scholarly journals Evidence and Trends in Burn Wound Debridement: An Evidence Map

2020 ◽  
Vol 28 (4) ◽  
pp. 232-242
Author(s):  
Benjamin Ziegler ◽  
Sebastian Fischer ◽  
Dawid Pieper ◽  
Tim Mathes ◽  
Ulrich Kneser ◽  
...  
Keyword(s):  
Standard Of Care ◽  
Wound Infection Rate ◽  
Optimal Timing ◽  
Burn Wound ◽  
Level Of Evidence ◽  
Evidence Map ◽  
Wound Debridement ◽  
Wound Excision ◽  
High Level ◽  
Enzymatic Debridement

Treatment of the burn wound is crucial in care of severely burned patients. Surgical strategies differ in technique and timing of wound excision and are considered to have an impact on morbidity and mortality of burn patients. Most techniques and strategies have been established during the last century and are still standard of care. Nonetheless, several newer techniques have been presented and evaluated recently. To summarize the evidence and trends for eschar removal by burn wound debridement currently available, an evidence map as variant of the systematic review, was prepared. For this purpose, a systematic literature search was performed in the PubMed databases until December 2016. While overall evidence in this domain is low, recent publications focus on optimal timing of wound excision, enzymatic debridement, and hydrosurgery. Several studies report the benefit of an early wound excision in terms of shorter hospital stay, lower wound infection rate, and reduction of postburn metabolic changes. Enzymatic debridement has been shown to be an effective tool for early eschar removal and in addition reduces the need for autografting of the debrided burn wound with a relatively high level of evidence (LoE 2-). Wound debridement by means of hydrosurgery is more precise compared to conventional wound excision and preserves viable dermis, but a positive effect on wound healing or scar formation could not been shown (LoE 2). Furthermore, rarely reported techniques comprise larvae therapy, debridement by laser, and other technical adjuncts, but the level of evidence is limited (LoE 4-/5).

The potential benefits of enzymatic debridement in multi-casualty burns incidents

Trauma ◽  
2021 ◽  
pp. 146040862110025
Author(s):  
John Kiely ◽  
Ibrahim Natalwala ◽  
Joseph Stallard ◽  
Orla Austin ◽  
Umair Anwar ◽  
...  
Keyword(s):  
Intensive Care ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Burn Wound ◽  
Post Injury ◽  
Wound Debridement ◽  
Potential Benefits ◽  
Goal Directed Fluid Therapy ◽  
Male Patients ◽  
Enzymatic Debridement

Bromelain-based enzymatic debridement (ED) is a topical treatment that is growing in popularity for the non-surgical management of burn wounds. Although initially used for small injuries, experience has grown in using it for burns >15% Total Burns Surface Area (TBSA). A household explosion resulted in burns to multiple patients, with four requiring burn wound debridement. This case report demonstrates their management using ED. Four adult male patients were treated with ED, mean age 38.4 years. Their injuries ranged from 5–24% TBSA (mean 14.9%), with a high proportion of intermediate-deep dermal injury to their faces and limbs. Our centre has performed enzymatic debridement since 2016 and all senior burns surgeons and burns intensive care specialists in the team are experienced in its use. We perform enzymatic debridement using Nexobrid™ (Mediwound Ltd., Israel). Three patients were managed on a single theatre list, using ED for their burns at 19, 16 and 23 hours post-injury. One patient had ED of his injuries on intensive care at 18 hours. Patients with >15% TBSA were treated in a critical care setting with goal directed fluid therapy. Through the use of enzymatic debridement we were able to achieve burn debridement for four patients in under 24 hours. While not a true mass casualty incident, our experience suggests that for an appropriately resourced service it is likely to have advantages in this scenario. We suggest that burns services regularly using this technique consider inclusion into mass casualty protocols, with training to staff to enable provision in such an incident.

