COVER: A Curriculum in the Management of Soft Tissue Injury and Infection for Junior Surgery Residents

ABSTRACT Background While wound management is a common task for practicing surgeons, there is a paucity of dedicated education on soft tissue management during residency training. Objective The COVER (Causes of soft tissue injury, Obstacles to closure, Vacuums and stitches, Epithelialization, Rationale for wound care) curriculum was developed to engage junior surgery residents in the management of soft tissue injury and infection. Methods Junior surgery residents participated in the COVER lab during academic years 2018–2020. Residents applied appropriate surgical management and wound care to cadaveric models of soft tissue injury and infection. Assessments included a pre-/post-curriculum and pre-/post-lab multiple choice questionnaire and survey. Results All eligible residents (n = 45, 27) participated in the COVER lab for both academic years. Postgraduate year (PGY)-1s, PGY-2s, and PGY-3s showed improvement in wound management knowledge with an average increase in score of 17%, 8%, and 18%, respectively. They also showed a change in their self-reported perceived ability to achieve primary soft tissue closure with confidence levels 22%, 20%, and 16%, respectively. This was again seen in perceived ability to manage soft tissue injuries and infections (28%, 28%, and 23%, respectively). There was a significant increase in performing new wound management skills (PGY-1 mean 51.3%, PGY-2 33.5%, PGY-3 20%; ANOVA, P = .0001). Conclusions The COVER curriculum provides a systematic approach to soft tissue injury and infection. Residents showed a significant increase in both soft tissue knowledge as well as confidence in ability to perform wound management.

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Mechanisms of Soft Tissue Injury

Facial Plastic Surgery ◽

10.1055/s-0041-1727247 ◽

2021 ◽

Author(s):

Oneida A. Arosarena ◽

Issam N. Eid

Keyword(s):

Soft Tissue ◽

Tissue Injury ◽

Visual Fields ◽

Soft Tissue Injury ◽

Soft Tissue Injuries ◽

Wound Management ◽

Facial Soft Tissue ◽

Tissue Injuries ◽

Free Closure ◽

High Level

AbstractSoft tissue trauma to the face is challenging to manage due to functional and aesthetic concerns. Management requires careful regional considerations to maintain function such as visual fields and oral competence in periorbital and perioral injuries, respectively. Basic wound management principles apply to facial soft tissue injuries including copious irrigation and tension-free closure. There is no consensus and high-level evidence for antibiotic prophylaxis especially in various bite injuries. Ballistic injuries and other mechanisms are briefly reviewed. Scar revision for soft tissue injuries can require multiple procedures and interventions. Surgery as well as office procedures such as resurfacing with lasers can be employed and will be reviewed.

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The Hazards of Skateboard-Riding

PEDIATRICS ◽

10.1542/peds.57.5.793 ◽

1976 ◽

Vol 57 (5) ◽

pp. 793-793

Author(s):

◽

Fernando Atienza ◽

Calvin Sia

Keyword(s):

Emergency Department ◽

Soft Tissue ◽

Bone Fractures ◽

Tissue Injury ◽

Skull Fracture ◽

Soft Tissue Injury ◽

Soft Tissue Injuries ◽

Major Surgery ◽

Cerebral Concussion ◽

Tissue Injuries

Skateboard-riding has become increasingly popular among Hawaii's children. The thrill of the ride and the challenge of keeping one's balance and working intricate maneuvers while speeding down a hill captures the fancy of many of our young. This sport, however, has produced an alarmingly high toll of injury and illness. Pediatricians and emergency departments of our major hospitals have seen and taken care of large numbers of patients (aged between 3 years and 35 years, but with a distribution overwhelmingly pediatric) with significant injuries which include cerebral concussion, fractures, soft tissue injuries of varying degrees of severity and complications, and injury to internal organs. During a three-month period at the Kauikeolani Children's Hospital, July to August 1975, there were 16 patients admitted with the following: seven cerebral concussions, one skull fracture, five assorted bone fractures, one soft tissue injury and infection, one retroperitoneal hemorrhage, and one instance of major surgery for removal of the spleen. During the months of August and September 1975 the Emergency Department of Straub Clinic reported the following skateboard injuries: 14 fractures, 14 soft tissue injuries, 5 lacerations, and 2 cerebral concussions. Of the 35 patients seen, three were admitted—one with an open fracture, one with cerebral concussion, and one with a skull fracture. During a four-week period (two weeks in June and July and two weeks in August and September) at the Emergency Department of Kaiser Medical Center, 66 cases of skateboard injuries were seen with six patients requiring admission for fractures and brain concussion.

