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Delayed primary skin closure

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https://www.readbyqxmd.com/read/28807399/wound-closure-tension-relieving-techniques-and-local-flaps
#1
REVIEW
Laura C Cuddy
Wounds are often addressed by primary or delayed primary closure. Although many skin wounds could go on to heal by second intention, this results in a less cosmetic outcome, takes longer, and in the long run, is often more expensive. As a general rule, the simplest method of wound closure that is likely to succeed should be chosen. If tension is present at the wound edges, wound dehiscence is likely to occur. Using specific techniques to relieve tension on wound edges and recruiting local flaps from neighboring regions are useful ways to achieve wound closure...
August 11, 2017: Veterinary Clinics of North America. Small Animal Practice
https://www.readbyqxmd.com/read/28442838/wound-outcome-following-primary-and-delayed-primary-skin-closure-techniques-after-laparotomy-for-non-traumatic-ileal-perforation-a-randomized-clinical-trial
#2
Vivek Agrawal, Mohit Kumar Joshi, Ashish Kumar Gupta, Bhupendra Kumar Jain
To study the effect of primary and delayed primary closure of skin incision on wound outcome in patients with non-traumatic ileal perforation, 68 patients of ileal perforation were studied in a prospective randomized clinical trial. Patients fulfilling inclusion criteria were divided into ileostomy and non-ileostomy groups, both of which were then randomized into two subgroups each depending on whether skin was closed primarily or in a delayed primary manner. Wound infection and dehiscence were the main outcome parameters studied...
April 2017: Indian Journal of Surgery
https://www.readbyqxmd.com/read/28431416/caring-for-critically-injured-children-an-analysis-of-56-pediatric-damage-control-laparotomies
#3
Miguel A Villalobos, Joshua P Hazelton, Rachel L Choron, Lisa Capano-Wehrle, Krystal Hunter, John P Gaughan, Steven E Ross, Mark J Seamon
BACKGROUND: Injury is the leading cause of death in children under 18 years. Damage control principles have been extensively studied in adults but remain relatively unstudied in children. Our primary study objective was to evaluate the use of damage control laparotomy (DCL) in critically injured children. METHODS: An American College of Surgeons-verified Level 1 trauma center review (1996-2013) of pediatric trauma laparotomies was undertaken. Exclusion criteria included: age older than 18 years, laparotomy for abdominal compartment syndrome or delayed longer than 2 hours after admission...
May 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28400148/accelerated-re-epithelialization-of-partial-thickness-skin-wounds-by-a-topical-betulin-gel-results-of-a-randomized-phase-iii-clinical-trials-program
#4
Juan P Barret, Fred Podmelle, Břetislav Lipový, Hans-Oliver Rennekampff, Hauke Schumann, Agnes Schwieger-Briel, Tobias R Zahn, Hans-Robert Metelmann
The clinical significance of timely re-epithelialization is obvious in burn care, since delayed wound closure is enhancing the risk of wound site infection and extensive scarring. Topical treatments that accelerate wound healing are urgently needed to reduce these sequelae. Evidence from preliminary studies suggests that betulin can accelerate the healing of different types of wounds, including second degree burns and split-thickness skin graft wounds. The goal of this combined study program consisting of two randomized phase III clinical trials in parallel is to evaluate whether a topical betulin gel (TBG) is accelerating re-epithelialization of split-thickness skin graft (STSG) donor site wounds compared to standard of care...
April 8, 2017: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/28399392/the-use-of-acellular-urinary-bladder-matrix-as-coverage-for-fasciocutaneous-free-flap-donor-sites-an-alternative-to-traditional-grafting-procedures
#5
James C Melville, Nicholas A Bennetts, Lauro Tijerina, Jonathan W Shum
PURPOSE: The purpose of this review is to 1) evaluate our early experience with urinary bladder matrix as a dressing for the management of complex wounds subsequent to fasciocutaneous or osteocutaneous vascularized tissue harvests, 2) assess coverage of exposed tendons and the duration of granulation and epithelial coverage, and 3) assess esthetic and functional outcomes compared with traditional means for the management of vascularized tissue harvest sites. PATIENTS AND METHODS: This prospective study consisted of 8 consecutive patients in whom a substantial cutaneous component was harvested as part of a vascularized tissue reconstruction, which did not permit for primary closure (n = 7) or had skin graft failure (exposed tendon) that required additional treatment (n = 1)...
