Severe Carpal and Tarsal Shearing Injuries Treated With an Immediate Arthrodesis in Seven Dogs

The medical records of seven dogs with severe, grade 3, open shearing wounds of the carpus or tarsus that were treated with an immediate arthrodesis were reviewed. Six dogs were managed with a transarticular external skeletal fixator (ESF), and one dog was treated with plate fixation. The soft tissues were managed simultaneously along with the definitive joint stabilization in all cases. Minor complications occurred in four dogs: one dog that required a skin graft, one dog in which a skin graft was recommended but not performed, one dog in which a secondary skin closure was performed, and one dog in which a delayed cancellous bone graft was placed. Major complications occurred in three dogs: two dogs that required restabilization of the arthrodesis and one dog that required implant (i.e., plate) removal due to infection. All dogs healed with acceptable functional and cosmetic results. Further long-term evaluation of five dogs revealed that all but one dog had either excellent or good functional outcomes, and the remaining dog had a fair outcome. Similarly, five dogs had either excellent or good cosmetic outcomes, with the remaining dog having a fair outcome. All owners were very satisfied with the overall results. This clinical study demonstrated that an immediate, definitive management technique, in which bone fusion and wound management are undertaken as simultaneous objectives, is a viable technique of managing severe periarticular shearing injuries. Transarticular stabilization with an ESF is the technique recommended.

Download Full-text

MODERN APPROACHES IN MANAGING WOUND DEFECTS IN CHILDREN WITH SURGICAL INFECTION

"Medical & pharmaceutical journal "Pulse" ◽

10.26787/nydha-2686-6838-2020-22-12-169-175 ◽

2020 ◽

pp. 169-175

Author(s):

Kuzmin A.I. ◽

Munin A.G. ◽

Zavyalkin V.A. ◽

Barskaya M.A. ◽

Terekhina M.I.

Keyword(s):

Surgical Treatment ◽

Hospital Stay ◽

Soft Tissues ◽

Local Treatment ◽

Wound Management ◽

Innovative Technologies ◽

Surgical Infection ◽

Results Of Treatment ◽

Inadequate Antibiotic Therapy ◽

Good Cosmetic

The results of treatment of 57 children with wound defects of soft tissues that have appeared at the background of surgical infections of various origins have been analyzed. The causes of the wound defects formation were analyzed according to the T.I.M.E. system.[7,8,9]. While treating the wound defects the strategy of creating the conditions close to the ones in an acute wound was followed («Wound bed preparation») [7,8,11]. We used several types of debridement aimed at shortening the phases of the wound process with the following closure of the wound defects by different methods [1,2,5,7]. The assessment of the effectiveness of local treatment was carried out taking into account the nature and severity of the phases of the wound process by the method of clinical observation of the state of the wound (the severity of symptoms of inflammation, the nature and amount of exudate, the presence and appearance of granulations, the presence of signs of wound epithelialization and scarring, the size of the wound), microbiological, cytological and histology and research [10]. The study revealed factors that disrupt wound healing during primary surgical treatment, in the management of foci of surgical infection, in the management of postoperative wounds, in the treatment of pressure ulcers in children with neurological pathology. During the initial surgical treatment of the received wounds, its inadequacy was noted - the abandonment of necrotic, defective tissues, foreign bodies, the presence of an undiagnosed infection, the absence or inadequate antibiotic therapy, constant tension of the skin edges, impaired blood flow and innervation, inadequate sanitation and drainage. The use of modern innovative technologies in wound management reduces hospital stay, reduces the duration of the use of antibiotics and other medications, contributes to a good cosmetic effect. Application of the current innovative technologies in wounds treatment shortens the hospital stay, decreases the duration of the use of antibiotics and other medicines, and contributes to better cosmetics effects [1,4,6]. The current trends in wounds treating with the choice of local treatment according to the phases of the wound process are presented in this article. The methods of active wound defects therapy and different types of debridement considering their pros and cons are analyzed.

