Diagnosis and Treatment of Uncommon Wounds

Pozez, Andrea L.; Aboutanos, Sharline Z.; Lucas, Valentina

doi:10.1016/j.cps.2007.08.012

Cited by 5 publications

(4 citation statements)

References 52 publications

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“…1,4,29,97 A number of adjunctive therapies have been trialed with variable success including negative pressure dressings, hyperbaric oxygen, muscle flaps, skin grafting, and other advanced wound dressing technologies. 99 Some of these will be discussed in the following section on reconstructive considerations. Evidence for these therapies is not robust, and is lacking especially for diabetics and those with peripheral arterial disease.…”

Section: Medical and Adjunctive Treatment Of Nstismentioning

confidence: 99%

“…103 Modalities for wound coverage include primary closure, secondary closure, or complex reconstructions that may involve free flap transfer. 99 Although small wound areas may heal spontaneously via epithelialization, major wounds may require application of skin grafts to promote adequate closure of healthy healing tissue. 104 Skin substitutes such as Integra and skin grafts also can be used, which offers coverage of wounds, promotion of wound healing, and reduction of risk of infection.…”

Section: Reconstructive Considerationsmentioning

confidence: 99%

“…104 Skin substitutes such as Integra and skin grafts also can be used, which offers coverage of wounds, promotion of wound healing, and reduction of risk of infection. 99,105 Vacuum-assisted closure (VAC) therapy has been demonstrated to be effective in managing nonhealing wounds in a systematic review of NSTI wounds. 1 The caveat is that some clinicians have recommended against the use of VAC until anaerobic infection has been excluded and wound has been cleaned by thorough repeated debridements.…”

Section: Reconstructive Considerationsmentioning

confidence: 99%

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Necrotizing Soft Tissue Infections in the Vasculopathic Patient: Review of Literature

Tsang

Cao²,

Gunanayagam³

et al. 2019

International Surgery

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Background: Necrotizing soft tissue infection is a surgical emergency associated with high mortality. Its presence in patients with risk factors for peripheral arterial disease such as diabetes mellitus is consistently associated with significantly poorer outcomes. Though it has been over a century since it was initially described in the literature, mortality rates remain high and treatment regimens are not standardized. Materials and methods: PubMed and Cochrane databases were searched for articles pertaining to necrotizing soft tissue infections. Articles were screened for relevance with the intent to compare outcomes in prospective studies of patients with diabetes mellitus or peripheral arterial disease. Patient demographics, clinical findings, mortality, rates of amputation, and morbidity were intended to be compared. Results: 857 articles were identified, 165 duplicates were removed, and 6 prospective trials were identified for inclusion. Due to significant paucity of data, patient heterogeneity, and lack of standardization for surgical management, a descriptive review of the literature in relation to necrotizing soft tissue infections was pursued, with a focus on high-risk patients with peripheral arterial disease or diabetes mellitus. Conclusions: Early aggressive surgical intervention or major amputation may reduce mortality at the cost of increased disability and poorer quality of life in the long term, and may be appropriate in vasculopaths with poorly controlled diabetes and rapidly progressive fulminant infection. However, there is a deficiency in high-level evidence supporting surgical decision-making in this setting, with no standardized protocols for amputation. Future research will be needed to clarify the patient population who would benefit from radical amputation versus intention for limb salvage.

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Section: Medical and Adjunctive Treatment Of Nstismentioning

confidence: 99%

Section: Reconstructive Considerationsmentioning

confidence: 99%

Section: Reconstructive Considerationsmentioning

confidence: 99%

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Necrotizing Soft Tissue Infections in the Vasculopathic Patient: Review of Literature

Tsang

Cao²,

Gunanayagam³

et al. 2019

International Surgery

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“…9 Improved open fracture care includes stabilizing the fracture, better care for wounds through techniques such as multiple wound wash, debridements and dressings, better infection control, and early wound coverage with graft or flap 10 surgical treatment remains the cornerstone for treating the deep infected and traumatic injury. 11 This care strategy may lower morbidity, diminish and disability and greatly assist survivors in leading full and meaningful lives.in most high-energy trauma, there are associated vessel injuries or large open wound where flap coverage is not possible; coverage of these types of wounds was demanding and challenging. These wounds underwent VAC dressing and numerous debridements.…”

Section: Introductionmentioning

confidence: 99%

Outcome of split-thickness skin graft (STSG) in complex orthopaedic trauma.

Ajay Kumar,

Zain Naseer,

Zameer Abbas

et al. 2023

TPMJ

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Objective: Complex orthopedics wounds are challenges to surgeon and patient in operative management. Road traffic accidents, the major cause of open fracture, represent a massive global health problem with high mortality and morbidity rates. Study Design: Retrospective study. Setting: Ghurki Trust Teaching Hospital, Lahore. Period: January 2021 to January 2022. Material & Methods: Thirty eight patients with open fractures with skin loss, treated with graft, and wound where a flap was not possible were included in the study. The outcome was assessed in terms of the outcome of STSG in complex orthopaedic trauma. Results: A total of 38 patients were included who underwent STSG graft. Among these, more than half of cases, 33(86.8%), were males, while 5(13.2%) were female cases with a mean age of 25.82±13.09 ranging from (6-63) years. Graft loss was found in 4 cases (10.5%), graft contracture in 7 cases, altered sensation in three cases, skin pigmentation in 4 cases, episode infection in 8 cases, and skin breakdown in only one case observed. Average hospital stay ranged from 2-3 weeks in all cases. Conclusion: It is concluded that Acute complex orthopedics wounds present a unique challenge for surgeons. Good surgical technique, early appropriate surgical intervention, source control, early use of broad-spectrum antibiotic therapy, VAC dressing, and early tissue coverage prevent wound infection and decrease the chances of limb amputation.

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