March 18, 2017: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/28399024/immediate-reconstruction-for-plantar-melanoma-a-paradigm-shift
#6
Hunter Oliver-Allen, Merisa Piper, Carolyn Vaughn, Hani Sbitany
INTRODUCTION: Plantar melanoma tumors are traditionally treated with wide local excision based on depth of invasion, followed by delayed reconstruction once negative surgical margins are confirmed. However, delayed reconstruction requires care for an open wound, a prolonged treatment course, and the need for an additional surgery. Immediate reconstruction has been shown to be oncologically safe in head and neck melanoma, but little is described in the literature regarding immediate reconstruction in plantar melanoma...
May 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28385946/the-management-of-open-tibial-fractures-in-children-a-retrospective-case-series-of-eight-years-experience-of-61-cases-at-a-paediatric-specialist-centre
#7
R S Nandra, F Wu, A Gaffey, C E Bache
AIMS: Following the introduction of national standards in 2009, most major paediatric trauma is now triaged to specialist units offering combined orthopaedic and plastic surgical expertise. We investigated the management of open tibia fractures at a paediatric trauma centre, primarily reporting the risk of infection and rate of union. PATIENTS AND METHODS: A retrospective review was performed on 61 children who between 2007 and 2015 presented with an open tibia fracture...
April 2017: Bone & Joint Journal
https://www.readbyqxmd.com/read/28345371/ewma-document-negative-pressure-wound-therapy
#8
Jan Apelqvist, Christian Willy, Ann-Mari Fagerdahl, Marco Fraccalvieri, Malin Malmsjö, Alberto Piaggesi, Astrid Probst, Peter Vowden
1. Introduction Since its introduction in clinical practice in the early 1990's negative pressure wounds therapy (NPWT) has become widely used in the management of complex wounds in both inpatient and outpatient care.(1) NPWT has been described as a effective treatment for wounds of many different aetiologies(2,3) and suggested as a gold standard for treatment of wounds such as open abdominal wounds,(4-6) dehisced sternal wounds following cardiac surgery(7,8) and as a valuable agent in complex non-healing wounds...
March 1, 2017: Journal of Wound Care
https://www.readbyqxmd.com/read/28301366/management-of-mastectomy-skin-necrosis-in-implant-based-breast-reconstruction
#9
Gloria R Sue, Chao Long, Gordon K Lee
BACKGROUND: Mastectomy skin necrosis is a significant problem after breast reconstruction. This complication may lead to poor wound healing and need for implant removal, which may delay subsequent oncologic treatment. We sought to characterize factors associated with mastectomy skin necrosis and propose a management algorithm. METHODS: A retrospective review was performed on consecutive patients undergoing implant-based breast reconstruction by the senior author from 2006 through 2015...
May 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28182639/assessing-the-suitability-of-medial-sural-artery-perforator-flaps-in-tongue-reconstruction-an-outcome-study
#10
Shao-Yu Hung, Charles Yuen Yung Loh, Soo-Ha Kwon, Chia-Hsuan Tsai, Kai-Ping Chang, Huang-Kai Kao
INTRODUCTION: Oncological resection of the tongue can be reconstructed using a multitude of free flaps. The medial sural artery perforator (MSAP) flap has been well described in the literature in terms of its anatomy and harvest. However, functional outcome studies of post-reconstruction tongue defects using the MSAP flap have not been reported. This study represents the largest outcome study of patients with tongue reconstructions using MSAP flaps and a comprehensive review of its use...
2017: PloS One
https://www.readbyqxmd.com/read/28160019/reconstructive-surgery-of-the-amputated-ring-finger
#11
Ricardo Monreal
PURPOSE: Loss of a fourth digit below the level of the proximal phalanx results in a weakened grip, loss of skilled movements, and the amputation stump is repeatedly traumatized. Transposition of an adjacent fifth digital ray can improve hand function and cosmetic appearance by closing the gap created by the missing digit. Digital ray amputation is not a commonly performed procedure. However, when performed correctly it can dramatically improve hand function and cosmesis. The aim of this study was to evaluate the functional and aesthetic results of the fifth ray radial translation and intercarpal arthrodesis in mutilating ring finger injuries...
