scholarly journals Delayed Primary Closure of Traumatic Tension Wounds Using Plastic Straps and Kirschner Wires

2018 ◽  
Vol 27 (1) ◽  
pp. 29-37
Author(s):  
Yalcin Yontar ◽  
Sedat Tatar ◽  
Ahmet Aydin ◽  
Atilla Coruh
Keyword(s):  
Primary Closure ◽  
Low Cost ◽  
Donor Site ◽  
Operating Time ◽  
Kirschner Wires ◽  
No Donor ◽  
Female Ratio ◽  
Delayed Primary Closure ◽  
Hospitalization Time ◽  
The Mean

Tension of the wound edges should be overcome with precise surgical planning, which is recognized as one of the major contributors to local complications by compromising circulation of the wound edges. In this article, it was aimed to present the clinical results of a surgical technique, in which the plastic straps and Kirschner wires are used for delayed primary closure of traumatic tension wounds. Depending on the assessment of the wound localization, wound dimension, and mobility of adjacent soft tissue, the technique was performed in 9 patients with a male to female ratio of 8:1. Gunshot injury was the leading cause (n = 5), and in most cases, the wounds were located at the lower extremities (n = 6). The mean time between performing the technique and closing the wound primarily and the mean hospitalization time were 4.8 ± 1.1 and 13.5 ± 3.9 days, respectively. In each case, wound closure and healing were achieved successfully without any serious complications. The presented technique provides advantages of using a low cost as well as a very simple equipment, improved and reliable stability during tightening process due to self-locking feature of the plastic straps, no donor site morbidity, short operating time with low rate of post-operative complications, and short hospitalization time. We recommend using this invaluable technique reliably for the treatment of traumatic tension wounds. However, further studies are needed for better evaluation of cosmetic and functional outcomes of the presented technique.

scholarly journals Low-Cost Customized Cranioplasty with Polymethyl Methacrylate Using 3D Printer Generated Mold: An Institutional Experience and Review of Literature

2021 ◽  
Author(s):  
Ankit Chaudhary ◽  
Virendra Deo Sinha ◽  
Sanjeev Chopra ◽  
Jitendra Shekhawat ◽  
Gaurav Jain
Keyword(s):  
Polymethyl Methacrylate ◽  
Bone Fractures ◽  
Low Cost ◽  
Operating Time ◽  
Three Dimensional ◽  
Wound Dehiscence ◽  
3D Printer ◽  
Skull Defects ◽  
Aesthetic Appearance ◽  
The Mean

Abstract Background Cranioplasty is performed to repair skull defects and to restore normal skull anatomy. Optimal reconstruction remains a topic of debate. Autologous bone flap is the standard option but it may not be available due to traumatic bone fractures, bone infection, and resorption. The authors present their experience with prefabrication of precise and low-cost polymethyl methacrylate (PMMA) mold using three-dimensional (3D) digital printing. Methods A total of 30 patients underwent cranioplasty between March 2017 and September 2019 at Sawai Man Singh Medical College Jaipur, India. Preoperative data included diagnosis for which decompressive craniectomy was done and Glasgow coma scale score. Intraoperative data included operating time. Postoperative data included cosmetic outcome in the form of cranial contour and margins, complications such as infection, seroma, implant failure, wound dehiscence, and hematoma. Results Patient age at cranioplasty ranged from 12 to 63 years with a mean age of 36.7 years. The mean operating time was 151.6 minutes (range 130–190 minutes). The mean follow-up period was 8 months (range 6–13 months). Postoperative wound dehiscence developed in one case (3.3%). Cranial contour and approximation of the margins were excellent and aesthetic appearance improved in all patients. Conclusion Low-cost PMMA implant made by digital 3D printer mold is associated with reconstruction of the deformed skull contour giving satisfactory results to the patient and his family members, at a low cost compared with other commercially available implants. This technique could be a breakthrough in cranioplasty.