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Skeletal and soft tissue injuries after manual and mechanical chest compressions

European Heart Journal - Quality of Care and Clinical Outcomes ◽

10.1093/ehjqcco/qcy062 ◽

2019 ◽

Vol 5 (3) ◽

pp. 259-265 ◽

Cited By ~ 4

Author(s):

Niklas Friberg ◽

Simon Schmidbauer ◽

Charles Walther ◽

Elisabet Englund

Keyword(s):

Cardiac Arrest ◽

Soft Tissue ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Soft Tissue Injuries ◽

Chest Compressions ◽

Sternal Fracture ◽

Tissue Injuries ◽

Severe Soft Tissue ◽

Severe Soft Tissue Injury

Abstract Aims To determine the rate of injuries related to cardiopulmonary resuscitation (CPR) in cardiac arrest non-survivors, comparing manual CPR with CPR performed using the Lund University Cardiac Assist System (LUCAS). Methods and results We prospectively evaluated 414 deceased adult patients using focused, standardized post-mortem investigation in years 2005 through 2013. Skeletal and soft tissue injuries were noted, and soft tissue injuries were evaluated with respect to degree of severity. We found sternal fracture in 38%, rib fracture in 77%, and severe soft tissue injury in 1.9% of cases treated with CPR with manual chest compressions (n = 52). Treatment with LUCAS CPR (n = 362) was associated with significantly higher rates of sternal fracture (80% of cases), rib fracture (96%), and severe soft tissue injury (10%), including several cases of potentially life-threatening injuries. Conclusion LUCAS CPR causes significantly more CPR-related injuries than manual CPR, while providing no proven survival benefit on a population basis. We suggest judicious use of the LUCAS device for cardiac arrest.

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Improper Acupuncture Causing Severe Multiple Soft Tissue Damage: A Case Report

10.21203/rs.3.rs-118203/v1 ◽

2020 ◽

Author(s):

yulong xie ◽

yan peng ◽

wengzong zhou ◽

qiantong qin ◽

hui wang ◽

...

Keyword(s):

Soft Tissue ◽

Acupuncture Treatment ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Soft Tissue Injuries ◽

Small Range ◽

Stroke Patients ◽

Coagulation Dysfunction ◽

Severe Soft Tissue ◽

Severe Soft Tissue Injury

Abstract Background Acupuncture therapy is well known. But there is no report that acupuncture in patients with coagulation dysfunction in stroke may lead to severe soft tissue injury. we report a case of acupuncture leading to severe soft tissue injury.Methods A 63-year-old female patient was hospitalized for stroke rehabilitation. After 2 years of discharge, severe subcutaneous hematoma caused by acupuncture was readmitted to hospital. She received medication and physical rehabilitation. we monitored the international standardized ratio (INR) in plasma and observed the degree of dissipation of subcutaneous hematoma. the changes of patients during treatment were explored by data analysis.Findings Subcutaneous hematoma (area 20×20 cm) disappeared completely after 3 weeks of physical factor therapy. Small range (area ≤3×3 cm) subcutaneous hematoma can heal itself within 2 weeks. Improper acupuncture is only one of the causes of soft tissue injury. Stroke with coagulation dysfunction is not a contraindication of acupuncture treatment.Interpretation Our report suggests that previously unanticipated acupuncture treatment for stroke patients with coagulation dysfunction may lead to severe multiple soft tissue injuries. Although coagulation dysfunction is not a contraindication of acupuncture treatment, acupuncture treatment for stroke patients with coagulation dysfunction should be vigilant, strengthen the level of acupuncture operation, and fundamentally eliminate the problem. These cases are validation and supplement of adverse clinical reactions caused by improper acupuncture.

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Training Load and Injury Risk in Elite Rugby Union: The Largest Investigation to Date

International Journal of Sports Medicine ◽

10.1055/a-1300-2703 ◽

2020 ◽

Author(s):

Stephen W. West ◽

Sean Williams ◽

Dario Cazzola ◽

Simon Kemp ◽

Matthew J. Cross ◽

...

Keyword(s):

Soft Tissue ◽

Injury Risk ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Soft Tissue Injuries ◽

Rugby Union ◽

Training Load ◽

Alternative Methods ◽

Load Monitoring ◽

The Relationship

AbstractTraining load monitoring has grown in recent years with the acute:chronic workload ratio (ACWR) widely used to aggregate data to inform decision-making on injury risk. Several methods have been described to calculate the ACWR and numerous methodological issues have been raised. Therefore, this study examined the relationship between the ACWR and injury in a sample of 696 players from 13 professional rugby clubs over two seasons for 1718 injuries of all types and a further analysis of 383 soft tissue injuries specifically. Of the 192 comparisons undertaken for both injury groups, 40% (all injury) and 31% (soft tissue injury) were significant. Furthermore, there appeared to be no calculation method that consistently demonstrated a relationship with injury. Some calculation methods supported previous work for a “sweet spot” in injury risk, while a substantial number of methods displayed no such relationship. This study is the largest to date to have investigated the relationship between the ACWR and injury risk and demonstrates that there appears to be no consistent association between the two. This suggests that alternative methods of training load aggregation may provide more useful information, but these should be considered in the wider context of other established risk factors.