Download Full-text

Long-Term Evaluation of Ifosfamide-Related Nephrotoxicity in Children

Journal of Clinical Oncology ◽

10.1200/jco.2008.17.5257 ◽

2009 ◽

Vol 27 (32) ◽

pp. 5350-5355 ◽

Cited By ~ 74

Author(s):

Odile Oberlin ◽

Oumaya Fawaz ◽

Annie Rey ◽

Patrick Niaudet ◽

Vita Ridola ◽

...

Keyword(s):

Multivariate Analysis ◽

Renal Toxicity ◽

Moderate Dose ◽

Median Dose ◽

Glomerular Function ◽

Term Evaluation ◽

Grade 3 ◽

Length Of Interval

PurposeIfosfamide is widely used in pediatric oncology but its nephrotoxicity may become a significant issue in survivors. This study is aimed at evaluating the incidence of late renal toxicity of ifosfamide and its risk factors.Patients and MethodsOf the 183 patients prospectively investigated for renal function, 77 treated for rhabdomyosarcoma, 39 for other soft tissue sarcoma, 39 for Ewing's sarcoma, and 28 for osteosarcoma were investigated at least 5 years after treatment. No patients had received cisplatin and/or carboplatin. Glomerular and tubular functions were graded according to the Skinner system.ResultsThe median dose of ifosfamide was 54 g/m2(range, 18 to 117 g/m2). After a median follow-up of 10 years, 89.5% of patients had normal tubular function, and 78.5% had normal glomerular function rate (GFR). Serum bicarbonate and calcium were normal in all patients. Hypomagnesemia was observed in 1.2% and hypophosphatemia in 1%. The tubular threshold for phosphate was reduced in 24% of the patients (grade 1 in 15%, grade 2 in 8%, and grade 3 in 0.5%). Glycosuria was detected in 37% of the patients but was more than 0.5 g/24 hours in only 5%. Proteinuria was observed in 12%. Ifosfamide dose and interval from therapy to investigations were predictors of tubulopathy in univariate and multivariate analysis. In a multivariate analysis, an older age at diagnosis and the length of interval since treatment had independent impacts on the risk of abnormal GFR.ConclusionRenal toxicity is moderate with a moderate dose of ifosfamide. However, since it can be permanent and can get worse with time, repeated long-term evaluations are important, and this risk should be balanced against efficacy.

Download Full-text

The Role of Soft Tissues in Plate Fixation of Proximal Phalanx Fractures

Clinical Orthopaedics and Related Research ◽

10.1097/00003086-200401000-00036 ◽

2004 ◽

Vol 418 ◽

pp. 213-218 ◽

Cited By ~ 16

Author(s):

Elizabeth Anne Ouellette ◽

Jay J Dennis ◽

Loren L Latta ◽

Edward L Milne ◽

Anna-Lena Makowski

Keyword(s):

Soft Tissues ◽

Plate Fixation ◽

Proximal Phalanx

Download Full-text

Advantages of skin closure with subcuticular suture for liver resection on postoperative and cosmetic outcomes: a propensity matched analysis

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02388-2 ◽

2022 ◽

Author(s):

Chihiro Kawaguchi ◽

Daisuke Hokuto ◽

Satoshi Yasuda ◽

Takahiro Yoshikawa ◽

Naoki Kamitani ◽

...

Keyword(s):

Liver Resection ◽

Skin Closure ◽

Subcuticular Suture ◽

Cosmetic Outcomes

Download Full-text

A custom-made conformer wrapped in lower oral mucosa for the correction of severely contracted socket

European Journal of Ophthalmology ◽

10.1177/1120672120974940 ◽

2020 ◽

pp. 112067212097494

Author(s):

Fan Yang ◽

Zhengkang Li ◽

Yuan Deng

Keyword(s):