Autologous osteochondral graft for traumatic defects of finger joints

2011 ◽  
Vol 37 (3) ◽  
pp. 251-257 ◽  
Author(s):  
W. C. Wu ◽  
M. W. M. Fok ◽  
K. Y. Fung ◽  
K. H. Tam
Keyword(s):  
Donor Site ◽  
Joint Space ◽  
Donor Site Morbidity ◽  
Finger Joint ◽  
Osteochondral Graft ◽  
Range Of Movement ◽  
No Donor ◽  
The Mean ◽  
Open Injuries

Finger joint defects in 16 adults were treated with an autologous osteochondral graft from the base of the second metacarpal, the radial styloid, the base of the third metacarpal or the trapezoid and these patients were followed up from between 12 and 62 months. There was no donor site morbidity. One patient had resorption of the graft and developed pain. The joint was subsequently fused. The mean range of movement was 55.8% of the opposite normal joint. At follow up, 15 patients had no discomfort or mild discomfort. Three had mild narrowing of the joint space and two had slight joint subluxation. Only two patients with concomitant severe injury to the same limb had difficulty performing daily activities. Ten were open injuries and these had poorer outcomes. A hemicondylar defect of a finger joint can be treated using an osteochondral graft obtained from the same hand.

scholarly journals Transurethral fragmentation of bladder stone in children: Our experience

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Ghulam Mujtaba Zafar ◽  
Naseem Javed ◽  
Fawad Humayun ◽  
Asif Iqbal
Keyword(s):  
Hospital Stay ◽  
Operating Time ◽  
Bladder Stone ◽  
Average Hospital ◽  
Female Ratio ◽  
Bladder Stones ◽  
Stone Recurrence ◽  
Febrile Uti ◽  
The Mean ◽  
One Year

Background: This study is performed to find the outcome of transurethral fragmentation and clearance of bladder stones in children as well as assessment of stone recurrence after the procedure. Methods: It was a retrospective analysis of the medical record of 365 patients with bladder stones, treated with transurethral fragmentation at the Department of Pediatric Urology, The Children’s Hospital and the Institute of Child Health, Lahore, over a period of 5 years. Bladder stones were fragmented by using ureterorenoscope (URS) and pneumatic Lithotripsy under general anesthesia. Patients were asked to void next day for spontaneous passage of stone fragments. Duration of procedure, hospital stay, peroperative, and postoperative complications were recorded on a self-structured proforma. The collected data was analyzed with SPSS, version 22. Results: The mean age of the patients was 4.7 ±2.31 years, and male to female ratio was 6:1. Clinical presentation was painful micturition with milking of penis (55%), followed by straining during micturition (17.5%), urinary retention (10%), increased frequency of urine (8%), febrile UTI (7.5%), and hematuria (2%). The mean stone size on ultrasound was 17.2 ±3.8 mm (Range 7-25 mm). The average operating time was 18 minutes (Range: 12-35 minutes). The transurethral fragmentation was successfully done in all (100%) patients. Average hospital stay was 24 hours. Most patients (98.5%) passed all stone fragments in urine & were stone free at one week, confirmed by ultrasound and X-Ray Kidney, Ureter, and Bladder (KUB). Postoperative minor complications were found in (6%) patients including hematuria (3%), dysuria (2%), febrile UTI (1%), failure to void (0.5%). Stone recurrence was 0.27% and no urethral stricture was noted up to one year follow up. Conclusion: Endoscopic treatment of bladder stone in children appears effective and safe by fragmenting the stone into multiple small pieces, which passed out spontaneously without any need for extraction of stone. The associated complications and recurrence rate are very negligible.

scholarly journals Low-Cost Customized Cranioplasty with Polymethyl Methacrylate Using 3D Printer Generated Mold: An Institutional Experience and Review of Literature

2020 ◽  
Vol 17 (02) ◽  
pp. 104-109
Author(s):  
Ankit Chaudhary ◽  
Virendra Deo Sinha ◽  
Sanjeev Chopra ◽  
Jitendra Shekhawat ◽  
Gaurav Jain
Keyword(s):  
Polymethyl Methacrylate ◽  
Bone Fractures ◽  
Low Cost ◽  
Operating Time ◽  
Three Dimensional ◽  
Wound Dehiscence ◽  
3D Printer ◽  
Skull Defects ◽  
Aesthetic Appearance ◽  
The Mean