Clinical Value of Debriding Enzymes as an Adjunct to Standard Early Surgical Excision in Human Burns: A Systematic Review

2020 ◽  
Vol 41 (6) ◽  
pp. 1224-1230 ◽  
Author(s):  
Seyed Hamid Salehi ◽  
Mahnoush Momeni ◽  
Masoud Vahdani ◽  
Mohammad Moradi
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Conflicts Of Interest ◽  
Healing Process ◽  
Standard Of Care ◽  
Surgical Excision ◽  
Burn Wound ◽  
Burn Wounds ◽  
Public Health Burden ◽  
Enzymatic Debridement

Abstract Burns are a significant public health burden worldwide. In addition to those who die, millions remain with life-threatening deformities and disabilities resulting in stigma and rejection. Surgical excision is currently the standard of care for removing necrotic tissues in burn wounds to prepare the wound bed for grafting or enhancing the healing process. However, there is a growing interest on enzymatic debridement as an adjunct therapy in burn wounds. The aim of this study was to investigate clinical trials using debriding agents for burn wound in humans in a systematic review. This was a systematic review of electronic databases including CINAHL, PubMed, Ovid Medline, Web of Science, Google Scholar, and Embase from January 1969 to February 2019. The study protocol was registered in PROSPERO registry. The following keywords were searched: “burn wounds”, “enzymatic debridement”, “papain”, “papain-urea”, “pine apple”, “Bromelain”, “collagenases”, “Nexobrid”, “Debrase”, “Debridase”, “Actinidia deliciosa”, “Sutilains”, “Debrace”, “piruvat acid”. Those studies fulfilling the inclusion and exclusion criteria with low score of bias based on Cochrane Bias Tool were reviewed. Sixteen investigations fulfilled our inclusion criteria to be reviewed. Six, seven, and three clinical trials on humans were found regarding collagenase, bromelain, and miscellaneous agents. Collagenase has been reported to be effective in burns below 25% of TBSA, especially in outpatients’ clinics. However, Nexobrid has been shown to be effective in deep burns and decreases the percentage of graft without significant adverse effects. There was not enough evidence supporting the clinical values of Papain, Sutilains, Urea, etc. Surgical excision still remains the standard of care for burn wounds debridement. However, enzymatic debridement, especially Bromelain might help to reduce sessions for surgical debridement or area under graft as an adjunct treatment. Despite the fact, more studies with larger sample sizes and with less conflicts of interest are needed to clearly elucidate the exact role of Bromelain.

scholarly journals Intra-articular injection of orthobiologics in patients undergoing high tibial osteotomy for knee osteoarthritis is safe and effective – a systematic review

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Brjan Kaiji Betzler ◽  
Aiman Haziq Bin Muhammad Ridzwan Chew ◽  
Hamid Rahmatullah Bin Abd Razak
Keyword(s):  
Knee Osteoarthritis ◽  
High Tibial Osteotomy ◽  
Platelet Rich Plasma ◽  
Standard Of Care ◽  
Current Evidence ◽  
Osteoarthritis Of The Knee ◽  
Tibial Osteotomy ◽  
Level Of Evidence ◽  
Minimum Number ◽  
High Level

Abstract Purpose To qualitatively evaluate the current evidence reporting outcomes of intra-articular injection of orthobiologics in patients undergoing high tibial osteotomy (HTO) for osteoarthritis of the knee. Methods A systematic search methodology of the PUBMED, EMBASE, and CINAHL databases was conducted in July 2021. The search workflow was in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The following inclusion criteria were adopted: clinical trials of any level of evidence, reporting outcomes following intra-articular injection of orthobiologics during high tibial osteotomy for knee osteoarthritis, with a minimum number of 10 patients treated. Duplicate data, studies on implanted orthobiologics and articles not written in English were excluded from this review. Results Eight studies were included in this review, with a total of 585 patients. Outcomes were discussed based on the types of orthobiologics used: (i) Platelet-Rich Plasma (PRP), (ii) Bone Marrow Aspirate Concentrate (BMAC), and (iii) Injected Mesenchymal Stem Cells (MSCs). Two studies utilised PRP, 4 studies utilised BMAC and 4 studies utilised injected MSCs.. Three studies provided Level II evidence and five studies provided Level III evidence. Statistically significant improvements in outcomes were documented in multiple trials, with few patients experiencing adverse events. Conclusion Intra-articular injection of orthobiologics in patients undergoing HTO is safe and effective with good outcomes reported. Due to the lack of high-level evidence, further research is required before this can be considered standard of care. Level of evidence III

