scholarly journals Role of VAC Dressing in the Large Open Fracture: A Single Center Prospective Study from Indore

2021 ◽  
Vol 8 (4) ◽  
pp. 22-25
Author(s):  
Himanshu Suman ◽  
Jyoti Krishna ◽  
Yash Sharma
Keyword(s):  
Wound Healing ◽  
Open Fracture ◽  
Early Period ◽  
Skin Barrier ◽  
Open Fractures ◽  
Hospital Environment ◽  
Vacuum Assisted Closure ◽  
The Mean ◽  
Mean Time

Background: As the body's protective skin barrier is breached in open fractures, and the potential of contamination is high, these can lead to significant morbidity. Vacuum-assisted closure (VAC) is the application of the negative pressure in open wounds, and it significantly improves wound healing both at the macro and micro levels. Material and Method: A total of 30 patients (23 males and 7 females with a mean age of 27 years) with large open fractures of long bones who received VAC therapy during the early period of treatment were studied. VAC dressing over wound was done following percutaneous pinning or external fixation. In addition, rates of infection, fracture union, duration of application of VAC, and the association of duration of VAC with the development of complications were evaluated. Results: The mean time between the trauma and the first debridement was 8.20 hours (range, 2–23). The mean duration of VAC application was ten days (range, 3–16). Delayed wound closure was performed in nine patients. In the remaining 21 patients, the mean decrease in the wound dimensions between pre and post-VAC application was found to be 43.06% (range, 20–60%). Conclusion: VAC application increases the patient's comfort by reducing the need for dressing changes, improves blood circulation, accelerates the formation of granulation tissue, reduces the rate of infection from the hospital environment, decreases edema, alleviates the need for secondary interventions, and also decreases wound dimensions. Keywords: wound, open fractures, vacuum-assisted closure, wound healing.

The use of the Ganga Hospital Score to predict the treatment and outcome of open fractures of the tibia

2020 ◽  
Vol 102-B (1) ◽  
pp. 26-32 ◽  
Author(s):  
Sunny Parikh ◽  
Harendra Singh ◽  
Agraharam Devendra ◽  
Jayaramaraju Dheenadhayalan ◽  
Arvinth S. Sethuraman ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Open Fracture ◽  
Length Of Hospital Stay ◽  
Open Fractures ◽  
Wound Management ◽  
Functional Score ◽  
Bony Union ◽  
Length Of Treatment ◽  
The Mean ◽  
Mean Time

Aims Open fractures of the tibia are a heterogeneous group of injuries that can present a number of challenges to the treating surgeon. Consequently, few surgeons can reliably advise patients and relatives about the expected outcomes. The aim of this study was to determine whether these outcomes are predictable by using the Ganga Hospital Score (GHS). This has been shown to be a useful method of scoring open injuries to inform wound management and decide between limb salvage and amputation. Methods We collected data on 182 consecutive patients with a type II, IIIA, or IIIB open fracture of the tibia who presented to our hospital between July and December 2016. For the purposes of the study, the patients were jointly treated by experienced consultant orthopaedic and plastic surgeons who determined the type of treatment. Separately, the study team (SP, HS, AD, JD) independently calculated the GHS and prospectively collected data on six outcomes for each patient. These included time to bony union, number of admissions, length of hospital stay, total length of treatment, final functional score, and number of operations. Spearman’s correlation was used to compare GHS with each outcome. Forward stepwise linear regression was used to generate predictive models based on components of the GHS. Five-fold cross-validation was used to prevent models from over-fitting. Results The mean follow-up was 11.4 months (3 to 31). The mean time to union was 9.7 months (3 to 21), the mean number of operations was 2.8 (1 to 11), the mean time in hospital was 17.7 days (5 to 84), the mean length of treatment was 92.7 days (5 to 730), the mean number of admissions was 1.7 (1 to 6), and the mean functional score (Lower Extremity Functional Score (LEFS)) was 60.13 (33 to 80). There was a significant correlation between the GHS and each of the outcome measures. A predictive model was generated from which the GHS could be used to predict the various outcome measures. Conclusion The GHS can be used to predict the outcome of patients who present with an open fracture of the tibia. Our model generates a numerical value for each outcome measure that can be used in clinical practice to inform the treating team and to advise patients. Cite this article: Bone Joint J 2020;102-B(1):26–32

scholarly journals Early Neuromuscular Blockade in Children with Pediatric Acute Respiratory Distress Syndrome

