Palestinian Experience in Stage Four Pressure Ulcer

Pressure ulcer (now called Pressure injury) happens when the bony prominence like the sacrum exposes to pressure for a long period and also can cause soft tissue injury. In order to prevent and cure pressure-induced wounds, continuous and attentive repositioning is necessary. Wound management begins with the identification and aggressive management of the modifiable factors, such as positioning, incontinence, spasticity, diet, devices, and medical comorbidity, which contribute to pressure injury formation. Initial interventions include washing, cleaning, and maintaining the surfaces of the wound. In certain cases, it may be sufficient to debride the non-viable or contaminated tissue; however, operational care in more severe cases or to encourage patient satisfaction may be necessary. Our patient is a 50-year-old overweighted man, nonsmoker, and confined to a wheelchair presented with a 20*20*8 stages 4 ulcers in the sacral area after multiple failed bedside debridement. When we use the fasciocutaneous we should consider the depth of the wound and fill dead space. Here we the local situation in Palestine as those patients are usually neglected and their management is restricted to bedside debridement, with no experience in flap reconstruction operations which would dramatically improve patients’ lives. We believe that further awareness is demanded for such procedures.

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

Journal of Graduate Medical Education ◽

10.4300/jgme-d-20-00278.1 ◽

2021 ◽

Vol 13 (1) ◽

pp. 95-102

Author(s):

Emily J. Onufer ◽

Erin G. Andrade ◽

Angelia DeClue ◽

Grant Bochicchio ◽

Paul Wise ◽

...

Keyword(s):

Soft Tissue ◽

Tissue Injury ◽

Wound Care ◽

Soft Tissue Injury ◽

Soft Tissue Injuries ◽

Wound Management ◽

Management Skills ◽

Perceived Ability ◽

Confidence Levels ◽

Multiple Choice Questionnaire

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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CASE SUMMARY ON ACUTE WOUND MANAGEMENT OF EXTENSIVE FACIAL SOFT TISSUE INJURY

10.36106/paripex/8102248 ◽

2020 ◽

pp. 1-3

Author(s):

Sunita Das ◽

Hironya Borah ◽

Arup Kakati

Keyword(s):

Soft Tissue ◽

Traffic Accidents ◽

Road Traffic ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Wound Management ◽

Aesthetic Outcome ◽

Facial Soft Tissue ◽

Physical Strain ◽

The Face

Injuries to the face are commonly encountered in the Emergency department and is usually seen following road traffic accidents. It may include injuries to the soft tissue or bones of the face. Soft tissue injuries of the face almost always include injuries to the nose, as it is the most prominent feature of the face. These injuries are often not life-threatening, but its mismanagement can hamper the functional and aesthetic outcome leading to permanent mental and physical strain. Thus, to achieve a suitable final outcome, proper understanding of the facial anatomy, assessment of the wound and its proper management is necessary. This report discusses the case of a middle aged man who suffered from contaminated facial soft tissue injury following road traffic accident. Good functional and aesthetic outcome was achieved with special emphasis on the proper assessment, irrigation and meticulous repair of the wound. Follow-up of the patient was done after being discharged from the hospital.

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Deep tissue injury: a narrative review on the aetiology of a controversial wound

British Journal of Nursing ◽

10.12968/bjon.2021.30.5.s32 ◽

2021 ◽

Vol 30 (5) ◽

pp. S32-S37

Author(s):

Matthew Wynn

Keyword(s):

Pressure Ulcer ◽

Tissue Injury ◽

Human Subjects ◽

Healthcare Services ◽

Narrative Review ◽

Advisory Panel ◽

Deep Tissue ◽

Deep Tissue Injury ◽

Pressure Injury ◽

Governance Processes

Deep tissue injuries (DTIs) were added to pressure ulcer grading systems in 2009. Since then, they have been associated with the same aetiological processes as other forms of pressure injury (PI). This is despite notable clinical differences in their presentation along with variations in natural history that suggest they are the consequence of processes distinct from those that cause other PIs. Understanding the aetiology of DTIs is essential to guide prevention and treatment in addition to ensuring healthcare governance processes deeply tied to pressure injury are effective and efficient. Current understanding of the aetiology of DTI has significant gaps, with several key challenges impeding progress in this area of PI research, including inconsistent reporting by healthcare services and the limitations of animal and computer models in addition to the ethical barriers to conducting studies on human subjects. Synthesis of early studies with studies undertaken before 2009 is also limited by the variety in definitions of DTI used before that published by the European Pressure Ulcer Advisory Panel, the National Pressure Injury Advisory Panel and the Pan Pacific Pressure Injury Alliance in 2009. To date, few prospective clinical studies have been conducted. This article presents a narrative review on the clinical and animal study evidence indicating contemporary understanding of DTI.

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