Treatment of perioperative swelling by rest, ice, compression, and elevation (RICE) without and with additional application of negative pressure (RICE+) in patients with a unilateral ankle fracture: study protocol for a monocentric, evaluator-blinded randomized controlled pilot trial

Background Edema is commonly seen after surgical fixation of ankle fractures. Rest, ice, compression, and elevation (RICE) is an established combination to prevent swelling but hardly able to stimulate lymphatic resorption. Recently, an epicutaneously applied negative pressure suction apparatus (LymphaTouch®) has been introduced to stimulate lymphatic flow. While postoperative recovery, soft tissue, and osseous healing as well as functional outcome are probably linked to the amount of postoperative swelling, estimates on this relative to prevention (RICE) or prevention + stimulated resorption (RICE+) of fluid are scarce. Methods and analysis This is a single-center, evaluator-blinded randomized pilot trial to investigate postoperative swelling in adults requiring surgical fixation of a closed unilateral ankle fracture. A total of 50 patients will be recruited and randomly assigned to RICE or RICE+ prior to surgery. All patients will undergo evaluator-blinded measurements of the ankle volume the day before surgery and subsequently from the evening of the 2nd postoperative day every 24 h until discharge. RICE will be initiated right after surgery and continued until discharge from the hospital in all patients. Additional application of negative pressure therapy (RICE+) will be initiated on the morning of the 2nd postoperative day and repeated every 24 h until the time of discharge from the hospital. Outcome measures are (i) the relative amount and the time course of the postoperative swelling, (ii) the demand for analgesic therapy (type and amount) together with the perception of pain, (iii) the rate of complications, and (iv) mobility of the ankle joint and the recovery of walking abilities during a 12-weeks follow-up period. Serum and urine samples taken prior to sugery and during postoperative recovery will allow to evaluate the ratio of naturally occurring stable calcium isotopes (δ44/42Ca) as a marker of skeletal calcium accrual. Ethics and dissemination The protocol was approved by the institutional Ethics Committee (Rostock University Medical Center, Rostock, Germany) in accordance with the Declaration of Helsinki (approval number: A 2020-0092). The results of this study will be actively disseminated through scientific publications and conference presentations. Trial registration DRKS, DRKS00023739. Registered on 14 December 2020

What’s new for the clinician? - Excerpts from and summaries of recently published papers

Extraction of third molars is one of the most common procedures performed by oral surgeons. Generally, these surgeries do not encounter difficulties but at times can result in complications. Postoperative complications may include swelling, pain, trismus, prolonged bleeding, dry socket, infection and sensory alterations of the inferior alveolar nerve or lingual nerve. For the swelling, the most common therapies include corticosteroids, non-steroid anti-inflammatory drugs (NSAIDs), or a combination of these agents. Elastic bandage application (Kinesio taping) is a technique that originates from sports sciences. Studies have reported its beneficial effects on swelling and trismus symptoms after oral and maxillofacial surgeries.1It has been claimed that elastic tapes reduce postoperative swelling by creating space between the dermis and fascia layers and thus increasing lymphatic and blood flow.1 Their alleviating effect on postoperative pain is due to dermal stimulation.1 Erdil and colleagues (2021)1 reported on a trail that sought to compare the effectiveness of submucosal dexamethasone injection, a therapeutic elastic bandage (Kinesio tape), and an NSAID (dexketoprofen trometamol) on postoperative swelling, trismus, pain following third molar surgery and alterations in the quality of life in the first postoperative week.

