In nerve transfers to restore elbow flexion, an appropriate size match between donor and recipient nerves appears to be a factor affecting clinical success. These data support a donor-to-recipient axon count ratio greater than 0.7:1 as the goal for brachial plexus nerve transfers to restore elbow flexion.
The standard treatment of cutaneous abscesses in the emergency department is incision and drainage (I&D). The purpose of this investigation is to determine the feasibility of using a povodine-iodine topical antiseptic solution (PVP-I) as a clinical adjunct in the treatment of superficial skin abscesses after I&D, and the data is related to “Pilot Study to Evaluate the Adjunct Use of a Povidone-Iodine Topical Antiseptic in Patients with Soft Tissue Abscesses” [Olson et al., 2019].
The data aims to determine if the daily application of PVP-I in the wound cavity and as an antiseptic hand wash would confer any benefit over I&D alone. The primary outcome was clinical cure 7–10 days after I&D. The secondary outcomes were rate of new abscess development and spread of infection in household contacts (HC) within 30 days.
change antibiotics, hospital admission) and number of wound-related return visits. Descriptive statistics were performed and noninferiority was determined using a margin of equivalence of 10% (0.10). A two-sided t-test and chi-square tests were used to compare follow-up visits and complications between the two treatment groups.Results: There were 2,889 subjects considered for enrollment and 2522 subjects were excluded. Top exclusion reasons: abscess had been previously treated (n¼588), abscess did not require packing/loop (n¼499), patient admitted to hospital (n¼298), patient unable to provide informed consent (n¼237), and abscess required specialist for drainage (n¼113). 367 subjects were approached and 238 subjects consented to randomization. 119 subjects were randomized to LD and 119 to I&D treatments. Five subjects were dropped from each group (admitted to the hospital after the procedure). Final study participants included the 75 LD and 65 I&D subjects that attended study follow-up visit at 14 days. For the primary study hypothesis of noninferiority, in LD group, 66 (88.0%) had abscess resolution versus 53 (81.5%) I&D subjects, for a difference of 6.5% (95% CI -5.5% to 18.4%), which is within the margin of noninferiority. There were 28 (37.3%) LD subjects and 41 (63.1%) I&D subjects who returned for a wound-related follow-up visit (p¼0.002) with a mean of .5 (SD¼0.8) visits per LD subject versus 1.2 (SD¼1.4) visits per I&D subject (p¼0.001). Complications were reported in 7 (9.3%) of the subjects in the LD group compared to 16 (24.6%)% in the I&D group (p¼0.01). There was not a significant difference in complications requiring hospital admission between the two treatment groups (5.9% vs 6.1% p¼1.00).Conclusions: Loop drainage is noninferior to traditional I&D as it is performed at our institution. There are fewer follow-up visits required and fewer complications for those undergoing LD.
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