.Result: Of 317 women who met the study criteria, 83 and 144 women had labor dystocia and spontaneous preterm birth, respectively, and 90 women were included as controls. Labor dystocia was a risk factor for histological chorioamnionitis (adjusted odds ratio, 6.3; 95% confidential interval, 1.9-20.5), histological chorioamnionitis stage ≥2 (adjusted odds ratio, 6.0; 95% confidence interval, 1.7-21.8), funisitis (adjusted odds ratio, 9.4; 95% confidence interval, 1.8-48.2), and funisitis stage ≥2 (adjusted odds ratio, 23.5; 95% confidence interval, 2.3-23.8). Spontaneous preterm birth was also a risk factor for histological chorioamnionitis (adjusted odds ratio, 3.7; 95% confidence interval, 1.7-7.8), histological chorioamnionitis stage ≥2 (adjusted odds ratio, 3.0; 95% confidence interval, 1.2-7.9), and funisitis (adjusted odds ratio, 4.5; 95% confidence interval, 1.2-16.8). However, the adjusted odds ratio was smaller in spontaneous preterm births than in labor dystocia. Conclusion: Labor dystocia is a risk factor for severe histological chorioamnionitis and funisitis. Further studies are required to evaluate the effects of histological chorioamnionitis and funisitis on long-term neonatal outcomes.

Sign in / Sign up

Export Citation Format

Share Document