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Soft-tissue injuries associated with cast application for distal limb orthopaedic conditions

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-10-03-0033 ◽

2011 ◽

Vol 24 (02) ◽

pp. 126-131 ◽

Cited By ~ 39

Author(s):

C. Davidson ◽

G. I. Arthurs ◽

R. L. Meeson

Keyword(s):

Soft Tissue ◽

Medical Records ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Soft Tissue Injuries ◽

Severe Injuries ◽

Calcaneal Tendon ◽

Tissue Injuries ◽

The Cost ◽

Susceptible Group

Summary Objectives: Casts applied for orthopaedic conditions can result in soft-tissue injuries. The purpose of our study was to describe the nature and prevalence of such complications. Methods: We performed a retrospective review of medical records of dogs and cats that had a cast placed for an orthopaedic condition between October 2003 and May 2009. The data were analysed and categorised. Results: Of the 60 animals that had a cast placed, 63% developed a soft-tissue injury (60% mild, 20% moderate and 20% severe). Injuries could occur any time during coaptation, and an association with duration of casting and severity (p = 0.42) was not shown. Severe injuries took the longest to resolve (p = 0.003). Sighthounds were significantly more likely to develop a soft-tissue injury (p = 0.04), and cross-breeds were less likely (p = 0.01). All common calcaneal tendon reconstructions suffered soft-tissue injuries, but significance was not shown (p = 0.08). Veterinarians identified the majority of injuries (80%) rather than the owners. The financial cost of treating soft-tissue injuries ranged from four to 121% the cost of the original orthopaedic procedure. Clinical significance: Soft-tissue injuries secondary to casting occur frequently, and can occur at any time during the casting period. Within our study, sighthounds were more likely to develop soft tissue injuries, and should therefore perhaps be considered as a susceptible group. The only reliable way to identify an injury is to remove the cast and inspect the limb.

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Morel-Lavallée Lesion Following a Low-speed Injury: A Case Report

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2020.7.48358 ◽

2020 ◽

Vol 4 (4) ◽

pp. 642-643

Author(s):

Daniel Porter ◽

Jeff Conley ◽

John Ashurst

Keyword(s):

Case Report ◽

Soft Tissue ◽

Lower Extremity ◽

Tissue Injury ◽

Fluid Collection ◽

Soft Tissue Injury ◽

Soft Tissue Injuries ◽

Low Speed ◽

Degloving Injury ◽

Tissue Injuries

Introduction: Soft tissue injuries are a common presenting complaint seen in the emergency department following trauma. However, internal degloving injuries are not commonly seen by the emergency provider. Case Report: A 57-year-old male presented with right lower extremity pain, bruising, and swelling after a low-speed bicycle accident five days prior. Physical examination revealed an edematous and ecchymotic right lower extremity extending from the mid-thigh distally. Computed tomography of the thigh demonstrated a hyperdense foci within the fluid collection suggesting internal hemorrhage and internal de-gloving suggestive of a Morel-Lavallée lesion. Discussion: The Morel-Lavallée lesion is a post-traumatic soft tissue injury that occurs as a result of shearing forces that create a potential space for the collection of blood, lymph, and fat. First described in 1853 by French physician Maurice Morel-Lavallée, this internal degloving injury can serve as a nidus of infection if not treated appropriately. Magnetic resonance imaging has become the diagnostic modality of choice due to its high resolution of soft tissue injuries. Treatment has been focused on either conservative management or surgical debridement after consultation with a surgeon. Conclusion: The emergency physician should consider Morel-Lavallée lesions in patients with a traumatic hematoma formation to avoid complications that come from delayed diagnosis.

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“Fixator-assisted Nailing” Technique for Closed Segmental Tibia Shaft Fracture with Extensive Soft Tissue Injury – A Case Report

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i08.2382 ◽

2021 ◽

Vol 11 (8) ◽

Author(s):

Vivek M Sodhai ◽

Chetan V Pradhan ◽

Parag K Sancheti ◽

Ashok K Shyam

Keyword(s):

Case Report ◽

Soft Tissue ◽

Internal Fixation ◽

External Fixator ◽

Road Traffic ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Treatment Strategies ◽

Soft Tissue Injuries ◽

Definitive Treatment

Introduction: Segmental tibia fractures with extensive soft tissue injuries are rare and surgical intervention is challenging with no definitive treatment strategies. Case Report: A 52-year-old man presented with closed right segmental tibia and fibula fracture with extensive blistering of skin caused due to road traffic accident. Distal pulses were palpable and there were no signs of compartment syndrome and other systemic injuries. In the presence of extensive blistering, a monoplanar external fixator was applied within 24 h of injury. 3 weeks later, skin condition was conducive for internal fixation, and closed intramedullary multi-locking nailing was performed using the external fixator for reduction. Fracture healed at 15 months and patient had an excellent functional outcome with full knee range of motion at 2-years follow-up without any complications. Conclusion: Fixator-assisted nailing is a simple, minimally invasive, and easily reproducible technique that is useful in reducing the fracture and preventing axial rotation of the intercalary segment minimizing the damage to the periosteal blood supply. Our case also highlights the importance of temporary external fixator in soft tissue healing and making the skin conducive for internal fixation. Keywords: Devascularization, fixator-assisted nailing, intercalary segment, rotational displacement, segmental tibial fracture.