Abstract Background Cranioplasty is performed to repair skull defects and to restore normal skull anatomy. Optimal reconstruction remains a topic of debate. Autologous bone flap is the standard option but it may not be available due to traumatic bone fractures, bone infection, and resorption. The authors present their experience with prefabrication of precise and low-cost polymethyl methacrylate (PMMA) mold using three-dimensional (3D) digital printing. Methods A total of 30 patients underwent cranioplasty between March 2017 and September 2019 at Sawai Man Singh Medical College Jaipur, India. Preoperative data included diagnosis for which decompressive craniectomy was done and Glasgow coma scale score was observed. Intraoperative data included operating time. Postoperative data included cosmetic outcome in the form of cranial contour and margins, complications such as infection, seroma, implant failure, wound dehiscence, and hematoma. Results Patient age at cranioplasty ranged from 12 to 63 years with a mean age of 36.7 years. The mean operating time was 151.6 minutes (range 130–190 minutes). The mean follow-up period was 8 months (range 6–13 months). Postoperative wound dehiscence developed in one case (3.3%). Cranial contour and approximation of the margins were excellent and aesthetic appearance improved in all patients. Conclusion Low-cost PMMA implant made by digital 3D printer mold is associated with reconstruction of the deformed skull contour giving satisfactory results to the patient and his family members, at a low cost compared with other commercially available implants. This technique could be a breakthrough in cranioplasty.

Evaluation of the Efficacy of Cryosurgery in Patients With Sebaceous Hyperplasia of the Face

2016 ◽  
Vol 21 (3) ◽  
pp. 202-206 ◽  
Author(s):  
Hatice Ataş ◽  
Müzeyyen Gönül
Keyword(s):  
Low Cost ◽  
Poor Response ◽  
Female Ratio ◽  
Excellent Response ◽  
Before And After ◽  
Male Female Ratio ◽  
The Face ◽  
The Mean ◽  
Mean Time

Background: Cryosurgery is an effective treatment for sebaceous hyperplasia, but there have been few clinical studies. Objectives: The aim of this study was to evaluate the efficacy and safety of cryosurgery in the treatment of sebaceous hyperplasia. Methods: Cryosurgery was performed 6 times, at 2-week intervals, with liquid nitrogen, and evaluated in 40 patients with 517 lesions ranging from 2 to 9 mm over the forehead, cheeks, and chin. All of the lesions were measured before and after the treatment. Results: The mean age of the participants was 54.7 ± 8.9 years, and the male/female ratio was 21/19 (1.1). The mean time of the disease duration was 4.2 ± 3.0 years. After 6 cooling cycles, an excellent response (76%-100%) was seen in 341 patients (65.9%), a very good response (51%-75%) was seen in 102 (19.7%), a good response (26%-50%) was seen in 57 (11.1%), a poor response (1%-25%) was seen in 15 (2.9%), and no response (0%) was seen in 2 (0.4%). Age ( P = .004) and sex ( P < .0001) were independent predictors of an excellent response. The excellent response rates were 71.4% for males, 61.8% for females, 70.4% for ages older than 55 years, and 61.8% for ages younger than 55 years. Temporary hyperpigmentation was found in 5 lesions (0.96%), and recurrence was not seen at the 4-month follow-up. Conclusions: The well-aimed and controlled used of cryosurgery is an effective method for treating significant cosmetic disfigurement in patients with sebaceous hyperplasia. It is a low-cost therapy without scarring, hypopigmentation, or recurrence.

scholarly journals Triple tubostomy and its outcome for blunt duodenal injury

2019 ◽  
Vol 22 (1) ◽  
pp. 12-17
Author(s):  
Narendra Pandit ◽  
Tek Narayan Yadav ◽  
Laligen Awale ◽  
Shailesh Adhikary
Keyword(s):  
Hospital Stay ◽  
Primary Closure ◽  
Early Stage ◽  
Primary Repair ◽  
Length Of Hospital Stay ◽  
Damage Control Surgery ◽  
Duodenal Fistula ◽  
Duodenal Injury ◽  
Female Ratio ◽  
The Mean

Introduction: Blunt duodenal injury in an uncommon form of abdominal injuries, which comprises less than 5% of all injuries. The diagnosis and management are challenging, because of delays in diagnosis due to subtle signs and symptoms in its early stage of presentation. Primary repair along with triple tubostomy (gastrostomy, retrograde duodenostomy and feeding jejunostomy) is a simple and safe method of damage control surgery in this group of patients. This study aims to report our experience in the management of this uncommon procedure. Methods: This is a retrospective analysis of the patients undergoing triple tubostomy (TT) for blunt duodenal injury at the Department of Surgery, B.P.Koirala Institute of Health Sciences (BPKIHS), Dharan, over a three and half years. The study included demographics, clinical profile, length of hospital stay, postoperative morbidity (duodenal fistula), rate and timing of spontaneous closure of fistula and mortality. Results: Eleven (6.7%) patients out of 164 blunt trauma abdomen had sustained a duodenal injury. Eight patients who underwent TT were included in the study. The mean age of the patient was 31.8 years (range: 18-67), with a male: female ratio of 3:1. The mean time to trauma and presentation was 4.25 days. The most common site of injury was the second part of the duodenum (87.5%), AAST grade III was seen in 62.5%, two (25%) patients were in shock at presentation. Eight patients required primary closure with triple tubostomy. Postoperatively, all patients had a duodenal fistula, which closed spontaneously in 6 (75%) patients at a mean duration of 17 days, with a mean postoperative length of hospital stay of 33.5 days. The remaining two (25%) patients died of an active fistula. Conclusion: Blunt duodenal trauma, when presented late can be managed with primary closure and triple tubostomy with acceptable postoperative outcomes.  