August 2017: International Orthopaedics
https://www.readbyqxmd.com/read/28087048/-characteristics-and-risk-factors-for-recurrence-of-cutaneous-squamous-cell-carcinoma-with-conventional-surgery-and-surgery-with-delayed-intraoperative-margin-assessment
#12
Judith Domínguez-Cherit, Georgina Rodríguez-Gutiérrez, Verónica Narváez Rosales, Sonia Toussaint Caire, Verónica Fonte Avalos
BACKGROUND: Non-melanoma skin cancer includes basal cell carcinoma and squamous cell carcinoma (SCC). Basal cell carcinoma is the most common and least aggressive but in a low percentage of cases, despite appropriate wide surgical margins, it can be aggressive, producing local invasion, recurrences and distance metastasis. SCC has a more aggressive behaviour invading first the skin, the lymph nodes and less frequently produces distance metastasis OBJECTIVE: To identify the characteristics of recurrent SCC and frequency of new SCC after conventional surgical and primary closure or closure delayed until a histological reporting of tumour-free surgical margins, in order to achieve a better surgical option, in our Mexican population...
January 10, 2017: Cirugia y Cirujanos
https://www.readbyqxmd.com/read/27916282/repair-of-complex-pharyngocutaneous-fistula-using-a-staged-temporoparietal-fascial-flap
#13
Nicholas B Abt, Priya Srikanth, Sidharth V Puram, Daniel G Deschler
INTRODUCTION: PCF is the most common major complication after salvage total laryngectomy (TL), especially for previously irradiated patients with laryngeal or hypopharyngeal cancer. METHODS/RESULTS: A 65-year-old woman presented with recurrent bilateral supraglottic SCC requiring salvage TL 5.5years after initial T1N0M0 epiglottic SCC resection. Her post-operative course was complicated by PCF development one month post-operatively and surgical fistula closure was delayed for adjuvant chemoradiotherapy...
March 2017: American Journal of Otolaryngology
https://www.readbyqxmd.com/read/27844118/the-cost-of-infection-in-severe-open-tibial-fractures-treated-with-a-free-flap
#14
Ulrik Kähler Olesen, Nicolas Jones Pedersen, Henrik Eckardt, Line Lykke-Meyer, Christian Thorsten Bonde, Upender Martin Singh, Martin McNally
PURPOSE: Open tibial fractures needing soft tissue cover are challenging injuries. Infection risk is high, making treatment difficult and expensive. Delayed skin closure has been shown to increase the infection rate in several studies. We aimed at calculating the direct and indirect cost of treatment, and to determine the effect of delayed skin closure on this cost. METHODS: We reviewed all records of patients treated with a free flap in our institution for an open tibial fracture from 2002 to 2013...
May 2017: International Orthopaedics
https://www.readbyqxmd.com/read/27836205/effectiveness-of-cyanoacrylate-microbial-sealant-in-the-reduction-of-surgical-site-infection-in-gynecologic-oncology-procedures-a-phase-iii-single-institution-prospective-randomized-trial
#15
RANDOMIZED CONTROLLED TRIAL
Eric D Thomas, Elizabeth K Nugent, Matthew C MacAllister, Katherine M Moxley, Lisa Landrum, Joan L Walker, D S McMeekin, Robert S Mannel, Gerald McGwin, Kathleen N Moore
OBJECTIVES: Surgery is a cornerstone for patients with gynecologic malignancies. Surgical site infections (SSI) remain a source of post-operative morbidity. Consequences range from escalated costs, delay in adjuvant therapy, and increased morbidity. Our primary objective was to evaluate the effectiveness of a cyanoacrylate microbial sealant (CMS) to reduce post-operative SSI following laparotomy for suspected gynecologic malignancy. METHODS: Patients were randomized using a 1:1 allocation to receive either standard skin preparation or standard preparation with CMS and stratified by BMI...