2020 ◽  
Vol 09 (03) ◽  
pp. 201-206
Author(s):  
Surabhi Chandra ◽  
Sahil Goel ◽  
Ritika Dawra
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Neuromuscular Blockade ◽  
Distress Syndrome ◽  
Control Group ◽  
Case Group ◽  
The Mean ◽  
Mean Time

AbstractPediatric acute respiratory distress syndrome (PARDS) is a challenging problem with high mortality. Role of neuromuscular blockade in the management of ARDS to date has been controversial, and this study was done to study the role of neuromuscular blockade in children having PARDS and development of associated complications, if any. This was a prospective, case–control study conducted in the pediatric intensive care unit (PICU) of a tertiary care teaching hospital, over a period of 24 months. Patients of age 1 to 18 years who presented with or developed PARDS during their course of hospitalization were included after written informed consent was obtained from their parents and/or guardians. Patients with PARDS requiring invasive mechanical ventilation were partitioned into a case group and a control group. Case group patients were sedated and paralyzed using midazolam (1 µg/kg/min) and vecuronium (1 µg/kg/min), respectively, along with institution of definitive management. Control group patients were given definitive and supportive therapy, but no neuromuscular blocking agents (NMBAs). All patients were followed up for signs and symptoms of myopathy or neuropathy during the entire duration of hospital stay and up to 3 months after discharge. During the study period, 613 patients were admitted to the PICU of which 91 patients qualified as having PARDS. Sepsis was the main etiology in 67 of the 91 patients (73.6%) with PARDS. Fifty-nine patients were included in the study, of which 29 patients were included in the case group and 30 patients were included in the control group. Among the 29 case group patients, 25 patients (86.2%) were successfully extubated. Four patients from the case group expired, while 14 out of 30 control group patients (46.7%) expired. Hypotension was present in 26 case group patients (89.6%), of which all showed resolution within 48 hours of definitive treatment. The mean time to resolution of hypotension was 41.6 hours (standard deviation [SD]: 5.759; range: 24–48) for case group patients, significantly lower (p < 0.0001) than the mean time to resolution of 103 hours (SD: 18.995; range: 90–126) for the 10 control group patients with hypotension that survived. Mean oxygenation index (OI) following 48 hours of vecuronium therapy was significantly lower (p < 0.0001; 95% confidence interval: 5.9129–9.9671) than mean OI at admission for case group patients. None of the patients receiving vecuronium exhibited neuromuscular deficit during their hospital stay, at time of discharge, or at follow-up evaluation up to 3 months after discharge. In this study, pediatric cases diagnosed with PARDS and managed with mechanical ventilation and vecuronium therapy had improved mean OI following 48 hours of NMBA therapy and a lower mortality when compared with matched control group patients. Incidence of NMBA-related weakness was not commonly observed in these patients.

scholarly journals Repeated Renal Biopsy - A Predictive Tool to Assess the Probability of Renal Flare in Lupus Nephritis

2016 ◽  
Vol 44 (6) ◽  
pp. 439-446 ◽  
Author(s):  
Gastón J. Piñeiro ◽  
Pilar Arrizabalaga ◽  
Manel Solé ◽  
Rosa M. Abellana ◽  
Gerard Espinosa ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Renal Biopsy ◽  
Clinical Laboratory ◽  
Predictive Tool ◽  
Renal Flare ◽  
Therapeutic Decisions ◽  
The Mean ◽  
Mean Time