scholarly journals Clinical Outcomes of Osteochondral Lesions of the Talus With Large Subchondral Cysts Treated With Osteotomy and Autologous Chondral Grafts: Minimum 2-Year Follow-up and Second-Look Evaluation

2020 ◽  
Vol 8 (7) ◽  
pp. 232596712093779
Author(s):  
Lu Bai ◽  
Siyao Guan ◽  
Sanbiao Liu ◽  
Tian You ◽  
Xiaoxiao Xie ◽  
...  
Keyword(s):  
Cartilage Repair ◽  
Donor Site ◽  
Arthroscopic Surgery ◽  
Case Series ◽  
Osteotomy Site ◽  
Osteochondral Lesions ◽  
Level Of Evidence ◽  
No Donor ◽  
Second Look ◽  
The Mean

Background: Osteochondral lesions of the talus (OLTs) with large subchondral cysts are challenging to treat. Purpose: To determine the safety and efficacy of autologous chondral grafting and malleolus osteotomy for treating OLTs associated with large subchondral cysts. Study Design: Case series; Level of evidence, 4. Methods: A total of 19 patients underwent autologous chondral grafting and malleolus osteotomy. We obtained the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot, and magnetic resonance observation of cartilage repair tissue (MOCART) scores at 1 and 2 years postoperatively. The International Cartilage Repair Society (ICRS) score was collected 2 years postoperatively during second-look arthroscopic surgery. Results: In all patients, the osteotomy site healed without nonunion or malunion. Only 1 patient developed joint space narrowing. No donor site complications occurred. The mean AOFAS score significantly improved at 1 year (from 72.8 ± 4.8 preoperatively to 93.7 ± 4.6; t = –13.708; P < .0001). The 1- and 2-year AOFAS scores were similar ( t = –0.755; P = .455), indicating stable improvement. The mean VAS score significantly decreased at 1 year (from 4.68 ± 0.67 preoperatively to 0.47 ± 0.69; t = 18.974; P < .0001). The 1- and 2-year VAS scores were similar ( t = –0.705; P = .455), as were the 1- and 2-year MOCART scores (64.2 ± 7.5 vs 67.4 ± 7.3, respectively; t = –1.312; P = .198). The ICRS scores were as follows: 7 points (abnormal) in 1 (5.2%) patient, 8 to 11 points (nearly normal) in 9 (47.4%) patients, and 12 points (normal) in 9 (47.4%) patients. Conclusion: Osteotomy combined with autologous osteochondral transplantation provided good functional outcomes in patients with OLTs and large subchondral cysts. Second-look arthroscopic surgery showed healthy cartilage healing.

scholarly journals Factors resulting in conversion of laparoscopic cholecystectomy to open cholecystectomy-institution based study

2017 ◽  
Vol 5 (1) ◽  
pp. 132 ◽  
Author(s):  
Naseer Ahmad Awan ◽  
Firdous Hamid ◽  
Irfan Nazir Mir ◽  
Mir Mujtaba Ahmad ◽  
Ajaz Ahmad Shah ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Open Cholecystectomy ◽  
Operating Time ◽  
Average Hospital ◽  
Visceral Injury ◽  
Female Ratio ◽  
Open Conversion ◽  
Number Of Patients ◽  
The Mean ◽  
Cbd Injury