A Comparison of General Anesthesia and Regional Anesthesia as a Risk Factor for Deep Vein Thrombosis Following Hip Surgery: A Critical Review

1990 ◽  
Vol 64 (04) ◽  
pp. 497-500 ◽  
Author(s):  
Martin H Prins ◽  
Jack Hirsh
Keyword(s):  
Deep Vein Thrombosis ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Lower Incidence ◽  
Hip Surgery ◽  
Level Of Evidence ◽  
Vein Thrombosis ◽  
Postoperative Thrombosis ◽  
High Level ◽  
Deep Vein

SummaryWe evaluated the evidence in support of the suggestion that the risk of deep vein thrombosis after hip surgery is lower with regional than with general anesthesia. A literature search was performed to retrieve all articles which reported on the incidence of postoperative thrombosis in both fractured and elective hip surgery. Articles were included if the method of anesthesia used was reported and if they used mandatory venography. Based upon the quality of study design the level of evidence provided by a study was graded.In patients who did not receive prophylaxis there were high level studies in elective and fractured hip surgery. All studies showed a statistically significantly lower incidence of postoperative deep vein thrombosis with regional anesthesia (relative risk reductions of 46-55%). There were no direct comparative studies in patients who received prophylaxis. However, between study comparisons did not show even a trend towards to lower incidence of postoperative thrombosis with regional anesthesia.

scholarly journals Organizational Strategies for End-User Development—A Systematic Literature Mapping

Informatics ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. 15
Author(s):  
Augusto S. C. Modesto ◽  
Rejane M. da C. Figueiredo ◽  
Cristiane S. Ramos ◽  
Letícia de S. Santos ◽  
Elaine Venson ◽  
...  
Keyword(s):  
Organizational Strategies ◽  
End User ◽  
Viable Option ◽  
Research Gaps ◽  
Systematic Mapping ◽  
Level Of Evidence ◽  
Body Of Knowledge ◽  
Methods And Techniques ◽  
Literature Mapping ◽  
High Level

In the last few years, several organizations have been looking for strategies to meet the needs of users of Information Technology (IT). The decentralization of IT and the empowerment of nonprofessional users have been a viable option among these strategies. This study aimed to identify the End-User Development (EUD) strategies adopted by organizations. A systematic mapping was performed in order to provide for a structured body of knowledge and find potential research gaps. The results show that EUD methods and techniques are the most common strategies addressed in the literature. Also, most of the EUD strategies identified a focus either on EUD managerial issues, such as risk management, or on more technical elements, such as the implementation of components for EUD applications. The benefits and barriers to the adoption of EUD by organizations are also presented in this study. In general, defining EUD processes is a common gap in EUD surveys. We reinforce the need to carry out more research on the adoption of EUD in organizations, with a high level of evidence to validate the results.

scholarly journals Virtual Reality Analgesia for Children With Large Severe Burn Wounds During Burn Wound Debridement

2020 ◽  
Vol 1 ◽  
Author(s):  
Hunter G. Hoffman ◽  
David R. Patterson ◽  
Robert A. Rodriguez ◽  
Raquel Peña ◽  
Wanda Beck ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Pain Intensity ◽  
Wound Care ◽  
Primary Outcome Measure ◽  
Control Group ◽  
Severe Burn ◽  
Burn Wound ◽  
Absolute Change ◽  
Wound Debridement ◽  
Pain Medications