Instagram and Pilon Fractures: An Analysis of Social Media and Its Relationship to Patient Injury Perception

Background: The purpose of this study was to investigate social media posts regarding pilon fractures and its relationship to patient injury perception. We evaluated Instagram media posts in patients who have suffered pilon fractures for the following variables: gender, tone, discussion of rehabilitation, activities of daily living (ADL) reference, incision/scar reference, pain, post of radiograph/imaging, external fixation reference, discussion of bracing/splinting, pre- or postoperative swelling, and need for reoperation. Results were determined by comparing each variable to gender and tone of the post to study patient injury perception. Methods: Public Instagram posts from within a 1-year time period were isolated and evaluated using the hashtag “#pilonfracture.” Individual posts were analyzed by authors. In total, 241 patient posts were included for investigation and analysis of patient injury perception via social media. Results: Of all included posts, 88% of posts had a positive tone. A majority of the posts (66.8%) mentioned rehabilitation and postoperative progress. There were significant associations between positive tone and rehabilitation ( P = .0001), as well as positive tone and ADLs ( P = .0361). Conclusion: Reported outcomes after surgical management of pilon fractures are generally poor. Nonetheless, this analysis of patients sharing their experience on social media after open reduction internal fixation of pilon fractures demonstrates a mostly positive attitude toward the injury and recovery. A positive tone of the post was significantly associated with mentions of rehabilitation and ADLs. Levels of Evidence: Level III: Retrospective comparative study

The Role of Tranexamic Acid in Aesthetic Plastic Surgery: A Survey of the British Association of Aesthetic Plastic Surgeons

Background Tranexamic acid (TXA) can reduce intra- and postoperative bleeding as well as minimizing postoperative swelling and ecchymosis. It can be administered both intravenously and topically during surgery with minimal side effects. Objectives To assess the evidence of TXA use in aesthetic surgery and to complete a survey of current practice of full British Association of Aesthetic Plastic Surgeons members. Methods The authors performed a literature review and online survey of full British Association of Aesthetic Plastic Surgeons members. Results There is an increased indication of TXA utilization in aesthetic surgery. It provides multiple surgeon and patient benefits. Conclusions TXA is a useful adjunct in aesthetic surgery.

The application of fluctuating currents in the early postoperative period in patients after operations on mammary gland

We conducted an objective and instrumental examination in 79 patients with radical mastectomy in the early postoperative period (2–4days), patients of the 1st group n=23 underwent 10procedures of postoperative suture fluctuation; patients of the 2nd group n=28 underwent 10procedures of fluctuating currents according to the extended technique; and patients of the 3rd group n=28 in addition to the extended technique underwent fluoridation of the forearm muscles by the same parameters. It has been proved that patients have reduced postoperative swelling, reduced pain, reduced the number of postoperative complications in the wound (inflammation, infectious processes, pain, suture divergence), shortened lymphorrhea. There is an increase in the amount and quality of movements, reduced sensitivity disorders in the upper limbs. Thus, the inclusion in the program of medical rehabilitation of various methods of appointment of fluctuating currents in the early postoperative period is appropriate and helps to reduce the time of recovery.

Reduction of postoperative swelling with a negative pressure treatment—A prospective study

Purpose: Perioperative swelling and edema are the main factors that influence the time to definitive operative care, healing rate, as well as postoperative infection rate. Device-based negative pressure treatment is a new method to reduce post-traumatic and postoperative swelling of the upper extremities. The objective of this study was to evaluate a new negative pressure treatment with LymphaTouch® (Helsinki, Finland) to reduce perioperative swelling in upper extremity injuries. Methods: We analyzed 45 patients (26 female and 19 male) after operative treatment of upper extremity injuries. A predefined treatment algorithm of 30 min using LymphaTouch® was performed on the patients every day for five consecutive days. Swelling was measured according to the neutral-zero method with six points of measurement. Results: A total of 16 patients underwent an operation on their upper arm. An average of 3.5 measurements was performed per patient, with the start of therapy at a mean of 5.13 days after the operation. All of the measured circumferences except the elbow and 10 cm below the elbow were reduced from day 0 to 3. The percent reduction of swelling (relative to day 0) was 10.36%, 11.35%, 17.34%, and 3.25% for days 1–4, respectively. The greatest reduction of circumference was obtained in the metacarpus (−51.6%) and wrist (−33.1%). Conclusion: The LymphaTouch® system and a 30-min treatment program can reduce postoperative swelling of the upper arm, wrist, and hand on the first 5 days after surgery. The ease of learning and self-applicability of LymphaTouch® makes it interesting for further controlled randomized trials.