Background: How one responds to treatment of lupus nephritis (LN) is based on clinical features, but the activity in renal biopsy (RB) is uncertain. We have described the therapeutic decisions after performing a repeated RB on the assessment of response to intravenous cyclophosphamide (IC) and the possible prognostic role of this repeated RB. Methods: Clinical, laboratory and histological features at the initial RB and repeated RB were analyzed in 35 patients. Results: Data in the initial versus the repeated RB were serum creatinine 1.23 ± 1.08 and 0.96 ± 0.45 mg/dl (p < 0.05), glomerular filtration rate <60 ml/min in 12 and 5% patients and proteinuria 4.1 ± 2.8 vs. 0.6 1.1 g/day (p < 0.05). Significant differences were detected in hematuria, nephrotic syndrome and serological immune features. Complete renal remission was reached in 60% (n = 21) at the time of the repeated RB, partial remission in 31.4% (n = 11), and no response IC in 8.6% (n = 3). Nine patients showed proliferative forms in the repeated RB, 3 of them had proteinuria <1 g/day. Just after the repeated RB, 34.3% increased or started a new immunosuppressive therapy, 17.1% remained with the same complementary IST, and 14.3% decreased or stopped it. In the follow-up post repeated RB, 34.5% without active lesions showed a renal flare versus 77.8% with active lesions (p = 0.04). The mean time was 120 and 45 months, respectively. Conclusion: A repeated biopsy in LN distinguishes patients in true remission from those in apparent remission. By doing this, we can identify patients who could benefit from intensified treatment and for whom unnecessary treatment methods can be modified or eliminated.

scholarly journals Radical treatment of severe open fractures of extremities by orthoplastic surgery: a 10-year retrospective study

2020 ◽  
Author(s):  
Zhao Yang ◽  
Chao Xu ◽  
Yong-Gang Zhu ◽  
Jun Li ◽  
Zi-Xiang Wu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Open Fracture ◽  
Aesthetic Surgery ◽  
Open Fractures ◽  
Soft Tissue Reconstruction ◽  
Central Unit ◽  
Chinese Characteristics ◽  
Tissue Reconstruction ◽  
The Mean

Abstract Orthoplastic treatment based on the collaboration of orthopedic and plastic surgeons in an “orthoplastic” central unit has been recommended by the British Association of Plastic Reconstructive and Aesthetic Surgery. However, this approach is not used worldwide especially in most developing countries. Based on the aggressive orthoplastic management, orthoplastic experience with Chinese characteristics has been carried out in last 10 years. The clinical data of 41 consecutive patients with severe open fracture (Gustilo IIIb or IIIc) of the limb, who underwent successful surgical debridement, fixation, and soft tissue reconstruction in one stage between January 2008 and April 2019, were retrospectively reviewed. Postoperative indicators, including infection rate and union time, were acquired by a regular follow-up and analyzed. The mean (±SD) age of the patients was 38±16 years. The soft tissue cover was achieved within 72 h. The overall rate of infection was 14.6% (6/41). Sex and the Mangled Extremity Severity Score were associated with infection. The median union time of 40 patients (one amputation) was 32 weeks. The overall rate of infection exhibited a lower tendency in this study. These results indicated that the single-stage radical orthoplastic treatment was an effective and reliable option for reconstructing severe open fractures.

Healing of Diabetic Neuroischemic Foot Wounds With vs Without Wound-Targeted Revascularization: Preliminary Observations From an 8-Year Prospective Dual-Center Registry

2019 ◽  
Vol 27 (1) ◽  
pp. 20-30 ◽  
Author(s):  
Vlad-Adrian Alexandrescu ◽  
Sophie Brochier ◽  
Augustin Limgba ◽  
Severine Balthazar ◽  
Hafid Khelifa ◽  
...  
Keyword(s):  
Wound Healing ◽  
Limb Salvage ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Technical Success ◽  
Free Survival ◽  
Limb Preservation ◽  
The Mean ◽  
Mean Time