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Joshi’s external stabilization system in the management of distal tibial and fibular fractures with associated soft tissue injury in children

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164162 ◽

2016 ◽

Vol 2 (4) ◽

pp. 323

Author(s):

Shivanand C. Mayi ◽

Sachin Shah ◽

Sadashiv R. Jidgekar ◽

Arunkumar Kulkarni

Keyword(s):

Soft Tissue ◽

Tissue Injury ◽

Wound Care ◽

Soft Tissue Injury ◽

Limb Length Discrepancy ◽

Minimal Invasive ◽

Stabilization System ◽

Tibial Shaft ◽

Fracture Stabilization ◽

External Stabilization

Background: Injuries around ankle and distal third of tibial shaft are among common paediatric bone trauma. Some of these cases are associated with soft tissue injury over the lower third of leg or around the ankle joint as tibia is subcutaneous on the anteromedial aspect. This study was conducted to know the outcome of these injuries with minimal invasive external fixation.Methods: Eleven patients in the age group of 4-14 years were included in this study. All patients had closed fracture of distal third tibial shaft or injury of distal tibial physis with associated soft tissue injury. Joshi’s external stabilization system was used to retain the reduction of fracture and appropriate wound care was taken. JESS was removed after radiological signs of fracture union.Results: Patients were followed up for mean period of 8.9 month. After JESS fixation healing of wound occurred at an average of 12.45 day and external fixator was removed at 6-8 weeks period. Three patients had grade 1 pin tract infection which was controlled by local dressing. No patient had stiffness of ankle at the time of JESS removal. No limb length discrepancy was seen in any of the patients in this study at their final follow up. Conclusions: JESS gives good results in fractures of distal tibial with associated soft tissue injury. It helps in better management of wound and fracture stabilization.

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A novel rat model of tibial fracture for trauma researches: a combination of different types of fractures and soft tissue injuries

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1386-4 ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Enxian Shi ◽

Gang Chen ◽

Bengang Qin ◽

Yi Yang ◽

Jintao Fang ◽

...

Keyword(s):

Soft Tissue ◽

Tibial Fracture ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Soft Tissue Injuries ◽

Trauma Research ◽

Group 4 ◽

Group 3 ◽

Tissue Injuries ◽

Group 1

Abstract Background The outcomes for open tibial fractures with severe soft tissue injury are still a great challenge for all the trauma surgeons in the treatment. However, most of the existing open tibial fracture models can only provide minimal soft tissue injury which cannot meet the requirement of severe trauma research. Our goal is to investigate a novel tibial fracture model providing different fractures combined with soft tissue injury for better application in trauma research. Methods A total of 144 Sprague-Dawley rats were randomly divided into 4 groups. With group 1 as control, the other groups sustained different right tibial fractures by the apparatus with buffer disc settings either 3 mm, 10 mm, or 15 mm. X-ray and computed tomography angiography (CTA) were performed at 6 h to evaluate the fracture patterns and vascular injuries. Peripheral blood and tibialis anterior muscle were harvested at 6 h, 1 day, 3 days, 7 days, 14 days, and 28 days for ELISA and histological analysis. Results X-ray and μCT results indicated that different fractures combined with soft tissue injuries could be successfully provided in this model. According to OTA and Gustilo classification, the fractures and soft tissue injuries were evaluated and defined: 36 type I in group 2, 34 type II in group 3, and 36 type III in group 4. The CTA confirmed no arterial injuries in groups 1 and 2, 2 arterial injuries in group 3, and 35 in group 4. ELISA indicated that the levels of pro-inflammatory cytokines TNF-α and IL-1β were significantly higher in group 4 than in other groups, and the levels of anti-inflammatory cytokines TGF-β and IL-10 were significantly higher in surgery groups than in group 1 in later stage or throughout the entire process. HE, Masson, and caspase-3 stains confirmed the most severe inflammatory cell infiltration and apoptosis in group 4 which lasted longer than that in groups 2 and 3. Conclusions The novel apparatus was valuable in performing different fractures combined with soft tissue injuries in a rat tibial fracture model with high reproducibility and providing a new selection for trauma research in the future.

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