January 2017: Gynecologic Oncology
https://www.readbyqxmd.com/read/27524532/use-of-the-bogota-bag-for-closure-of-open-abdominal-wound-after-exploratory-laparotomy-our-experience-at-mayo-hospital-lahore
#16
Yar Muhammad, Khalid Masood Gondal, Umair Ahmed Khan
OBJECTIVE: To assess the efficacy of Bogota bag for closure of open abdominal wounds after laparotomy where the primary closure cannot be achieved and other closure techniques are not available. METHODS: The descriptive study was conducted at Mayo Hospital, Lahore, Pakistan, from September 2011 to February2015, and comprised patients who underwent laparotomy and peritoneal cavities and who could not be closed primarily because of various reasons like traumatic loss and oedematous gut...
August 2016: JPMA. the Journal of the Pakistan Medical Association
https://www.readbyqxmd.com/read/27363660/negative-pressure-therapy-is-effective-in-abdominal-incision-closure
#17
Nathan W Kugler, Thomas W Carver, Jasmeet S Paul
BACKGROUND: CDC wound classification demonstrates surgical site infection (SSI) occurs in 15%-30% of contaminated (class III) and >30% of dirty-infected (class IV) wounds. Several techniques have been used to decrease SSI rates in midline laparotomy incisions; however, no technique has shown superiority. Evidence suggests incisional negative pressure wound therapy (INPWT) can decrease wound complications, but no literature exists regarding INPWT for high-risk laparotomy incisions. We sought to analyze the efficacy of INPWT in the management of high-risk midline laparotomy incisions...
June 15, 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/27351470/melanoma-extirpation-with-immediate-reconstruction-the-oncologic-safety-and-cost-savings-of-single-stage-treatment
#18
Irena Karanetz, Sharon Stanley, Denis Knobel, Benjamin D Smith, Nicholas Bastidas, Mansoor Beg, Armen K Kasabian, Neil Tanna
BACKGROUND: The timing of reconstruction following melanoma extirpation remains controversial, with some advocating definitive reconstruction only when the results of permanent pathologic evaluation are available. The authors evaluated oncologic safety and cost benefit of single-stage neoplasm extirpation with immediate reconstruction. METHODS: The authors reviewed all patients treated with biopsy-proven melanoma followed by immediate reconstruction during a 3-year period (January of 2011 to December of 2013)...
July 2016: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/27129759/wound-hygiene-practices-after-total-knee-arthroplasty-does-it%C3%A2-matter
#19
Anthony L Yu, David C Alfieri, Kristen N Bartucci, Adam M Holzmeister, Harold W Rees
BACKGROUND: Current literature is limited with regard to standardized postoperative surgical site hygiene after total knee arthroplasty (TKA). With little guidance from the literature, the timing of permissible postoperative cleaning is a decision made by the individual surgeon using anecdotal evidence. A standardized wound care regimen is of particular interest to minimize the risk of infection. METHODS: To examine what species of bacteria recolonize the surgical site postoperatively, a randomized controlled trial was performed of 16 TKA patients who were allowed to shower at 2 days postoperatively and of 16 patients who were asked to wait until 2 weeks postoperatively before showering after TKA...
October 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27106143/comparison-between-primary-closure-and-skin-grafts-of-the-free-fibula-osteocutaneous-flap-donor-site
#20
Masaya Akashi, Kazunobu Hashikawa, Hiroyuki Takasu, Kazuhiro Watanabe, Junya Kusumoto, Akiko Sakakibara, Takumi Hasegawa, Tsutomu Minamikawa, Takahide Komori
PURPOSE: This study aimed to compare the size of skin paddles, the postoperative course, and donor site complications between primary closure and skin grafts of the free fibula flap donor site. METHODS: Thirty-five consecutive patients were enrolled. Medical records were retrospectively reviewed for risk factors for delayed healing, size of skin paddles, time to resumption of gait with a mobility aid and self-ambulation, early donor site morbidity, and late donor site complaints...
September 2016: Oral and Maxillofacial Surgery
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