Purpose: To assess the clinical efficacy of endovascular angiosome-oriented wound-targeted revascularization (WTR) vs indirect (wound-indifferent) revascularization (IR) in diabetic patients with neuroischemic foot ulcers. Materials and Methods: Between April 2009 and July 2017, 167 diabetic patients (mean age 72.8 years; 137 men) with chronic limb-threatening ischemia (Rutherford category 5) and foot wounds (Wagner 2–4) in 194 limbs were prospectively registered and scheduled for primary infragenicular endovascular treatment. Specific angiosome source artery reperfusion sustained by patent foot arches or arterial-arterial connections was attempted initially. If this approach failed, topographic revascularization via available collaterals (WTRc) and IR were sequentially attempted. Results: Reperfusion was successful in 176 (91%) of 194 limbs (113 with WTR, 28 with WTRc, and 35 with IR); the global angiosome-oriented technical success (WTR and WTRc) was 73% (141/194). The mean follow-up was 10.9±0.7 months (range 3–12.5). Over 1 year, 102 (58%) of the 176 successfully treated limbs experienced wound healing [79/113 (70%) in the WTR group, 15/28 (54%) in the WTRc group, and 7/35 (20%) in the IR group; p=0.011]. The mean time to healing was 6.8±0.4 months in the WTR group, 7.9±0.6 months in the WTRc group, and 9.8±0.7 months in the IR group (p=0.001). Relapses were noted in 18 (16%) WTR limbs, 5 (18%) WTRc limbs, and 6 (17%) IR limbs. Comparison between WTR and IR and WTRc vs IR showed improved cicatrization in the angiosome-oriented groups (p<0.05). Major adverse limb events (MALE) and limb salvage were different between WTR and WTRc and between WTR and IR groups (p<0.05), while WTRc vs IR was not. Amputation-free survival was not influenced by the revascularization strategy (p=0.093). Conclusion: Wound healing in diabetic patients with chronic limb-threatening ischemia appeared to be improved by intentional wound-targeted revascularization, but no uniform benefit concerning MALE or limb preservation was observed. IR still represents an alternative for limb salvage in cases in which angiosome-guided revascularization fails.

scholarly journals KEPERCAYAAN MEREK DAN BRAND AFFECT SEBAGAI ANTESEDEN DARI LOYALITAS MEREK

Media Ekonomi ◽  
2018 ◽  
Vol 18 (1) ◽  
pp. 9
Author(s):  
Sri Rahayu ◽  
Mugi Harsono
Keyword(s):  
Competitive Advantage ◽  
Brand Loyalty ◽  
The Other ◽  
Brand Trust ◽  
Social Expression ◽  
The Mean ◽  
Marketing Costs ◽  
Brand Affect ◽  
Mean Time

The purpose of this paper is to explain the important role of brand and brand loyalty inmarketing activities. This paper also explains the antecedents of brand loyalty. The role of a branddoes not only actas a name, but also increasing the company's competitive advantage. The benefitsof a brand for consumers are, among many others, for emotional, self and social expression,attitudes, values and culture benefits. In the mean time, the role of brand loyalty in marketingis to contribute to the survival of the company, to increase new customer opportunities as well asto reduce marketing costs. To improve a brand loyalty, a companyshould increase its brand trustin advance as it plays an important role in improving brand loyalty. A cpmpany brand trust hastwo dimensions of intention and reliability. Brand affect, on the other hand, is an important forimproving a brand loyalty. Therefore,a company’sbrand trust and brand affect should be improvedfor the brand loyalty to improve as well.Key words : Brand trust, Brand Affect, Brand Loyalty

Ocular Outcomes after Gold Weight and Facial Nerve Resection

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P32-P32
Author(s):  
Ali Razfar ◽  
Ahmed Afifi ◽  
Ernest Kelvin Manders ◽  
Eugene N Myers ◽  
Jonas T Johnson ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Lower Eyelid ◽  
Upper Eyelid ◽  
Ocular Symptoms ◽  
Gold Weight ◽  
The Mean ◽  
Eye Closure ◽  
Mean Time