Background: Laparoscopic surgery has revolutionized the way it is performed for an increasing number of patients. In this study, we determined the various reasons for conversion of laparoscopic cholecystectomy in our setup.Methods: This was a descriptive study, conducted at Government Medical College Srinagar, Frommay 2015 to June 2017. The study included 450patients with symptomatic cholelithiasis, who underwent laparoscopic cholecystectomy. All patients were operated by experienced laparoscopic surgeons with experience of more than 300 Laparoscopic cholecystectomies. Cases that required conversion from laparoscopic to open surgery were analyzed and the factors possible for such conversion were studied.Results: The mean age of patients was 45.6 years and male to female ratio 1:3.8. The mean operating time was 49 minutes and average hospital stay was 2 days. Out of 450 patients, 26(5.8%) required open conversion. Factors responsible for open conversion were dense adhesions in 12(2.7%), obscure anatomy at clot’s triangle in 6, (1.3%), significant intra-operative bleeding 5 (1.1), CBD injury 1(0.2%), visceral injury 1 (0.2%), and instrument failure in 1(0.2%) conversions.Conclusions: Open conversion rate of laparoscopic cholecystectomy in this study was 5.8%. The commonest cause of conversion was dense adhesions around the gall-bladder. Preventable factors like instrument failure or power breakdown can be addressed by a reliable back up.

scholarly journals 625 The Impact of COVID-19 on Burn Care at a Regional Burn Center

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S168-S168
Author(s):  
Alan D Rogers ◽  
Plast Surg
Keyword(s):  
Operating Time ◽  
Total Body Surface Area ◽  
Length Of Hospital Stay ◽  
Nurse Specialist ◽  
Female Ratio ◽  
Burn Care ◽  
Burn Center ◽  
The Mean ◽  
The Impact ◽  
Clinic Visits

Abstract Introduction The COVID-19 pandemic has had a profound global impact, not least on hospital functioning. Institutions have all had to prepare and adapt to a large number of admissions, and the influence on elective and emergency surgical services, including burn care, has been significant; it may be some time before we know the full extent of this. While many centers were able to commence more normal activities for a while, we are now seeing an exponential rise in cases again, with potentially catastrophic consequences for the provision of burn care. Methods A review of all admissions, operative cases and clinic visits between 1 April and 31 August 2020 was undertaken at an American Burn Association verified burn center. These data were compared with the same five-month period in the preceding two years. Results Selected data highlights are tabulated (Table 1). During the five months in question, fewer patients were admitted than the previous two years (N=81 versus 121). The mean total body surface area was slightly higher this year (13.7%), and the mean length of hospital stay longer (18 days). The male-to-female ratio of admitted patients was greater during the five months of 2020, at 2.9:1, compared to 1.7:1. No significant differences in terms of etiology were detected, however. As expected, clinic visits reduced dramatically from a mean of 160 patient visits per month to just 81 per month, with the majority conducted virtually. During 2020 the operative cases were similar in number to previous years (N=176), but the mean duration was significantly longer (190 minutes). The total time utilised for burn surgery was similar to previous years (572 hours). Table 1. Selected burn center data comparing 2020 with 2019 and 2018. Conclusions This study demonstrates that although total admissions were slightly reduced, the demands on Burn ICU bed resources and burn operating time were similar. The data supports the notion that removing scheduled operating time for our service resulted in less efficient execution of acute burn surgeries and longer hospital stays. Although formal clinic visits were significantly reduced and were mainly conducted virtually, several patients were satisfied by a novel and user-friendly email service conducted by our clinic nurse specialist.

In Vivo Actuation System for Mechanostimulation of Large Wound Healing

2011 ◽  
Author(s):  
Umut Atakan Gurkan ◽  
Alexandra Dubikovsky ◽  
Lynetta J. Freeman ◽  
Paul W. Snyder ◽  
Russell D. Meldrum ◽  
...  
Keyword(s):  
Primary Closure ◽  
Donor Site ◽  
Wound Management ◽  
Noninvasive Methods ◽  
Surgical Interventions ◽  
Delayed Primary Closure ◽  
Actuation System ◽  
Graft Harvest ◽  
Large Wound

The incidence of large open wounds in the US is estimated to be about 5–7 million per year which results in a cost of greater than $20 billion for wound management [1]. Large open wounds occur due to burns, trauma, and secondary to surgical interventions, ulcers or pressure sores. The current clinical practice is to treat large open wounds by delayed primary closure where skin is stretched under constant tension to approximate wound edges by relying on the extensibility of the neighboring skin, by skin grafting or by managing the wound to heal by second intention. Delayed primary closure is inapplicable when the strength of the skin is compromised (e.g. age, diabetes). Furthermore, delayed primary closure usually leads to excessive wound tension which introduces hypertrophic scars [2] and ischemia [3] to the skin and the underlying muscles. Skin autografts may result in morbidity of the donor site. Therefore, there is the need for noninvasive methods which will enable large wound closure in a reasonable time frame with minimal scar formation while alleviating or reducing the need for skin graft harvest.

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