Early debridement reduces time to healing in elderly patients with pretibial injury

Tuboku-Metzger, Vanessa Re; Chambers, Jeffrey W.; Osmani, O.; Eltigani, T.; Skillman, Joanna

doi:10.1016/j.bjps.2013.12.013

Cited by 7 publications

(7 citation statements)

References 1 publication

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“…We note these three outliers, as they illustrate that conservative management has the propensity to cause lengthy inpatient durations and highlight the multidisciplinary nature of dealing with such injuries as increased physiotherapy, occupational therapy and community care packages were required before these patients could be safely discharged. This increase in inpatient stay for conservatively managed patients is consistent with Cahill et al, 7 who found that surgically managed patients stayed on average 59.8 days compared with 123 days for those conservatively managed, and Tuboku-Metzger et al, 11 who found that surgically managed patients stayed 55 days compared with 110 days for those managed conservatively.…”

Section: Discussionsupporting

confidence: 80%

“…3 A prospective study on the surgical management of pretibial lacerations reported a cancellation rate of 50%, overall starvation time of 18 hours and a delay between referral and surgery of 10 days. 15,16 Tubuku- Metzger et al 11 reviewed all patients admitted to their tertiary plastic surgery centre and found that delay in surgery had significant effects on outcome. These figures must be reduced if patient outcomes are to be improved.…”

Section: Discussionmentioning

confidence: 99%

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The management of pretibial lacerations

Singh

Khatib

Elfaki

et al. 2017

annals

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Introduction Pretibial lacerations are common injuries, often presenting in the elderly and infirm. Unclear management pathways often result in inappropriate care. We identify patient demographics, morbidity risk factors, injury severity and management options. Materials and methods This retrospective study involved analysing databases and hardcopy notes for patients admitted with pretibial lacerations to Addenbrooke's Hospital, January to December 2012. Microsoft Excel and Fishers exact test were used to analyse the data with a P-value of less than 0.05 representative of statistical significance. Information on patient demographics, site of lesion, preoperative symptoms, management, operative details and clinical outcomes were collected. Results A total of 36 patients were identified; the mean age was 79 years (± 16 years, 1 standard deviation) with a three to two female to male preponderance; 57% of injuries were caused by mechanical fall, 33% traumatic blunt impact and 7% road traffic accidents. American Society of Anesthesiologists physical status classification was 43% level III, 40% II, 9% I and 9% IV. Dunkin classification of severity was 33% grade III, 30% grade I, 24% grade IV and 12% grade II. Median inpatient duration was 11 days for surgically managed compared with 15 days for conservatively managed patients. Discussion Pretibial lacerations tend to affect the elderly. Management is compounded by polypharmacy and comorbidities. If inadequately managed, such injuries can adopt characteristics of chronic wounds, with lengthy inpatient stays. Surgical intervention may be appropriate where injuries are severe and the patient stable enough for theatre. Conclusions We believe that surgical management with autologous tissue repair, with minimal delay between presentation and theatre, is warranted for extensive injuries wherever possible, with conservative management used for predominantly less extensive pretibial lacerations.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

The management of pretibial lacerations

Singh

Khatib

Elfaki

et al. 2017

annals

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“…15 They found that patients debrided and skin grafted within seven days of injury had an average healing time of 55 days, whereas if surgery was delayed by eight days or more, healing took an average of 110 days. While we were unable to compare healing times before and after the adoption of our current care standards in the QVH, our survey indicates that a grafted defect will heal in approximately 60 days.…”

Section: Discussionmentioning

confidence: 98%

The epidemiology and mortality of pretibial lacerations

Cahill

Gilleard

Weir

et al. 2015

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…Additionally, as quality improvement initiatives are increasingly important for hospitals, demonstrating the benefits of reconstructive surgery in managing complications, reducing length of stay, and increasing patient satisfaction will establish the value of reconstructive surgeons to the hospital system. 30, 36–39 …”

Section: Bundled Payments and Accountable Care Organizationsmentioning

confidence: 99%

Plastic Surgery Practice Models and Research Aims under the Patient Protection and Affordable Care Act

Giladi

Yuan

Chung

2015

Plastic and Reconstructive Surgery

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As the healthcare landscape in the United States changes under the Affordable Care Act (ACA), providers are set to face numerous new challenges. Although concerns about practice sustainability with declining reimbursement have dominated the dialogue, there are more pressing changes to the healthcare funding mechanism as a whole that must be addressed. Plastic surgeons, involved in various practice models each with different relationships to hospitals, referring physicians, and payers, must understand these reimbursement changes in order to dictate adequate compensation in the future. Here we discuss bundle payments and Accountable Care Organizations (ACOs), and how plastic surgeons might best engage in these new system designs. In addition, we review the value of a focused and driven health-services research agenda in plastic surgery, and the importance of this research in supporting long-term financial stability for the specialty.

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Early debridement reduces time to healing in elderly patients with pretibial injury

Cited by 7 publications

References 1 publication

The management of pretibial lacerations

The management of pretibial lacerations

The epidemiology and mortality of pretibial lacerations

Plastic Surgery Practice Models and Research Aims under the Patient Protection and Affordable Care Act

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