Objective 1) To assess the effectiveness of acute gold weight placement following facial nerve resection. 2) To determine the role of concomitant lower eyelid procedures. Methods 22 patients who received an upper eyelid gold weight at the time of parotidectomy and facial nerve resection were retrospectively reviewed (mean follow-up: 23 months). Outcomes included the assessment of eye closure, gold weight complications (i.e., extrusion, need to upsize weight), ectropion, and need for tarsal strip procedure. Results The range of gold weight size used was 1–1.4 (g), where 1.2 g was the predominant size used (18/22). 12 patients (12/22, 54.5%) presented with ocular symptoms following gold weight placement. Within these 12 patients, 9 presented with lower lid ectropion, 5 with lagopthalmos, and 6 with corneal exposure. 9 of the 12 patients subsequently received a tarsal strip procedure. The mean time to lower eyelid procedure was 14.2 months (range: 0–61) following gold weight placement. 6 patients, in addition to a gold weight, also underwent a static sling to the midface at the time of facial nerve resection. None of these 6 patients received subsequent lower eyelid procedure. Two patients required gold weight upsizing. Two patients required weight removal because of exposure. Conclusions Insertion of 1.2 gm upper eyelid weight with concomitant placement of midface sling is recommended at the time of acute facial nerve resection. Due to the need to tighten the lower eyelid in a majority of patients, we now also recommend performing a tarsal strip procedure at the time of facial nerve resection.

A two-equation model for contaminant dispersion in natural streams

1987 ◽  
Vol 178 ◽  
pp. 257-277 ◽  
Author(s):  
Ronald Smith
Keyword(s):  
Equation Model ◽  
Time Of Arrival ◽  
Contaminant Exposure ◽  
Dispersion Process ◽  
Contaminant Dispersion ◽  
Natural Streams ◽  
The Mean ◽  
Mean Time ◽  
Temporal Spread

A simple two-equation model is derived which has the properties that the total contaminant exposure, the mean time of arrival, the temporal spread, and the skewness, are asymptotically correct at large distances downstream of a discharge. The role of changes in the breadth of a river upon the dispersion process is investigated by a means of an illustrative example. This reveals cubic dependence upon the breadth, and hence the great importance of wide reaches of rivers as regards contaminant dispersion.

scholarly journals A review of the TOPHAT (Turned-down Onto Pericapsular-tissue Hemisectioned Amputated Toe) filleted toe flap technique for wound coverage during ray amputations

2020 ◽  
Author(s):  
Nadia Sim ◽  
Shaun Lee ◽  
Hao Yun Yap ◽  
Qian Ying Tan ◽  
Jerilyn Tan ◽  
...  
Keyword(s):  
Wound Healing ◽  
Soft Tissue ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Skin Grafting ◽  
Wound Therapy ◽  
Flap Technique ◽  
The Mean ◽  
Mean Time ◽  
Ray Amputation

Abstract Background: Wound healing post ray amputation for toe gangrene is commonly complicated by adjacent digital loss after applying Topical Negative Pressure Wound Therapy (TNPWT). This is either due to mechanical soft tissue erosion or trauma to the adjacent digital artery from direct pressure effect. This ultimately results in exposure of the adjacent Metatarsal-Phalangeal Joint (MTPJ) with eventual gangrene and a larger wound bed, thus mandating further ray amputation and subsequently enlarge the wound bed. We describe the use of the TOPHAT filleted toe flap technique – a combination of a filleted toe flap to protect the adjacent MTPJ capsule and a novel Negative Pressure Wound Therapy with instillation and dwell-time (NPWTi-d) dressing technique. The fillet flap protects the adjacent joint capsule and reduce the wound burden whilst allowing the wound to benefit from TNPWT, thereby accelerating wound healing. Methods: We conducted a prospective review of patients with toe gangrene requiring ray amputations who underwent the TOPHAT filleted toe flap technique in our institution from 2019 and 2020. Complications such as wound dehiscence, hematoma, flap necrosis and secondary infection were recorded. Other outcomes recorded were time taken to final skin grafting and time taken for complete wound epithelialisation. Results: 9 patients underwent treatment with the TOPHAT filleted toe flap technique between 2019 and 2020. 2 patients had minimal tip necrosis of the flap which required minor debridement. All except 2 patients whom declined further treatment, progressed to definitive skin coverage with skin grafting. One patient had progressive arterial disease despite successful skin grafting and required above knee amputation. The mean time to final skin grafting was 49.5 days post-operatively and the mean time to final wound epithelialisation was 107.5 days post-operatively. Patients were all satisfied with the outcomes and were able to return to pre-morbid function. Conclusions: The TOPHAT filleted toe flap technique has a consistent vascular supply that provides durable soft tissue coverage. It is a robust and easily reproducible technique to accelerate wound healing after ray amputations even in patients with peripheral vascular disease.

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