The objective of this study was to compare the effect of adjunctive virtual reality vs. standard analgesic pain medications during burn wound cleaning/debridement. Participants were predominantly Hispanic children aged 6–17 years of age, with large severe burn injuries (TBSA = 44%) reporting moderate or higher baseline pain during burn wound care. Using a randomized between-groups design, participants were randomly assigned to one of two groups, (a) the Control Group = pain medications only or (b) the VR Group = pain medications + virtual reality. A total of 50 children (88% Hispanic) with large severe burns (mean TBSA > 10%) received severe burn wound cleaning sessions. For the primary outcome measure of worst pain (intensity) on Study Day 1, using a between groups ANOVA, burn injured children in the group that received virtual reality during wound care showed significantly less pain intensity than the No VR control group, [mean worst pain ratings for the No VR group = 7.46 (SD = 2.93) vs. 5.54 (SD = 3.56), F(1,48) = 4.29, < 0.05, MSE = 46.00]. Similarly, one of the secondary pain measures, “lowest pain during wound care” was significantly lower in the VR group, No VR = 4.29 (SD = 3.75) vs. 1.68 (2.04) for the VR group, F(1,47) = 9.29, <0.005, MSE = 83.52 for Study Day 1. The other secondary pain measures showed the predicted pattern on Study Day 1, but were non-significant. Regarding whether VR reduced pain beyond Study Day 1, absolute change in pain intensity (analgesia = baseline pain minus the mean of the worst pain scores on Study days 1–10) was significantly greater for the VR group, F(1,48) = 4.88, p < 0.05, MSE = 34.26, partial eta squared = 0.09, but contrary to predictions, absolute change scores were non-significant for all secondary measures.

Comparing Midterm Outcomes of High-Level Athletes Versus Nonathletes Undergoing Primary Hip Arthroscopy: A Propensity-Matched Comparison With Minimum 5-Year Follow-up

2021 ◽  
pp. 036354652110417
Author(s):  
Andrew E. Jimenez ◽  
Peter F. Monahan ◽  
David R. Maldonado ◽  
Benjamin R. Saks ◽  
Hari K. Ankem ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Statistical Significance ◽  
Arthroscopic Surgery ◽  
Harris Hip Score ◽  
Control Group ◽  
Level Of Evidence ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
High Level

Background: High-level athletes (HLAs) have been shown to have better short-term outcomes than nonathletes (NAs) after hip arthroscopy. Purpose: (1) To report midterm outcomes of HLAs after primary hip arthroscopy and (2) to compare their results with a propensity-matched cohort of NA patients. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed between February 2008 and November 2015 for HLAs (professional, college, or high school) who underwent primary hip arthroscopy in the setting of femoroacetabular impingement syndrome (FAIS). HLAs were included if they had preoperative, minimum 2-year, and minimum 5-year follow-up data for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Hip Outcome Score Sports-Specific Subscale (HOS-SSS). Radiographic and intraoperative findings, surgical procedures, patient-reported outcomes (PROs), patient acceptable symptomatic state (PASS), minimal clinically important difference (MCID), and return to sport were reported. The HLA study group was propensity-matched to a control group of NA patients for comparison. Results: A total 65 HLA patients (67 hips) were included in the final analysis with mean follow-up time of 74.6 ± 16.7 months. HLAs showed significant improvement in all PROs recorded, achieved high rates of MCID and PASS for mHHS (74.6% and 79.4%, respectively) and HOS-SSS (67.7% and 66.1%, respectively), and returned to sport at high rates (80.4%). When compared with the propensity-matched NA control group, HLAs reported higher baseline but comparable postoperative scores for the mHHS and NAHS. HLA patients achieved MCID and PASS for mHHS at similar rates as NA patients, but the HLA patients achieved PASS for HOS-SSS at higher rates that trended toward statistical significance (66.1% vs 48.4%; P = .07). NA patients underwent revision arthroscopic surgery at similar rates as HLA patients (14.9% vs 9.0%, respectively; P = .424). Conclusion: Primary hip arthroscopy results in favorable midterm outcomes in HLAs. When compared with a propensity-matched NA control group, HLAs demonstrated a tendency toward higher rates of achieving PASS for HOS-SSS but similar arthroscopic revision rates at minimum 5-year follow-up.

scholarly journals The Use of a Synthetic Cartilage Implant for Hallux Rigidus

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0045
Author(s):  
Niall Smyth ◽  
Jonathan Kaplan ◽  
Amiethab Aiyer
Keyword(s):  
Polyvinyl Alcohol ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Hallux Rigidus ◽  
Reference List ◽  
Great Toe ◽  
Level Of Evidence ◽  
High Level ◽  
Ability Measure