Oral Mucosa ◽

Clinical Effects ◽

Compression Bandage ◽

Artificial Eye ◽

Lower Lip ◽

Custom Made ◽

Good Cosmetic ◽

Contracted Socket ◽

Cosmetic Outcomes ◽

The Mean

Purpose: To investigate the clinical effects of a custom-made conformer wrapped in lower oral mucosa for the correction of severely contracted socket. Methods: Clinical data and photographs of 32 patients with severely contracted socket were retrospectively analyzed. Among the 32 cases, 21 were males and 11 were females. Their ages ranged from 20 to 71 years (mean, 45 years). Each patient underwent conjunctival sac plasty using a custom-made conformer wrapped by oral mucosa, then compression bandage for 1 month. All patients received tarsorrhaphy 6 months postoperatively, and an artificial eye was worn 1 week later. Results: All the grafts were fully vascularized. The conjunctival sacs had enough space to fit the desirable artificial eyes, and adequate aesthetic outcomes were reached postoperatively. The mean depth of the upper fornix was 4.28 ± 0.66 mm preoperatively and 18.84 ± 0.65 mm postoperatively ( p < 0.01), and lower fornix depth was 2.69 ± 0.42 and 8.78 ± 0.82 mm, respectively ( p < 0.01). Lower lip deformity occurred in one case. Conclusion: A custom-made conformer wrapped in lower oral mucosa was a safe and effective grafting material. The grafts can be effectively used in the reconstruction of severely contracted socket and lead to good cosmetic outcomes.

Download Full-text

A modified Fox pentagon technique performed using a polytetrafluoroethylene sling in frontalis suspension to treat blepharophimosis syndrome

Science Progress ◽

10.1177/0036850419893880 ◽

2020 ◽

Vol 103 (1) ◽

pp. 003685041989388

Author(s):

Yuan Wang ◽

Qian Wu ◽

Li Li ◽

Wen Liu ◽

Cheng Li ◽

...

Keyword(s):

Retrospective Study ◽

Functional Outcomes ◽

Average Score ◽

Palpebral Fissure ◽

Cosmetic Results ◽

Frontalis Suspension ◽

Good Cosmetic ◽

Cosmetic Outcomes ◽

The Mean

The purpose of this study was to evaluate the functional and cosmetic outcomes of a new modified Fox pentagon technique performed using polytetrafluoroethylene in frontalis suspension surgery for blepharophimosis syndrome. This retrospective study enrolled 40 patients diagnosed with blepharophimosis syndrome from March 2016 to October 2018. All patients underwent frontalis suspension using a new modified Fox pentagon technique. The functional and cosmetic outcomes were evaluated. After the operation, the mean palpebral fissure height increased from 2.68 to 6.93 in right eyes and from 2.73 to 6.98 in left eyes. The mean MRD1 increased from 0.53 to 3.76 in right eyes and from 0.50 to 3.78 in left eyes. While preoperative to postoperative differences were statistically significant ( p < 0.01), there were no significant differences between right and left eyes either before or after the surgery ( p > 0.01). All patients achieved good cosmetic results with an average score of 0.6. We have experimentally created a modified Fox pentagon technique performed using a polytetrafluoroethylene sling in a frontalis suspension to treat BPES; this approach yielded favorable cosmetic and functional outcomes.

Download Full-text

Experience with the Malleable Ear Dressing, A Versatile Silicone-Lined Bandage for the Auricle

Ear Nose & Throat Journal ◽

10.1177/014556130308200811 ◽

2003 ◽

Vol 82 (8) ◽

pp. 570-574 ◽

Cited By ~ 5

Author(s):

Frederick A. Godley

Keyword(s):

Skin Graft ◽

Wound Dressing ◽

Skin Flap ◽

Skin Closure ◽

External Ear ◽

Light Pressure ◽

Surgical Wounds

The repair of surgical wounds of the external ear—whether it be a primary skin closure, a skin flap, or a skin graft—presents several challenges with respect to healing. One of these challenges is that it is not easy to fashion a wound dressing that has a smooth, moisture-containing surface, conforms to the shape of the auricle, and adheres to it while providing light pressure. An ear dressing that features these characteristics—the malleable ear dressing—is expected to become commercially available soon. In this article, the author describes his use of this dressing in 48 patients and reviews the results of follow-up questioning of 20 of these patients. Based on these findings, the author concludes that this dressing is effective, comfortable, aesthetically acceptable, and can be worn continuously for 7 consecutive days without complications.