Category: Other Introduction/Purpose: Hallux rigidus is one of the most common pathologies afflicting the foot. Various joint salvage techniques have been described with a multitude of different implants. Recently, a synthetic cartilage implant composed of polyvinyl alcohol (PVA) received FDA premarket approval for treatment of arthritis of the great toe and has been used in over 4,000 cases. The purpose of this study was to systematically review the clinical evidence supporting the use of a PVA implant in hallux rigidus. Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Using the terms “cartiva OR polyvinyl alcohol OR synthetic cartilage OR hemiarthroplasty AND hallux rigidus OR great toe arthritis OR first toe arthritis “ we searched the PubMed/Medline database in December 2017. In addition, the reference list of publications were scanned for further relevant studies. Results: 4 studies met the inclusion criteria, all of which were derived from a single randomized controlled trial. At short-term follow-up (2 years), patients undergoing placement of a PVA implant had significant improvement in Foot and Ankle Ability Measure (FAAM) sports and activity of daily living, as well as VAS pain scores. The outcomes of the surgery were found to be noninferior compared to arthrodesis. At intermediate follow-up (5 years), the improvement in clinical outcomes persisted and implant survivorship was 96%. Conclusion: There are limited studies available detailing the outcomes of a PVA implant for hallux rigidus, however the results that are available demonstrate a high level of evidence. There are no long-term publications assessing the outcomes of a PVA implant for hallux rigidus.

scholarly journals THE PREVENTION METHOD OF SPORTS MEDICINE IMAGING MODELING

2021 ◽  
Vol 27 (8) ◽  
pp. 833-836
Author(s):  
Fei Wu ◽  
Xuejun Ma ◽  
Wenjiang Zhao ◽  
Shuhua Qu
Keyword(s):  
Sports Medicine ◽  
Main Type ◽  
Sports Injury ◽  
Acute Injury ◽  
Chronic Injury ◽  
Level Of Evidence ◽  
Prevention Method ◽  
High Level ◽  
And Control ◽  
Type Of Injury

ABSTRACT Introduction: Sports injury is an important reason to interfere with sports training and physical exercise since it will not only bring unnecessary pain to the injured body, but also bring out negative emotions in athletes. Objective: To study the sports injury characteristics of high level competitive aerobics athletes in China. Methods: Literature data, questionnaire survey, expert interviews, field observation, mathematical statistics and physiotherapy tracking were used. Results: Wrists, ankles, waist and knees were the most frequently injured parts in high level competitive aerobics athletes in China. The main type of injury was acute injury, but chronic injury (48.18%) could not be ignored. Ninety percent of active high-level competitive aerobics athletes train with injuries, and 10 percent of them completely stop training because of injuries. Conclusions: Athletes should pay attention to their physical reserve and strengthen physical training. They must also be attentive to self-supervision, their own subjective feelings, and control the amount of exercise done. Level of evidence II; Therapeutic studies - investigation of treatment results.

scholarly journals State of the Art Regarding the Management of Multiligamentous Injuries of the Knee

2014 ◽  
Vol 8 (1) ◽  
pp. 215-218 ◽  
Author(s):  
Nigel T Mabvuure ◽  
Marco Malahias ◽  
Behrooz Haddad ◽  
Sandip Hindocha ◽  
Wasim S Khan
Keyword(s):  
Best Practice ◽  
Knee Injuries ◽  
Operative Management ◽  
Convincing Evidence ◽  
Optimal Timing ◽  
Active Debate ◽  
Recommendations For Practice ◽  
High Level ◽  
Non Operative Management ◽  
Serious Injuries

Multiligamentous knee injuries are rare but serious injuries that can threaten limb viability. As such, they require careful management to give patients the best chance of immediate and ultimate functional recovery. However, as these injuries are rare, there is paucity in prospective comparative studies large enough to provide high level evidence for best practice. This lack of comprehensive and convincing evidence has made the management of multiligamentous knee injuries an area of active debate and controversy. The debate on whether surgical management leads to better outcomes than non-operative management, the optimal timing of surgery after injury and whether repair is better than reconstruction is still ongoing. Using the Oxford Levels of Evidence, this review summarises the latest high level evidence to provide answers to these issues. Recommendations for practice have also been offered and assigned a grade using a published scale.

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