Download Full-text

Long-term evaluation of ifosfamide-related nephrotoxicity in children: The French experience

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.9551 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 9551-9551

Author(s):

O. Fawaz ◽

A. Rey ◽

P. Niaudet ◽

D. Orbach ◽

C. Bergeron ◽

...

Keyword(s):

Renal Toxicity ◽

Univariate Analysis ◽

Multivariate Analyse ◽

French Experience ◽

Term Evaluation ◽

Tubular Toxicity ◽

Grade 3 ◽

Median Interval

9551 Background: Ifosfamide-induced nephrotoxicity is a significant issue in patients treated for tumours during childhood. This study aimed at documenting incidence of late renal toxicity of ifosfamide and its risk factors. Methods: 183 patients have been investigated. 100 were male. Median age at treatment was 9.3 years (0.4–18 years). Median dose of ifosfamide was 54 g/m2 (18–77 g/m2). No patients received cisplatin and/or carboplatinum. Diagnoses included rhabdomyosarcoma (77), other soft tissue sarcoma (39), Ewing (39), and osteosarcoma (28). Investigations were performed at a median interval of 10.3 years (5–20.7) after the end of the treatment, at a median age of 21.6 years (7.1–44.2). No patient had electrolyte or vitamine supplementation. Glomerular and tubular functions were graded according to the Skinner's system. Results: After 5 year minimal follow-up 55% had normal tubular and 79% had normal glomerular functions. Natraemia, kalaemia, serum HCO3 and calcaemia were normal in all patients. Hypomagnesaemia was observed in 4, hypophosphaetemia in 8 %. The tubular threshold for phosphate was reduced in 44% of the patients (grade 2 or 3 in 15%, grade 3 in 1 pt). Significant glycosuria (> 0.5 g/24h) was detected in 5 % of the patients but it was clearly abnormal only in 5 patients. 34% of the patients had beta2 microglobulinuria, however, proteinuria was observed in only 12%. Cumulative dose of ifosfamide, older age at treatment and follow-up since treatment were predictor for tubulopathy in univariate and multivariate analyse. The glomerular filtration rate was normal in 79% of the patients. 21% had a grade 1 toxicity and 1 patient a grade 2. Univariate analysis did not find any prognostic factor for glomerular toxicity apart from the association with tubular toxicity. Conclusions: Since ifosfamide-induced renal toxicity can be severe, long term evaluation is important and this risk should be balanced carefully against efficacy. No significant financial relationships to disclose.

Download Full-text

Transvaginal Hybrid NOTES Procedure for Treatment of Gallstone Ileus

Case Reports in Surgery ◽

10.1155/2016/9513874 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Takuya Shiraishi ◽

Naoki Tomizawa ◽

Tatsumasa Andoh ◽

Kazuhisa Arakawa ◽

Yasuaki Enokida ◽

...

Keyword(s):

Gallstone Ileus ◽

Acute Onset ◽

Wound Complications ◽

Transvaginal Specimen Extraction ◽

Initial Surgery ◽

Good Cosmetic ◽

Mechanical Bowel Obstruction ◽

Cosmetic Outcomes ◽

Hybrid Notes ◽

Totally Laparoscopic

Gallstone ileus is a rare mechanical bowel obstruction, and previously reported cases have been treated laparoscopically with good results. Although transvaginal hybrid NOTES without a minilaparotomy has been reported to decrease the incidence of surgical wound complications, to our knowledge, this procedure has not been used previously to treat gallstone ileus. We present a case of a 63-year-old woman who underwent transvaginal hybrid NOTES procedure for treatment of gallstone ileus. This case was admitted to our hospital following acute-onset abdominal pain and vomiting. We diagnosed gallstone ileus with cholecystoduodenal fistula by computed tomography and performed totally laparoscopic surgery using only three 5 mm abdominal ports with transvaginal specimen extraction and enterectomy. The patient’s postoperative course was uneventful, and laparoscopic cholecystectomy and fistula repair were performed 8 months after the initial surgery. The patient experienced additional pain relief and good cosmetic outcomes. In conclusion, using transvaginal hybrid NOTES may become a future option to minimize the invasiveness of other laparoscopic procedures.

Download Full-text